Fillable Printable Form 990 Schedule A

Form 990 Schedule A

SCHEDULE A

(Form 990 or 990-EZ)

Department of the Treasury

Internal Revenue Service

Public Charity Status and Public Support

Complete if the organization is a section 501(c)(3) organization or a section 4947(a)(1) nonexempt charitable trust.

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Attach to Form 990 or Form 990-EZ.

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Information about Schedule A (Form 990 or 990-EZ) and its instructions is at www.irs.gov/form990.

OMB No. 1545-0047

2016

Open to Public

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 12, check only one box.)

A church, convention of churches, or association of churches described in section 170(b)(1)(A)(i).

A school described in section 170(b)(1)(A)(ii). (Attach Schedule E (Form 990 or 990-EZ).)

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

hospital’s name, city, and state:

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.)

A federal, state, or local government or governmental unit described in section 170(b)(1)(A)(v).

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.)

A community trust described in section 170(b)(1)(A)(vi). (Complete Part II.)

An agricultural research organization described in section 170(b)(1)(A)(ix) operated in conjunction with a land-grant college

or university or a non-land-grant college of agriculture (see instructions). Enter the name, city, and state of the college or

university:

An organization that normally receives: (1) more than 33

% of its support from contributions, membership fees, and gross

receipts from activities related to its exempt functions—subject to certain exceptions, and (2) no more than 33

% of its

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.)

11 An organization organized and operated exclusively to test for public safety. See section 509(a)(4).

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 in lines 12a through 12d that describes the type of supporting organization and complete lines 12e, 12f, and 12g.

Type I. A supporting organization operated, supervised, or controlled by its supported organization(s), typically by giving

the supported organization(s) the power to regularly appoint or elect a majority of the directors or trustees of the

supporting organization. You must complete Part IV, Sections A and B.

Type II. A supporting organization supervised or controlled in connection with its supported organization(s), by having

control or management of the supporting organization vested in the same persons that control or manage the supported

organization(s). You must complete Part IV, Sections A and C.

Type III functionally integrated. A supporting organization operated in connection with, and functionally integrated with,

its supported organization(s) (see instructions). You must complete Part IV, Sections A, D, and E.

Type III non-functionally integrated. A supporting organization operated in connection with its supported organization(s)

that is not functionally integrated. The organization generally must satisfy a distribution requirement and an attentiveness

requirement (see instructions). You must complete Part IV, Sections A and D, and Part V.

Check this box if the organization received a written determination from the IRS that it is a Type I, Type II, Type III

functionally integrated, or Type III non-functionally integrated supporting organization.

f Enter the number of supported organizations . . . . . . . . . . . . . . . . . . . . . . .

g Provide the following information about the supported organization(s).

(i) Name of supported organization

(ii) EIN (iii) Type of organization

(described on lines 1–10

above (see instructions))

(iv) Is the organization

listed in your governing

document?

(v) Amount of monetary

support (see

instructions)

(vi) Amount of

other support (see

instructions)

Yes No

(A)

(B)

(C)

(D)

(E)

Total

For Paperwork Reduction Act Notice, see the Instructions for Form 990 or 990-EZ.

Cat. No. 11285F Schedule A (Form 990 or 990-EZ) 2016

Schedule A (Form 990 or 990-EZ) 2016

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Part II

Support Schedule for Organizations Described in Sections 170(b)(1)(A)(iv) and 170(b)(1)(A)(vi)

(Complete only if you checked the box on line 5, 7, or 8 of Part I or if the organization failed to qualify under

Part III. If the organization fails to qualify under the tests listed below, please complete Part III.)

Section A. Public Support

Calendar year (or fiscal year beginning in)

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Gifts, grants, contributions, and

membership fees received. (Do not

include any “unusual grants.”) . . .

Tax revenues levied for the

organization’s benefit and either paid

to or expended on its behalf . . .

