O

Schedule of Contributors

Department of the Treasury

Internal Revenue Service

Cat. No. 30613X Schedule B (Form 990, 990

Employer ide

Organization type (check one):

(Form 990, 990-EZ,

Supplementary Information for

line 1 of Form 990, 990-EZ, and 990-PF (see instructions)

Schedule B

Name of 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. (Note: Only a section 501(c)(7), (8

organization can check boxes for both the General Rule and a Special Rule—see instructions.)

For organizations filing Form 990, 990-EZ, or 990-PF that received, during the year, $5,000 or more (in m

property) from any one contributor. (Complete Parts I and II.)

For a section 501(c)(3) organization filing Form 990, or Form 990-EZ, that met the 331⁄3% support test of 

under sections 509(a)(1)/170(b)(1)(A)(vi) and received from any one contributor, during the year, a contrib

greater of $5,000 or 2% of the amount on line 1 of these forms. (Complete Parts I and II.)

For a section 501(c)(7), (8), or (10) organization filing Form 990, or Form 990-EZ, that received from any 

during the year, aggregate contributions or bequests of more than $1,000 for use exclusively for religiou

scientific, literary, or educational purposes, or the prevention of cruelty to children or animals. (Complete 

III.)

For a section 501(c)(7), (8), or (10) organization filing Form 990, or Form 990-EZ, that received from any 

during the year, some contributions for use exclusively for religious, charitable, etc., purposes, but these 

not aggregate to more than $1,000. (If this box is checked, enter here the total contributions that were r

the year for an exclusively religious, charitable, etc., purpose. Do not complete any of the Parts unless t

applies to this organization because it received nonexclusively religious, charitable, etc., contributions of 

during the year.)  $

Caution: Organizations that are not covered by the General Rule and/or the Special Rules do not file Schedule 

990-EZ, or 990-PF), but they must check the box in the heading of their Form 990, Form 990-EZ, or on line 2 o

990-PF, to certify that they do 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 Paperwork Reduction Act Notice, see the Instructions

for Form 990, Form 990-EZ, and Form 990-PF.
Schedule B (Form 990, 990-EZ, or 990-PF) (2004) Page 

Part I

(a)

No.

(b)

Name, address, and ZIP + 4

(c)

Aggregate contributionsType 

Pers

Payr

Nonc

(Comple

a nonca

(a)

No.

(b)

Name, address, and ZIP + 4

(c)

Aggregate contributionsType 

Pers

Payr

Nonc

(Comple

a nonca

(a)

No.

(b)

Name, address, and ZIP + 4

(c)

Aggregate contributionsType 

Pers

Payr

Nonc

(Comple

a nonca

(a)

No.

(b)

Name, address, and ZIP + 4

(c)

Aggregate contributionsType 

Pers

Payr

Nonc

(Comple

a nonca

(a)

No.

(b)

Name, address, and ZIP + 4

(c)

Aggregate contributionsType 

Pers

Payr

Nonc

(Comple

a nonca

$

$

$

$

$

Contributors (See Specific Instructions.)

(a)

No.

(b)

Name, address, and ZIP + 4

(c)

Aggregate contributionsType 

Pers

Payr

Nonc

(Comple

a nonca

$

Schedule B (Form 990, 990

Name of organization Employer ide
Schedule B (Form 990, 990-EZ, or 990-PF) (2004) Page _

Part I

(a)

No.

(b)

Name, address, and ZIP + 4

(c)

Aggregate contributionsType 

Pers

Payr

Nonc

(Comple

a nonca

(a)

No.

(b)

Name, address, and ZIP + 4

(c)

Aggregate contributionsType 

Pers

Payr

Nonc

(Comple

a nonca

(a)

No.

(b)

Name, address, and ZIP + 4

(c)

Aggregate contributionsType 

Pers

Payr

Nonc

(Comple

a nonca

(a)

No.

