Schedule G (Form 990 Or 990-Ez) - Supplemental Information Regarding Fundraising Or Gaming Activities - 2012 Page 2

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Schedule G (Form 990 or 990-EZ) 2012
Page
Part II
Fundraising Events. Complete if the organization answered “Yes” to Form 990, Part IV, line 18, or reported more
than $15,000 of fundraising event contributions and gross income on Form 990-EZ, lines 1 and 6b. List events with
gross receipts greater than $5,000.
(a) Event #1
(b) Event #2
(c) Other events
(d) Total events
(add col. (a) through
col. (c))
(event type)
(event type)
(total number)
1
Gross receipts .
.
.
.
2
Less: Contributions .
.
3
Gross income (line 1 minus
line 2) .
.
.
.
.
.
.
4
Cash prizes .
.
.
.
.
5
Noncash prizes
.
.
.
6
Rent/facility costs .
.
.
7
Food and beverages .
.
8
Entertainment .
.
.
.
9
Other direct expenses
.
(
)
10
Direct expense summary. Add lines 4 through 9 in column (d)
.
.
.
.
.
.
.
.
.
.
▶
Net income summary. Combine line 3, column (d), and line 10 .
.
.
.
.
.
.
.
.
.
11
▶
Part III
Gaming. Complete if the organization answered “Yes” to Form 990, Part IV, line 19, or reported more
than $15,000 on Form 990-EZ, line 6a.
(b) Pull tabs/instant
(d) Total gaming (add
(a) Bingo
(c) Other gaming
col. (a) through col. (c))
bingo/progressive bingo
1
Gross revenue .
.
.
.
2
Cash prizes .
.
.
.
.
3
Noncash prizes
.
.
.
4
Rent/facility costs .
.
.
5
Other direct expenses
.
%
%
%
Yes
Yes
Yes
6
Volunteer labor .
.
.
.
No
No
No
(
)
7
Direct expense summary. Add lines 2 through 5 in column (d)
.
.
.
.
.
.
.
.
.
.
▶
Net gaming income summary. Combine line 1, column d, and line 7
.
.
.
.
.
.
.
.
8
▶
9
Enter the state(s) in which the organization operates gaming activities:
a Is the organization licensed to operate gaming activities in each of these states?
.
.
.
.
.
.
.
.
.
Yes
No
b If “No,” explain:
10a Were any of the organization’s gaming licenses revoked, suspended or terminated during the tax year?
Yes
No
.
b If “Yes,” explain:
Schedule G (Form 990 or 990-EZ) 2012

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