The value of services or facilities

furnished by a governmental unit to the

organization without charge . . . .

4 Total. Add lines 1 through 3 . . . .

The portion of total contributions by

each person (other than a

governmental unit or publicly

supported organization) included on

line 1 that exceeds 2% of the amount

shown on line 11, column (f) . . . .

Public support. Subtract line 5 from line 4

Section B. Total Support

Calendar year (or fiscal year beginning in)

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7 Amounts from line 4 . . . . . .

Gross income from interest, dividends,

payments received on securities loans,

rents, royalties and income from similar

sources . . . . . . . . . .

Net income from unrelated business

activities, whether or not the business

is regularly carried on . . . . .

Other income. Do not include gain or

loss from the sale of capital assets

(Explain in Part VI.) . . . . . . .

11 Total support. Add lines 7 through 10

12 Gross receipts from related activities, etc. (see instructions) . . . . . . . . . . . .

13 First five years. If the Form 990 is for the organization’s first, second, third, fourth, or fifth tax year as a section 501(c)(3)

organization, check this box and stop here . . . . . . . . . . . . . . . . . . . . . . . . .

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Section C. Computation of Public Support Percentage

14 Public support percentage for 2016 (line 6, column (f) divided by line 11, column (f)) . . . . 14 %

15 Public support percentage from 2015 Schedule A, Part II, line 14 . . . . . . . . . .

15 %

16 a 33

% support test—2016. If the organization did not check the box on line 13, and line 14 is 33

% or more, check this

box and stop here. The organization qualifies as a publicly supported organization . . . . . . . . . . . .

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b 33

% support test—2015. If the organization did not check a box on line 13 or 16a, and line 15 is 33

% or more, check

this box and stop here. The organization qualifies as a publicly supported organization . . . . . . . . . . .

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10%-facts-and-circumstances test—2016. If the organization did not check a box on line 13, 16a, or 16b, and line 14 is

10% or more, and if the organization meets the “facts-and-circumstances” test, check this box and stop here. Explain in

Part VI how the organization meets the “facts-and-circumstances” test. The organization qualifies as a publicly supported

organization . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

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10%-facts-and-circumstances test—2015. If the organization did not check a box on line 13, 16a, 16b, or 17a, and line

15 is 10% or more, and if the organization meets the “facts-and-circumstances” test, check this box and stop here.

Explain in Part VI how the organization meets the “facts-and-circumstances” test. The organization qualifies as a publicly

supported organization . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

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18 Private foundation. If the organization did not check a box on line 13, 16a, 16b, 17a, or 17b, check this box and see

instructions . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

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Schedule A (Form 990 or 990-EZ) 2016

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Part III

Support Schedule for Organizations Described in Section 509(a)(2)

(Complete only if you checked the box on line 10 of Part I or if the organization failed to qualify under Part II.

If the organization fails to qualify under the tests listed below, please complete Part II.)

Section A. Public Support

Calendar year (or fiscal year beginning in)

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Gifts, grants, contributions, and membership fees

received. (Do not include any “unusual grants.”)

Gross receipts from admissions, merchandise

sold or services performed, or facilities

furnished in any activity that is related to the

organization’s tax-exempt purpose . . .

Gross receipts from activities that are not an

unrelated trade or business under section 513

Tax revenues levied for the

organization’s benefit and either paid

to or expended on its behalf . . .

The value of services or facilities

furnished by a governmental unit to the

organization without charge . . . .

6 Total. Add lines 1 through 5 . . . .

7a Amounts included on lines 1, 2, and 3

received from disqualified persons .

Amounts included on lines 2 and 3

received from other than disqualified

persons that exceed the greater of $5,000

or 1% of the amount on line 13 for the year

c Add lines 7a and 7b . . . . . .

8 Public support. (Subtract line 7c from

line 6.) . . . . . . . . . . .

Section B. Total Support

Calendar year (or fiscal year beginning in)

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9 Amounts from line 6 . . . . . .

