Form 8879-Eo - Irs E-File Signature Authorization For An Exempt Organization Sample - 2015 Page 29
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41CANCER SUPPORT COMMUNITY MONTANA
81-0542266
Schedule G (Form 990 or 990-EZ) 2015
Page
3
11
Does the organization conduct gaming activities with nonmembers?
~~~~~~~~~~~~~~~~~~~~~~~~~~~
Yes
No
12
Is the organization a grantor, beneficiary or trustee of a trust or a member of a partnership or other entity formed
to administer charitable gaming?
~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~
Yes
No
13
Indicate the percentage of gaming activity conducted in:
a
The organization's facility
~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~
13a
%
b
An outside facility
~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~
13b
%
14
Enter the name and address of the person who prepares the organization's gaming/special events books and records:
Name |
Address |
Yes
No
Does the organization have a contract with a third party from whom the organization receives gaming revenue?
~~~~~~
15
a
If "Yes," enter the amount of gaming revenue received by the organization |
$
and the amount
b
of gaming revenue retained by the third party | $
.
c
If "Yes," enter name and address of the third party:
Name |
Address |
16
Gaming manager information:
Name |
Gaming manager compensation |
$
Description of services provided |
Director/officer
Employee
Independent contractor
17
Mandatory distributions:
a
Is the organization required under state law to make charitable distributions from the gaming proceeds to
Yes
No
retain the state gaming license? ~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~
b
Enter the amount of distributions required under state law to be distributed to other exempt organizations or spent in the
organization's own exempt activities during the tax year | $
Part IV
Supplemental Information.
Provide the explanations required by Part I, line 2b, columns (iii) and (v); and Part III, lines 9, 9b, 10b, 15b,
15c, 16, and 17b, as applicable. Also provide any additional information (see instructions).
Schedule G (Form 990 or 990-EZ) 2015
532083 09-14-15
32
13340919 792194 141677
2015.04020 CANCER SUPPORT COMMUNITY MO 141677_1
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