(b)

Name, address, and ZIP + 4

(c)

Aggregate contributionsType 

Pers

Payr

Nonc

(Comple

a nonca

(a)

No.

(b)

Name, address, and ZIP + 4

(c)

Aggregate contributionsType 

Pers

Payr

Nonc

(Comple

a nonca

$

$

$

$

$

Contributors (See Specific Instructions.)

(a)

No.

(b)

Name, address, and ZIP + 4

(c)

Aggregate contributionsType 

Pers

Payr

Nonc

(Comple

a nonca

$

Schedule B (Form 990, 990

Name of organization Employer ide
Schedule B (Form 990, 990-EZ, or 990-PF) (2004) Page 

Part I

(a)

No.

(b)

Name, address, and ZIP + 4

(c)

Aggregate contributionsType 

Pers

Payr

Nonc

(Comple

a nonca

(a)

No.

(b)

Name, address, and ZIP + 4

(c)

Aggregate contributionsType 

Pers

Payr

Nonc

(Comple

a nonca

(a)

No.

(b)

Name, address, and ZIP + 4

(c)

Aggregate contributionsType 

Pers

Payr

Nonc

(Comple

a nonca

(a)

No.

(b)

Name, address, and ZIP + 4

(c)

Aggregate contributionsType 

Pers

Payr

Nonc

(Comple

a nonca

(a)

No.

(b)

Name, address, and ZIP + 4

(c)

Aggregate contributionsType 

Pers

Payr

Nonc

(Comple

a nonca

$

$

$

$

$

Contributors (See Specific Instructions.)

(a)

No.

(b)

Name, address, and ZIP + 4

(c)

Aggregate contributionsType 

Pers

Payr

Nonc

(Comple

a nonca

$

Schedule B (Form 990, 990

Name of organization Employer ide
Schedule B (Form 990, 990-EZ, or 990-PF) (2004)

Part II

(a) No.

from

Part I

(b)

Description of noncash property given

(c)

FMV (or estimate)

(see instructions)

Da

(a) No.

from

Part I

(b)

Description of noncash property given

(c)

FMV (or estimate)

(see instructions)

Da

(a) No.

from

Part I

(b)

Description of noncash property given

(c)

FMV (or estimate)

(see instructions)

Da

(a) No.

from

Part I

(b)

Description of noncash property given

(c)

FMV (or estimate)

(see instructions)

Da

(a) No.

from

Part I

(b)

Description of noncash property given

(c)

FMV (or estimate)

(see instructions)

Da

Page _

$ 

$ 

$ 

$ 

$ 

Noncash Property (See Specific Instructions.)

(a) No.

from

Part I

(b)

Description of noncash property given

(c)

FMV (or estimate)

(see instructions)

Da

$ 

Schedule B (Form 990, 990

Name of organization Employer ide
Schedule B (Form 990, 990-EZ, or 990-PF) (2004)

Part II

(a) No.

from

Part I

(b)

Description of noncash property given

(c)

FMV (or estimate)

(see instructions)

Da

(a) No.

from

Part I

(b)

Description of noncash property given

(c)

FMV (or estimate)

(see instructions)

Da

(a) No.

from

Part I

(b)

Description of noncash property given

(c)

FMV (or estimate)

(see instructions)

Da

(a) No.

from

Part I

(b)

Description of noncash property given

(c)

FMV (or estimate)

(see instructions)

Da

(a) No.

from

Part I

(b)

Description of noncash property given

(c)

FMV (or estimate)

(see instructions)

Da

Page _

$ 

$ 

$ 

$ 

$ 

Noncash Property (See Specific Instructions.)

