Form 8879-Eo - Irs E-File Signature Authorization For An Exempt Organization Sample - 2015 Page 23

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OMB No. 1545-0047
Supplemental Financial Statements
SCHEDULE D
2015
(Form 990)
| Complete if the organization answered "Yes" on Form 990,
Part IV, line 6, 7, 8, 9, 10, 11a, 11b, 11c, 11d, 11e, 11f, 12a, or 12b.
Open to Public
| Attach to Form 990.
Department of the Treasury
Inspection
| Information about Schedule D (Form 990) and its instructions is at
Internal Revenue Service
Name of the organization
Employer identification number
CANCER SUPPORT COMMUNITY MONTANA
81-0542266
Part I
Organizations Maintaining Donor Advised Funds or Other Similar Funds or Accounts.
Complete if the
organization answered "Yes" on Form 990, Part IV, line 6.
(a)
Donor advised funds
(b)
Funds and other accounts
1
Total number at end of year
~~~~~~~~~~~~~~~
2
Aggregate value of contributions to (during year)
~~~~
3
Aggregate value of grants from (during year)
~~~~~~
Aggregate value at end of year
~~~~~~~~~~~~~
4
Did the organization inform all donors and donor advisors in writing that the assets held in donor advised funds
5
are the organization's property, subject to the organization's exclusive legal control? ~~~~~~~~~~~~~~~~~~
Yes
No
Did the organization inform all grantees, donors, and donor advisors in writing that grant funds can be used only
6
for charitable purposes and not for the benefit of the donor or donor advisor, or for any other purpose conferring
impermissible private benefit? ••••••••••••••••••••••••••••••••••••••••••••
Yes
No
Part II
Conservation Easements.
Complete if the organization answered "Yes" on Form 990, Part IV, line 7.
1
Purpose(s) of conservation easements held by the organization (check all that apply).
Preservation of land for public use (e.g., recreation or education)
Preservation of a historically important land area
Protection of natural habitat
Preservation of a certified historic structure
Preservation of open space
2
Complete lines 2a through 2d if the organization held a qualified conservation contribution in the form of a conservation easement on the last
Held at the End of the Tax Year
day of the tax year.
a
Total number of conservation easements
~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~
2a
b
Total acreage restricted by conservation easements
~~~~~~~~~~~~~~~~~~~~~~~~~~
2b
c
Number of conservation easements on a certified historic structure included in (a)
~~~~~~~~~~~~
2c
d
Number of conservation easements included in (c) acquired after 8/17/06, and not on a historic structure
listed in the National Register
~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~
2d
3
Number of conservation easements modified, transferred, released, extinguished, or terminated by the organization during the tax
year |
4
Number of states where property subject to conservation easement is located |
5
Does the organization have a written policy regarding the periodic monitoring, inspection, handling of
violations, and enforcement of the conservation easements it holds? ~~~~~~~~~~~~~~~~~~~~~~~~~
Yes
No
Staff and volunteer hours devoted to monitoring, inspecting, handling of violations, and enforcing conservation easements during the year
6
|
7
Amount of expenses incurred in monitoring, inspecting, handling of violations, and enforcing conservation easements during the year
| $
8
Does each conservation easement reported on line 2(d) above satisfy the requirements of section 170(h)(4)(B)(i)
and section 170(h)(4)(B)(ii)? ~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~
Yes
No
9
In Part XIII, describe how the organization reports conservation easements in its revenue and expense statement, and balance sheet, and
include, if applicable, the text of the footnote to the organization's financial statements that describes the organization's accounting for
conservation easements.
Part III
Organizations Maintaining Collections of Art, Historical Treasures, or Other Similar Assets.
Complete if the organization answered "Yes" on Form 990, Part IV, line 8.
1
a
If the organization elected, as permitted under SFAS 116 (ASC 958), not to report in its revenue statement and balance sheet works of art,
historical treasures, or other similar assets held for public exhibition, education, or research in furtherance of public service, provide, in Part XIII,
the text of the footnote to its financial statements that describes these items.
b
If the organization elected, as permitted under SFAS 116 (ASC 958), to report in its revenue statement and balance sheet works of art, historical
treasures, or other similar assets held for public exhibition, education, or research in furtherance of public service, provide the following amounts
relating to these items:
(i)
Revenue included on Form 990, Part VIII, line 1
~~~~~~~~~~~~~~~~~~~~~~~~~~~~ | $
(ii)
Assets included in Form 990, Part X
~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~ |
$
2
If the organization received or held works of art, historical treasures, or other similar assets for financial gain, provide
the following amounts required to be reported under SFAS 116 (ASC 958) relating to these items:
a
Revenue included on Form 990, Part VIII, line 1
~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~ | $
b
Assets included in Form 990, Part X
••••••••••••••••••••••••••••••••••• |
$
LHA
For Paperwork Reduction Act Notice, see the Instructions for Form 990.
Schedule D (Form 990) 2015
532051
11-02-15
26
13340919 792194 141677
2015.04020 CANCER SUPPORT COMMUNITY MO 141677_1

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