10a

Gross income from interest, dividends,

payments received on securities loans, rents,

royalties and income from similar sources .

Unrelated business taxable income (less

section 511 taxes) from businesses

acquired after June 30, 1975 . . . .

c Add lines 10a and 10b . . . . .

Net income from unrelated business

activities not included in line 10b, whether

or not the business is regularly carried on

Other income. Do not include gain or

loss from the sale of capital assets

(Explain in Part VI.) . . . . . . .

13 Total support. (Add lines 9, 10c, 11,

and 12.) . . . . . . . . . .

First five years. If the Form 990 is for the organization’s first, second, third, fourth, or fifth tax year as a section 501(c)(3)

organization, check this box and stop here . . . . . . . . . . . . . . . . . . . . . . . . .

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Section C. Computation of Public Support Percentage

15 Public support percentage for 2016 (line 8, column (f) divided by line 13, column (f)) . . . . . 15 %

16 Public support percentage from 2015 Schedule A, Part III, line 15 . . . . . . . . . . .

16 %

Section D. Computation of Investment Income Percentage

17 Investment income percentage for 2016 (line 10c, column (f) divided by line 13, column (f)) . . . 17 %

18 Investment income percentage from 2015 Schedule A, Part III, line 17 . . . . . . . . . .

18 %

19a

% support tests—2016. If the organization did not check the box on line 14, and line 15 is more than 33

%, and line

17 is not more than 33

%, check this box and stop here. The organization qualifies as a publicly supported organization .

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% support tests—2015. If the organization did not check a box on line 14 or line 19a, and line 16 is more than 33

%, and

line 18 is not more than 33

%, check this box and stop here. The organization qualifies as a publicly supported organization

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20 Private foundation. If the organization did not check a box on line 14, 19a, or 19b, check this box and see instructions

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Schedule A (Form 990 or 990-EZ) 2016

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Part IV

Supporting Organizations

(Complete only if you checked a box in line 12 on Part I. If you checked 12a of Part I, complete Sections A

and B. If you checked 12b of Part I, complete Sections A and C. If you checked 12c of Part I, complete

Sections A, D, and E. If you checked 12d of Part I, complete Sections A and D, and complete Part V.)

Section A. All Supporting Organizations

Yes No

Are all of the organization’s supported organizations listed by name in the organization’s governing

documents? If “No,” describe in Part VI how the supported organizations are designated. If designated by

class or purpose, describe the designation. If historic and continuing relationship, explain.

Did the organization have any supported organization that does not have an IRS determination of status

under section 509(a)(1) or (2)? If “Yes,” explain in Part VI how the organization determined that the supported

organization was described in section 509(a)(1) or (2).

Did the organization have a supported organization described in section 501(c)(4), (5), or (6)? If “Yes,” answer

(b) and (c) below.

Did the organization confirm that each supported organization qualified under section 501(c)(4), (5), or (6) and

satisfied the public support tests under section 509(a)(2)? If “Yes,” describe in Part VI when and how the

organization made the determination.

Did the organization ensure that all support to such organizations was used exclusively for section 170(c)(2)(B)

purposes? If “Yes,” explain in Part VI what controls the organization put in place to ensure such use.

Was any supported organization not organized in the United States (“foreign supported organization”)? If

“Yes,” and if you checked 12a or 12b in Part I, answer (b) and (c) below.

Did the organization have ultimate control and discretion in deciding whether to make grants to the foreign

supported organization? If “Yes,” describe in Part VI how the organization had such control and discretion

despite being controlled or supervised by or in connection with its supported organizations.

Did the organization support any foreign supported organization that does not have an IRS determination

under sections 501(c)(3) and 509(a)(1) or (2)? If “Yes,” explain in Part VI what controls the organization used

to ensure that all support to the foreign supported organization was used exclusively for section 170(c)(2)(B)

purposes.

