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) (2003)

Employer identification number

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), or (10)

organization can check box(es) 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 money or

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 the regulations

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

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 one contributor,

during the year, aggregate contributions or bequests 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 Form 990-EZ, that received from any one contributor,

during the year, some 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: Organizations that are not covered by the General Rule and/or the Special Rules do not file Schedule B (Form 990,

990-EZ, or 990-PF), but they must check the box in the heading of their Form 990, Form 990-EZ, or on line 1 of their Form

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 and Form 990-EZ.

2003
Schedule B (Form 990, 990-EZ, or 990-PF) (2003) Page _____ to _____ 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 Specific 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) (2003)

Name of organization Employer identification number
Schedule B (Form 990, 990-EZ, or 990-PF) (2003) Page _____ to _____ 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 Specific 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) (2003)

Name of organization Employer identification number
Schedule B (Form 990, 990-EZ, or 990-PF) (2003) Page _____ to _____ 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 Specific 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) (2003)

Name of organization Employer identification number
Schedule B (Form 990, 990-EZ, or 990-PF) (2003)

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 _____ to _____ of Part II

$ / /

$ / /

$ / /

$ / /

$ / /

Noncash Property (See Specific 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) (2003)

Name of organization Employer identification number
Schedule B (Form 990, 990-EZ, or 990-PF) (2003)

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 _____ to _____ of Part II

$ / /

$ / /

$ / /

$ / /

$ / /

Noncash Property (See Specific 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) (2003)

Name of organization Employer identification number
Schedule B (Form 990, 990-EZ, or 990-PF) (2003)

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 _____ to _____ 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) (2003)

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) (2003)

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 _____ to _____ 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) (2003)

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) (2003) Page 9

Schedule B (Form 990, 990-EZ, or 990-PF) (2003)

All section 501(c)(7), (8), or (10) organizations that listed an

exclusively religious, charitable, etc., contribution on Part I or II

must also complete Part III to—

However, if a section 501(c)(7), (8), or (10) organization did not

receive a contribution of more than $1,000 during the year for

exclusively religious, charitable, etc., purposes, and consequently

was not required to complete Parts I through III, it need only

check the correct Special Rules box applicable to that

organization on the front of Schedule B and enter, in the space

provided, the total contributions it did receive during the year for

an exclusively religious, charitable, etc., purpose.

Specific Instructions

Note: You may duplicate Parts I through III if more copies of

these Parts are needed. 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.

Show the contributor’s name, address, aggregate contributions

for the year, and the type of contribution.

2. Show the total amount received from such contributions

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

1. Provide further information on such contributions of more

than $1,000 during the year, and

If a contribution came directly from a “contributor,” check the

“Person” box. Check the “Payroll” box for indirect contributions;

i.e., employees’ contributions forwarded by an employer. (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.)

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 the type described

above, reported $700,000 in total contributions, gifts, grants, and

similar amounts received on line 1d of its Form 990. 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, i.e., $14,000. 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, during the year, contributed $5,000

or more as described above under the General Rule.

List in Part I each contributor whose aggregate contributions

for an exclusively religious, charitable, etc., purpose were more

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

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

of amount). For a noncash contribution, complete Part II.

For contributions or bequests to a section 501(c)(7), (8), or (10)

organization received for use exclusively for religious, charitable,

scientific, literary, or educational purposes, or the prevention of

cruelty to children or animals (sections 170(c)(4), 2055(a)(3), or

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.

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 1 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 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 Expenditures,

do not need to be reported in Part I of Schedule B if the

organization paid the amount specified by I.R.C. 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).

● 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) (Regulations

section 1.6033-2(a)(2)(iii)(a)).
Schedule B (Form 990, 990-EZ, or 990-PF) (2003) Page 10

Schedule B (Form 990, 990-EZ, or 990-PF) (2003)

Part III. Section 501(c)(7), (8), or (10) organizations that received

contributions or bequests for use exclusively for religious,

charitable, etc., purposes must complete Parts I through III for

those persons whose gifts totaled more than $1,000 during the

year. Show also, in the heading of Part III, total gifts to these

organizations that were $1,000 or less for the year and were for

an exclusively religious, charitable, etc., purpose. Complete this

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 (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 2 years after

the date the original donee received the property.

If an amount is set aside for an exclusively religious,

charitable, etc., purpose, show in column (d) how the amount is

held (e.g., 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.

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.