(a) No.

from

Part I

(b)

Description of noncash property given

(c)

FMV (or estimate)

(see instructions)

Da

$ 

Schedule B (Form 990, 990

Name of organization Employer ide
Schedule B (Form 990, 990-EZ, or 990-PF) (2004)

Part III

(a) No.

from

Part I

(b)

Purpose of gift

(c)

Use of gift

(d)

Description of ho

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

aggregating more than $1,000 for the year. (Complete columns (a) through (e) and the following 

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 tran

Page __

Transferee’s name, address, and ZIP  4

(a) No.

from

Part I

(b)

Purpose of gift

(c)

Use of gift

(d)

Description of ho

(e)

Transfer of gift

Relationship of transferor to tran

(a) No.

from

Part I

(b)

Purpose of gift

(c)

Use of gift

(d)

Description of ho

(e)

Transfer of gift

Relationship of transferor to tran

(a) No.

from

Part I

(b)

Purpose of gift

(c)

Use of gift

(d)

Description of ho

(e)

Transfer of gift

Relationship of transferor to tran

Schedule B (Form 990, 990

Name of organization Employer ide

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) (2004)

Part III

(a) No.

from

Part I

(b)

Purpose of gift

(c)

Use of gift

(d)

Description of ho

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

aggregating more than $1,000 for the year. (Complete columns (a) through (e) and the following 

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 tran

Page __

Transferee’s name, address, and ZIP  4

(a) No.

from

Part I

(b)

Purpose of gift

(c)

Use of gift

(d)

Description of ho

(e)

Transfer of gift

Relationship of transferor to tran

(a) No.

from

Part I

(b)

Purpose of gift

(c)

Use of gift

(d)

Description of ho

(e)

Transfer of gift

Relationship of transferor to tran

(a) No.

from

Part I

(b)

Purpose of gift

(c)

Use of gift

(d)

Description of ho

(e)

Transfer of gift

Relationship of transferor to tran

Schedule B (Form 990, 990

Name of organization Employer ide

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) (2004) 

Schedule B (Form 990, 990

All section 501(c)(7), (8), or (10) organization

exclusively religious, charitable, etc., contribut

must also complete Part III to—

However, if a section 501(c)(7), (8), or (10) o

receive a contribution of more than $1,000 du

exclusively religious, charitable, etc., purposes

consequently was not required to complete Pa

need only check the correct Special Rules box 

organization on the front of Schedule B and e

provided, the total contributions it did receive 

an exclusively religious, charitable, etc., purpo

Specific Instructions

Note: You may duplicate Parts I through III if m

these Parts are needed. Number each page of 

Part I. In column (a), identify the first contribut

and the second contributor as No. 2, etc. Num

Show the contributor’s name, address, aggreg

for the year, and the type of contribution.

2. Show the total amount received from suc

that were for $1,000 or less during the year.

1. Provide further information on such contr

than $1,000 during the year, and

If a contribution came directly from a “contr

“Person” box. Check the “Payroll” box for indi

that is, employees’ contributions forwarded by 

an employer withholds contributions from emp

periodically gives them to the organization, rep

employer’s name and address and the total am

you know that a particular employee gave eno

separately.)

General Rule

Section 501(c)(3) organizations that file Form 990 or Form

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)/170(b)(1)(A)(vi) (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 is greater than 2% of the amount reported on

Example. A section 501(c)(3) organization, of t

above, reported $700,000 in total contribution

similar amounts received on line 1d of its Form 

organization is only required to list in Parts I a

Schedule B each person who contributed mor

of $5,000 or 2% of $700,000, that is, $14,000

contributor who gave a total of $11,000 would 

Parts I and II for this section 501(c)(3) organiza

the $11,000 contribution to the organization w

$5,000, it did not exceed $14,000.

Section 501(c)(7), (8), or (10) organizations. 

to these social and recreational clubs, fraterna

domestic fraternal societies, orders, or associa

not for an exclusively religious, charitable, etc

Part I, each contributor who, during the year, 

or more as described above under the Genera

List in Part I each contributor whose aggreg

for an exclusively religious, charitable, etc., pu

than $1,000 during the year. To determine the 

amount, total all of a contributor’s gifts for the 

of amount). For a noncash contribution, comp

For contributions or bequests to a section 5

organization received for use exclusively for re

scientific, literary, or educational purposes, or 

cruelty to children or animals (sections 170(c)(

2522(a)(3))—

Unless the organization is covered by one of the Special Rules

below, it must list on 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 year. Complete Part II for a noncash contribution.

