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Line 5. Example—List of donors other than governmental units and publicly supported organizations

Assumption: 2% of the amount on Schedule A (Form 990 or 990-EZ), Part II, line 11, column (f) is $12,000

Contributors whose total gifts from 2010 through 2014 were in excess of the 2% limitation

(a)

(b)

(c)

(d)

(e)

(f)

(g)

Name

2010

2011

2012

2013

2014

Total

Excess

contributions

(col. (f) minus the

2% limitation)

XYZ Foundation

$59,000

$3,000

$18,000

$80,000

$68,000

Banana Office

$12,000

$3,000

$1,000

$16,000

$4,000

Supply

Plum Corporation

$15,000

$30,000

$18,000

John Smith

$5,000

$1,000

$16,000

$4,000

Sue Adams

$10,000

$30,000

$18,000

Raisin Trade

$20,000

$7,000

$27,000

$15,000

Assoc.

Total. Add the items in column (g). Enter the total here and on Part II, column (f), line 5

$127,000

. . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Part III. Support Schedule

1.170A-9(f)(3). Include the following

does not qualify as a publicly supported

information.

organization under section

for Organizations

170(b)(1)(A)(iv) or 170(b)(1)(A)(vi) for the

Explain whether the organization

Described in Section

2014 tax year and should check the box

maintains a continuous and bona fide

509(a)(2)

on this line. If the organization does not

program for solicitation of funds from the

qualify as a public charity under any of the

general public, community, membership

boxes in Part I, lines 1 through 11, it is a

group involved, governmental units, or

If an organization checked the

other public charities.

private foundation as of the beginning of

box in Part I, for line 9, it should

TIP

the 2014 tax year for filing purposes and

complete Part III and insert the

List all other facts and circumstances,

should not file Form 990, Form 990-EZ, or

appropriate dollar amounts. Do not leave

including the sources of support, whether

Schedule A (Form 990 or 990-EZ) for the

the organization has a governing body

Part III blank or report only zeros if the

2014 tax year. Instead, the organization

which represents the broad interests of the

organization had any support during the

should file Form 990-PF and check Initial

public, and whether the organization

period. If the organization checks the box

return of a former public charity on Form

in Part III, on line 14, it should stop there

generally provides facilities or services

990-PF, at the top of page 1.

and not complete the rest of Part III.

directly for the benefit of the general public

on a continuing basis.

If Form 990 or 990-EZ is for the

If the organization checked the

If the organization is a membership

organization's sixth tax year as a

TIP

box in Part I, for line 9, and also

organization, explain whether the

TIP

section 501(c)(3) organization,

checks the box in Part III, for

solicitation for dues-paying members is

the organization should compute the

line 20, the organization should complete

designed to enroll a substantial number of

public support percentage on its Form 990

Part II to determine if it qualifies as a

persons from the community, whether

or 990-EZ for its first five tax years before

publicly supported organization under

dues for individual members have been

it checks the box on line 18. If its public

section 170(b)(1)(A)(vi). If it does qualify,

fixed at rates designed to make

support percentage for its first five tax

the organization should instead check the

membership available to a broad

years is 33

% or more, or if it meets the

box in Part I, for line 5, 7, or 8, whichever

cross-section of the interested public, and

10% “facts and circumstances” test for its

applies.

whether the activities of the organization

first five tax years, it will qualify as a public

will likely appeal to persons having some

charity for its sixth tax year. If the

Public Support Test. For an

broad common interest or purpose.

organization qualifies under the 10% test,

organization to qualify as a publicly

explain in Part VI.

Line 17b. If the organization did not

supported organization under section

check a box on line 13, 16a, 16b, or 17a,

509(a)(2):

If the organization does not

and line 15 is 10% or more, and if the

More than 33

% of its support normally

qualify as a publicly supported

organization meets the "facts and

TIP

must come from gifts, grants,

organization under section

circumstances" test, check the box on

contributions, membership fees, and

170(b)(1)(A)(vi), it can complete Part III to

this line and do not complete the rest

gross receipts from admissions, sales of

determine if it qualifies as a publicly

of Part II. The organization qualifies as a

merchandise, performance of services, or

supported organization under section

publicly supported organization for 2014. If

furnishing of facilities in an activity which is

509(a)(2).

this box is checked, explain in Part VI how

not an unrelated trade or business

the organization meets the "facts and

under section 513; and

circumstances" test in Regulations section

No more than 33

% of its support

1.170A-9(f)(3). Include the same

normally must come from gross

information identified in the instructions for

investment income and net unrelated

line 17a, earlier.

business income (less section 511 tax)

from businesses acquired by the

Line 18. If the organization did not check

organization after June 30, 1975.

a box on line 13, 16a, 16b, 17a, or 17b, it

Instructions for Schedule A (Form 990 or 990-EZ)

-7-

Instructions For Schedule A (Form 990 Or 990-Ez) - Public Charity Status And Public Support - 2014 Page 7

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