Schedule A (Form 990 Or 990-Ez) - Public Charity Status And Public Support - 2013
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4OMB No. 1545-0047
Public Charity Status and Public Support
SCHEDULE A
2013
(Form 990 or 990-EZ)
Complete if the organization is a section 501(c)(3) organization or a section
4947(a)(1) nonexempt charitable trust.
Open to Public
Attach to Form 990 or Form 990-EZ.
▶
Department of the Treasury
Information about Schedule A (Form 990 or 990-EZ) and its instructions is at
Internal Revenue Service
Inspection
▶
Name of the organization
Employer identification number
Part I
Reason for Public Charity Status (All organizations must complete this part.) See instructions.
The organization is not a private foundation because it is: (For lines 1 through 11, check only one box.)
1
A church, convention of churches, or association of churches described in section 170(b)(1)(A)(i).
2
A school described in section 170(b)(1)(A)(ii). (Attach Schedule E.)
3
A hospital or a cooperative hospital service organization described in section 170(b)(1)(A)(iii).
A medical research organization operated in conjunction with a hospital described in section 170(b)(1)(A)(iii). Enter the
4
hospital’s name, city, and state:
5
An organization operated for the benefit of a college or university owned or operated by a governmental unit described in
section 170(b)(1)(A)(iv). (Complete Part II.)
6
A federal, state, or local government or governmental unit described in section 170(b)(1)(A)(v).
7
An organization that normally receives a substantial part of its support from a governmental unit or from the general public
described in section 170(b)(1)(A)(vi). (Complete Part II.)
8
A community trust described in section 170(b)(1)(A)(vi). (Complete Part II.)
9
An organization that normally receives: (1) more than 33
/
% of its support from contributions, membership fees, and gross
1
3
receipts from activities related to its exempt functions—subject to certain exceptions, and (2) no more than 33
/
% of its
1
3
support from gross investment income and unrelated business taxable income (less section 511 tax) from businesses
acquired by the organization after June 30, 1975. See section 509(a)(2). (Complete Part III.)
10
An organization organized and operated exclusively to test for public safety. See section 509(a)(4).
11
An organization organized and operated exclusively for the benefit of, to perform the functions of, or to carry out the
purposes of one or more publicly supported organizations described in section 509(a)(1) or section 509(a)(2). See section
509(a)(3). Check the box that describes the type of supporting organization and complete lines 11e through 11h.
a
Type I
b
Type II
c
Type III–Functionally integrated
d
Type III–Non-functionally integrated
e
By checking this box, I certify that the organization is not controlled directly or indirectly by one or more disqualified persons
other than foundation managers and other than one or more publicly supported organizations described in section 509(a)(1)
or section 509(a)(2).
f
If the organization received a written determination from the IRS that it is a Type I, Type II, or Type III supporting
organization, check this box .
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g
Since August 17, 2006, has the organization accepted any gift or contribution from any of the
following persons?
(i) A person who directly or indirectly controls, either alone or together with persons described in (ii) and
Yes
No
(iii) below, the governing body of the supported organization? .
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11g(i)
(ii) A family member of a person described in (i) above? .
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11g(ii)
(iii) A 35% controlled entity of a person described in (i) or (ii) above? .
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11g(iii)
h
Provide the following information about the supported organization(s).
(i) Name of supported
(ii) EIN
(iii) Type of organization
(iv) Is the organization
(v) Did you notify
(vii) Amount of monetary
(vi) Is the
in col. (i) listed in your
the organization in
organization
(described on lines 1–9
organization in col.
support
col. (i) of your
(i) organized in the
governing document?
above or IRC section
support?
U.S.?
(see instructions))
Yes
No
Yes
No
Yes
No
(A)
(B)
(C)
(D)
(E)
Total
For Paperwork Reduction Act Notice, see the Instructions for
Cat. No. 11285F
Schedule A (Form 990 or 990-EZ) 2013
Form 990 or 990-EZ.
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