Form 990 Schedule A Instructions Page 7

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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 2012 through 2016 were in excess of the 2% limitation
(a)
(b)
(c)
(d)
(e)
(f)
(g)
Name
2012
2013
2014
2015
2016
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
$15,000
$30,000
$18,000
John Smith
$5,000
$5,000
$5,000
$1,000
$16,000
$4,000
Sue Adams
$10,000
$10,000
$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
. . . . . . . . . . . . . . . . . . . . . . . . . . . .
contributions. See Regulations section
The distribution of certain low cost
Line 14. Round to the nearest
1.170A-9(f)(7)(iii).
articles incidental to the solicitation of
hundredth decimal point in reporting the
charitable contributions (except to the
Include on line 12 gross receipts from
percentage of public support. For
extent such gross receipts are properly
admissions, sales of merchandise,
example, if the organization calculates
treated as charitable contributions
performance of services, or furnishing of
its public support percentage as
reportable on line 1 rather than as
facilities in any activity which isn't an
58.3456%, this percentage would be
proceeds of a sale or exchange), and
unrelated trade or business (within the
rounded to 58.35% when reported on
exchange and rental of members lists.
meaning of section 513). See section
line 14.
See section 513(h).
509(d)(2). Include membership fees to
Line 15. For 2016 enter the public
the extent they are payments to
Line 13. An organization that checks
support percentage from the 2015
purchase admissions, merchandise,
this box should stop here and shouldn't
Schedule A (Form 990 or 990-EZ), Part
services, or the use of facilities in a
complete the rest of Part II. It shouldn't
II, line 14. Round to the nearest
related activity. For example, include on
make a public support computation on
hundredth decimal point in reporting the
this line gross receipts from:
line 14 or 15 or check any of the boxes
percentage of public support.
A trade or business in which
on lines 16 through 18.
substantially all work is performed by
Line 16a. If the organization didn't
Example. An organization receives
volunteers (such as book fairs and
check the box on line 13, and line 14 is
an exemption letter from the IRS that it
sales of gift wrap paper). See section
33
% or more, check the box on this
1
3
is exempt from tax under section
513(a)(1).
line and don't complete the rest of
501(c)(3) and qualifies as a public
A trade or business carried on by the
Part II. The organization qualifies as a
charity under section 170(b)(1)(A)(vi)
organization primarily for the
publicly supported organization for 2016
effective on its date of incorporation.
convenience of its members, students,
and 2017.
When the organization prepares Part II
patients, officers, or employees. See
Line 16b. If the organization didn't
for each of its first five tax years as a
section 513(a)(2).
check a box on line 13 or 16a, and
section 501(c)(3) organization, it should
A trade or business which is the
line 15 is 33
% or more, check the box
check the box on line 13 and shouldn't
1
3
selling of merchandise, substantially all
on this line and don't complete the
complete the rest of Part II. When the
of which the organization received as
rest of Part II. The organization
organization prepares Part II for its sixth
gifts or contributions. See section
qualifies as a publicly supported
tax year and subsequent years, it
513(a)(3).
organization for 2016.
shouldn't check the box on line 13 and
“Qualified public entertainment
should complete the rest of Part II.
Line 17a. If the organization didn't
activities” or “qualified convention and
check a box on line 13, 16a, or 16b, and
trade show activities” of certain
An organization in its first five
line 14 is 10% or more, and if the
organizations. See section 513(d).
years as a section 501(c)(3)
TIP
organization meets the "facts and
Furnishing certain hospital services.
organization should make the
circumstances" test, check the box on
See section 513(e).
public support computations on a copy
this line and don't complete the rest
A trade or business consisting of
of Schedule A that it keeps for itself. An
of Part II. The organization qualifies as
conducting bingo games, but only if the
organization should carefully monitor its
a publicly supported organization for
conduct of such games is lawful. See
public support on an ongoing basis to
2016 and 2017.
section 513(f).
ensure that it will meet a public support
Qualified pole rentals by a mutual or
test in the sixth year and succeeding
If this box is checked, explain in Part
cooperative telephone or electric
years.
IV how the organization meets the "facts
company. See section 513(g).
and circumstances" test in Regulations
Instructions for Schedule A (Form 990 or 990-EZ)
-7-

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