To determine the $5,000 or more amount, total all of the

contributor’s gifts only if they are $1,000 or more for the year.

Special Rules

Public Inspection

Schedule B is:

● Open to public inspection for a section 527 political

organization that files Form 990 or Form 990-EZ, or

If an organization files a copy of Form 990, or Form 990-EZ,

and attachments, with any state, it should not include its

Schedule B 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 Form 990-EZ.

See the Instructions for Form 990 and Form 990-EZ, as well

as the Instructions for Form 990-PF, for phone help information

and the public inspection rules for those forms and their

attachments.

Contributors To Be Listed on Part I

A “contributor” (person) includes individuals, fiduciaries,

partnerships, corporations, associations, trusts, and exempt

organizations.

● Open to public inspection for an organization that files Form

990-PF,

General Instructions

Purpose of Form

Schedule B (Form 990, 990-EZ, or 990-PF) is used to provide

information on contributions the organization reported on line 1

of its—

● Form 990, Return of Organization Exempt From Income Tax,

● Form 990-EZ, Short Form Return of Organization Exempt

From Income Tax.

● Form 990-PF, Return of Private Foundation,

Who Must File Schedule B

All organizations must attach a completed Schedule B to their

Form 990, 990-EZ, or 990-PF, unless they certify that they do

not meet the filing requirements of this schedule by checking the

proper box in the heading of their Form 990, Form 990-EZ, or on

line 2 of Form 990-PF. See the instructions for Schedule B found

in the separate instructions for those forms.

or

For section 527 organizations that file a For

Organization Notice of Section 527 Status, the 

addresses of contributors that are not reported 

Political Organization Report of Contributions 

do not need to be reported in Part I of Schedu

organization paid the amount specified by I.R.

In this case, enter “Pd. 527(j)(1)” in column (b)

name, address, and zip code; but you must en

contributions in column (c).

● For the other organizations that file Form 990 or Form 990-EZ,

the names and addresses of contributors are not open to public

inspection. All other information, including the amount of

contributions, the description of noncash contributions, and any

other information provided will be open to public inspection,

unless it clearly identifies the contributor.

line 1d of Form 990 (or line 1 of Form 990-EZ) 

section 1.6033-2(a)(2)(iii)(a)).
Schedule B (Form 990, 990-EZ, or 990-PF) (2004) 

Schedule B (Form 990, 990

Part III. Section 501(c)(7), (8), or (10) organizat

contributions or bequests for use exclusively f

charitable, etc., purposes must complete Parts 

those persons whose gifts totaled more than $

year. Show also, in the heading of Part III, tota

organizations that were $1,000 or less for the 

an exclusively religious, charitable, etc., purpo

information only on the first Part III page.

Report on property with readily determinable market value

(e.g., market quotations for securities) by listing 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

contribution date. See Regulations section 20.2031-2 to

determine the value of contributed stocks and bonds. When fair

market value cannot be readily determined, use an appraised or

estimated value. To determine the amount of a noncash

contribution that is subject to an outstanding debt, subtract the

debt from the property’s fair market value.

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.

Original (first) and successor donee (recipien

must file Form 8282, Donee Information Retur

exchange, consume, or otherwise dispose of (

consideration) charitable deduction property (p

money or certain publicly traded securities) wi

the date the original donee received the prope

If an amount is set aside for an exclusively r

charitable, etc., purpose, show in column (d) h

held (e.g., whether it is commingled with amou

purposes). If the organization transferred the g

organization, show the name and address of t

organization in column (e) and explain the rela

the two organizations.

Part II. In column (a), show the number that corresponds to the

contributor’s number in Part I. Describe the noncash

contribution. Note the public inspection rules discussed above.