Did the organization add, substitute, or remove any supported organizations during the tax year? If “Yes,”

answer (b) and (c) below (if applicable). Also, provide detail in Part VI, including (i) the names and EIN

numbers of the supported organizations added, substituted, or removed; (ii) the reasons for each such action;

(iii) the authority under the organization's organizing document authorizing such action; and (iv) how the action

was accomplished (such as by amendment to the organizing document).

Type I or Type II only. Was any added or substituted supported organization part of a class already

designated in the organization's organizing document?

Substitutions only. Was the substitution the result of an event beyond the organization's control?

Did the organization provide support (whether in the form of grants or the provision of services or facilities) to

anyone other than (i) its supported organizations, (ii) individuals that are part of the charitable class benefited

by one or more of its supported organizations, or (iii) other supporting organizations that also support or

benefit one or more of the filing organization’s supported organizations? If “Yes,” provide detail in Part VI.

Did the organization provide a grant, loan, compensation, or other similar payment to a substantial contributor

(defined in section 4958(c)(3)(C)), a family member of a substantial contributor, or a 35% controlled entity with

regard to a substantial contributor? If “Yes,” complete Part I of Schedule L (Form 990 or 990-EZ).

8 Did the organization make a loan to a disqualified person (as defined in section 4958) not described in line 7?

“Yes,”

complete Part I of Schedule L (Form 990 or 990-EZ).

Was the organization controlled directly or indirectly at any time during the tax year by one or more

disqualified persons as defined in section 4946 (other than foundation managers and organizations described

in section 509(a)(1) or (2))? If “Yes,” provide detail in Part VI.

Did one or more disqualified persons (as defined in line 9a) hold a controlling interest in any entity in which

the supporting organization had an interest? If “Yes,” provide detail in Part VI.

Did a disqualified person (as defined in line 9a) have an ownership interest in, or derive any personal benefit

from, assets in which the supporting organization also had an interest? If “Yes,” provide detail in Part VI.

10a

Was the organization subject to the excess business holdings rules of section 4943 because of section

4943(f) (regarding certain Type II supporting organizations, and all Type III non-functionally integrated

supporting organizations)? If “Yes,” answer 10b below.

10a

Did the organization have any excess business holdings in the tax year? (Use Schedule C, Form 4720, to

determine whether the organization had excess business holdings.)

10b

Schedule A (Form 990 or 990-EZ) 2016

Page 5

Part IV

Supporting Organizations (continued)

Yes No

11 Has the organization accepted a gift or contribution from any of the following persons?

A person who directly or indirectly controls, either alone or together with persons described in (b) and (c)

below, the governing body of a supported organization?

11a

b A family member of a person described in (a) above? 11b

A 35% controlled entity of a person described in (a) or (b) above? If “Yes” to a, b, or c, provide detail in Part VI.

11c

Section B. Type I Supporting Organizations

Yes No

1 Did the directors, trustees, or membership of one or more supported organizations have the power to

regularly appoint or elect at least a majority of the organization’s directors or trustees at all times during the

tax year? If “No,” describe in Part VI how the supported organization(s) effectively operated, supervised, or

controlled the organization’s activities. If the organization had more than one supported organization,

describe how the powers to appoint and/or remove directors or trustees were allocated among the supported

organizations and what conditions or restrictions, if any, applied to such powers during the tax year.

Did the organization operate for the benefit of any supported organization other than the supported

organization(s) that operated, supervised, or controlled the supporting organization? If “Yes,” explain in Part

VI how providing such benefit carried out the purposes of the supported organization(s) that operated,

supervised, or controlled the supporting organization.

Section C. Type II Supporting Organizations

Yes No

Were a majority of the organization’s directors or trustees during the tax year also a majority of the directors

or trustees of each of the organization’s supported organization(s)? If “No,” describe in Part VI how control

or management of the supporting organization was vested in the same persons that controlled or managed

the supported organization(s).

