Fillable Supplemental Information Regarding Fundraising or Gaming Activities SCHEDULE G (Form 990 or 990-EZ)

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Supplemental Information Regarding Fundraising or Gaming Activities SCHEDULE G (Form 990 or 990-EZ)

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SCHEDULE G
(
Form 990 or 990-EZ)
Department of the Treasury
Internal Revenue Service
Supplemental Information Regarding Fundraising or Gaming Activities
Complete if the organization answered “Yes” on Form 990, Part IV, line 17, 18, or 19, or if the
organization entered more than $15,000 on Form 990-EZ, line 6a.
▶
Attach to Form 990 or Form 990-EZ.
▶
Go to www.irs.gov/Form990 for instructions and the latest information.
OMB No. 1545-0047
2018
Open to Public
Inspection
Name of the organization Employer identification number
Part I
Fundraising Activities. Complete if the organization answered “Yes” on Form 990, Part IV, line 17.
Form 990-EZ filers are not required to complete this part.
1 Indicate whether the organization raised funds through any of the following activities. Check all that apply.
a
Mail solicitations
b
Internet and email solicitations
c
Phone solicitations
d
In-person solicitations
e Solicitation of non-government grants
f
Solicitation of government grants
g
Special fundraising events
2
a
Did the organization have a written or oral agreement with any individual (including officers, directors, trustees,
or key employees listed in Form 990, Part VII) or entity in connection with professional fundraising services? Yes No
b
If “Yes,” list the 10 highest paid individuals or entities (fundraisers) pursuant to agreements under which the fundraiser is to be
compensated at least $5,000 by the organization.
(i) Name and address of individual
or entity (fundraiser)
(ii) Activity
(iii) Did fundraiser have
custody or control of
contributions?
(iv) Gross receipts
from activity
(v) Amount paid to
(or retained by)
fundraiser listed in
col. (i)
(vi) Amount paid to
(or retained by)
organization
Yes No
1
2
3
4
5
6
7
8
9
10
Total . . . . . . . . . . . . . . . . . . . . . .
▶
3
List all states in which the organization is registered or licensed to solicit contributions or has been notified it is exempt from
registration or licensing.
For Paperwork Reduction Act Notice, see the Instructions for Form 990 or 990-EZ. Cat. No. 50083H Schedule G (Form 990 or 990-EZ) 2018
Schedule G (Form 990 or 990-EZ) 2018
Page 2
Part II
Fundraising Events. Complete if the organization answered “Yes” on 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.
RevenueDirect Expenses
(a) Event #1
(event type)
(b) Event #2
(event type)
(c) Other events
(total number)
(d) Total events
(add col. (a) through
col. (c))
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) . . . . . . . . . .
▶
11 Net income summary. Subtract line 10 from line 3, column (d) . . . . . . . . . .
▶
Part III
Gaming. Complete if the organization answered “Yes” on Form 990, Part IV, line 19, or reported more than
$15,000 on Form 990-EZ, line 6a.
RevenueDirect Expenses
(a) Bingo
(b) Pull tabs/instant
bingo/progressive bingo
(c) Other gaming
(d) Total gaming (add
col. (a) through col. (c))
1 Gross revenue . . . .
2 Cash prizes . . . . .
3 Noncash prizes . . .
4 Rent/facility costs . . .
5 Other direct expenses .
6 Volunteer labor . . . .
Yes %
No
Yes %
No
Yes %
No
7 Direct expense summary. Add lines 2 through 5 in column (d) . . . . . . . . . .
▶
8
Net gaming income summary. Subtract line 7 from line 1, column (d) . . . . . . . .
▶
9 Enter the state(s) in which the organization conducts gaming activities:
a Is the organization licensed to conduct 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) 2018
Schedule G (Form 990 or 990-EZ) 2018
Page 3
11 Does the organization conduct gaming activities with nonmembers? . . . . . . . . . . . . . Yes No
12
Is the organization a grantor, beneficiary or trustee of a trust, or a member of a partnership or other entity
formed to administer charitable gaming? . . . . . . . . . . . . . . . . . . . . . .
Yes No
13 Indicate the percentage of gaming activity conducted in:
a The organization’s facility . . . . . . . . . . . . . . . . . . . . . . . . .
13a
%
b An outside facility . . . . . . . . . . . . . . . . . . . . . . . . . . . .
13b
%
14
Enter the name and address of the person who prepares the organization’s gaming/special events books and
records:
Name
▶
Address
▶
15a
Does the organization have a contract with a third party from whom the organization receives gaming
revenue? . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
Yes No
b If “Yes,” enter the amount of gaming revenue received by the organization
▶
$ and the
amount of gaming revenue retained by the third party
▶
$
c If “Yes,” enter name and address of the third party:
Name
▶
Address
▶
16 Gaming manager information:
Name
▶
Gaming manager compensation
▶
$
Description of services provided
▶
Director/officer Employee Independent contractor
17 Mandatory distributions:
a
Is the organization required under state law to make charitable distributions from the gaming proceeds to
retain the state gaming license? . . . . . . . . . . . . . . . . . . . . . . . . .
Yes No
b
Enter the amount of distributions required under state law to be distributed to other exempt organizations or
spent in the organization’s own exempt activities during the tax year
▶
$
Part IV
Supplemental Information. Provide the explanations required by Part I, line 2b, columns (iii) and (v); and
Part III, lines 9, 9b, 10b, 15b, 15c, 16, and 17b, as applicable. Also provide any additional information.
See instructions.
Schedule G (Form 990 or 990-EZ) 2018
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Supplemental Information Regarding Fundraising or Gaming Activities SCHEDULE G (Form 990 or 990-EZ)

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Completed 23 May 2019

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