Section D. All Type III Supporting Organizations

Yes No

Did the organization provide to each of its supported organizations, by the last day of the fifth month of the

organization’s tax year, (i) a written notice describing the type and amount of support provided during the prior tax

year, (ii) a copy of the Form 990 that was most recently filed as of the date of notification, and (iii) copies of the

organization’s governing documents in effect on the date of notification, to the extent not previously provided?

Were any of the organization’s officers, directors, or trustees either (i) appointed or elected by the supported

organization(s) or (ii) serving on the governing body of a supported organization? If “No,” explain in Part VI how

the organization maintained a close and continuous working relationship with the supported organization(s).

By reason of the relationship described in (2), did the organization’s supported organizations have a

significant voice in the organization’s investment policies and in directing the use of the organization’s

income or assets at all times during the tax year? If “Yes,” describe in Part VI the role the organization’s

supported organizations played in this regard.

Section E. Type III Functionally Integrated Supporting Organizations

Check the box next to the method that the organization used to satisfy the Integral Part Test during the year (see instructions).

The organization satisfied the Activities Test. Complete line 2 below.

The organization is the parent of each of its supported organizations. Complete line 3 below.

The organization supported a governmental entity. Describe in Part VI how you supported a government entity (see instructions).

Yes No 2 Activities Test. Answer (a) and (b) below.

Did substantially all of the organization’s activities during the tax year directly further the exempt purposes of

the supported organization(s) to which the organization was responsive? If “Yes,” then in Part VI identify

those supported organizations and explain how these activities directly furthered their exempt purposes,

how the organization was responsive to those supported organizations, and how the organization determined

that these activities constituted substantially all of its activities.

Did the activities described in (a) constitute activities that, but for the organization’s involvement, one or more

of the organization’s supported organization(s) would have been engaged in? If “Yes,” explain in Part VI the

reasons for the organization’s position that its supported organization(s) would have engaged in these

activities but for the organization’s involvement.

3 Parent of Supported Organizations. Answer (a) and (b) below.

Did the organization have the power to regularly appoint or elect a majority of the officers, directors, or

trustees of each of the supported organizations? Provide details in Part VI.

Did the organization exercise a substantial degree of direction over the policies, programs, and activities of each

of its supported organizations? If “Yes,” describe in Part VI the role played by the organization in this regard.

Schedule A (Form 990 or 990-EZ) 2016

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Part V

Type III Non-Functionally Integrated 509(a)(3) Supporting Organizations

Check here if the organization satisfied the Integral Part Test as a qualifying trust on Nov. 20, 1970 (explain in Part VI). See

instructions. All other Type III non-functionally integrated supporting organizations must complete Sections A through E.

Section A - Adjusted Net Income (A) Prior Year

(B) Current Year

(optional)

1 Net short-term capital gain 1

2 Recoveries of prior-year distributions 2

3 Other gross income (see instructions) 3

4 Add lines 1 through 3. 4

5 Depreciation and depletion 5

6 Portion of operating expenses paid or incurred for production or

collection of gross income or for management, conservation, or

maintenance of property held for production of income (see instructions)

7 Other expenses (see instructions) 7

8 Adjusted Net Income (subtract lines 5, 6, and 7 from line 4). 8

Section B - Minimum Asset Amount (A) Prior Year

(B) Current Year

(optional)

1 Aggregate fair market value of all non-exempt-use assets (see

instructions for short tax year or assets held for part of year):

a Average monthly value of securities 1a

b Average monthly cash balances 1b

c Fair market value of other non-exempt-use assets 1c

d Total (add lines 1a, 1b, and 1c) 1d

e Discount claimed for blockage or other

factors (explain in detail in Part VI):

2 Acquisition indebtedness applicable to non-exempt-use assets 2

3 Subtract line 2 from line 1d. 3

4 Cash deemed held for exempt use. Enter 1-1/2% of line 3 (for greater amount,

see instructions). 4

5 Net value of non-exempt-use assets (subtract line 4 from line 3) 5

6 Multiply line 5 by .035. 6

7 Recoveries of prior-year distributions 7

8 Minimum Asset Amount (add line 7 to line 6) 8

Section C - Distributable Amount Current Year

1 Adjusted net income for prior year (from Section A, line 8, Column A)

2 Enter 85% of line 1. 2

3 Minimum asset amount for prior year (from Section B, line 8, Column A) 3

4 Enter greater of line 2 or line 3. 4

5 Income tax imposed in prior year 5

6 Distributable Amount. Subtract line 5 from line 4, unless subject to

emergency temporary reduction (see instructions).

Check here if the current year is the organization’s first as a non-functionally integrated Type III supporting organization (see

instructions).

Schedule A (Form 990 or 990-EZ) 2016

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Type III Non-Functionally Integrated 509(a)(3) Supporting Organizations (continued)

Part V

Section D - Distributions Current Year

1 Amounts paid to supported organizations to accomplish exempt purposes

Amounts paid to perform activity that directly furthers exempt purposes of supported

organizations, in excess of income from activity

3 Administrative expenses paid to accomplish exempt purposes of supported organizations

4 Amounts paid to acquire exempt-use assets

5 Qualified set-aside amounts (prior IRS approval required)

6 Other distributions (describe in Part VI). See instructions.

7 Total annual distributions. Add lines 1 through 6.

8 Distributions to attentive supported organizations to which the organization is responsive

(provide details in Part VI). See instructions.

9 Distributable amount for 2016 from Section C, line 6

Line 8 amount divided by Line 9 amount

Section E - Distribution Allocations (see instructions)

(i)

Excess Distributions

(ii)

Underdistributions

Pre-2016

(iii)

Distributable

Amount for 2016

1 Distributable amount for 2016 from Section C, line 6

Underdistributions, if any, for years prior to 2016

(reasonable cause required—explain in Part VI). See

instructions.

3 Excess distributions carryover, if any, to 2016:

c From 2013 . . . . .

d From 2014 . . . . .

e From 2015 . . . . .

f Total of lines 3a through e

g Applied to underdistributions of prior years

h Applied to 2016 distributable amount

i Carryover from 2011 not applied (see instructions)

j Remainder. Subtract lines 3g, 3h, and 3i from 3f.

Distributions for 2016 from

Section D, line 7:

a Applied to underdistributions of prior years

b Applied to 2016 distributable amount

c Remainder. Subtract lines 4a and 4b from 4.

Remaining underdistributions for years prior to 2016, if

any. Subtract lines 3g and 4a from line 2. For result

greater than zero, explain in Part VI. See instructions.

Remaining underdistributions for 2016. Subtract lines 3h

and 4b from line 1. For result greater than zero, explain in

Part VI. See instructions.

7 Excess distributions carryover to 2017. Add lines 3j

and 4c.

8 Breakdown of line 7:

Excess from 2013 . . .

c Excess from 2014 . . .

d Excess from 2015 . . .

e Excess from 2016 . . .

Schedule A (Form 990 or 990-EZ) 2016

Page 8

Part VI

Supplemental Information. Provide the explanations required by Part II, line 10; Part II, line 17a or 17b; Part

III, line 12; Part IV, Section A, lines 1, 2, 3b, 3c, 4b, 4c, 5a, 6, 9a, 9b, 9c, 11a, 11b, and 11c; Part IV, Section

B, lines 1 and 2; Part IV, Section C, line 1; Part IV, Section D, lines 2 and 3; Part IV, Section E, lines 1c, 2a, 2b,

3a, and 3b; Part V, line 1; Part V, Section B, line 1e; Part V, Section D, lines 5, 6, and 8; and Part V, Section E,

lines 2, 5, and 6. Also complete this part for any additional information. (See instructions.)

Schedule A (Form 990 or 990-EZ) 2016