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SCHEDULE G                  Supplemental Information Regarding Fundraising or Gaming Activities                                               OMB No. 1545-0047
(Form 990)                           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.
Department of the Treasury                                   ▶ Attach to Form 990 or Form 990-EZ.                                             2021
Internal Revenue Service                   ▶ Go to www.irs.gov/Form990 for instructions and the latest information.                           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                                            e     Solicitation of non-government grants
     b        Internet and email solicitations                              f     Solicitation of government grants
     c        Phone solicitations                                           g     Special fundraising events
     d        In-person solicitations
 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.

                                                                      (iii) Did fundraiser have                          (v) Amount paid to 
        (i) Name and address of individual            (ii) Activity     custody or control of   (iv) Gross receipts      (or retained by)     (vi) Amount paid to 
              or entity (fundraiser)                                        contributions?      from activity            fundraiser listed in      (or retained by) 
                                                                                                                              col. (i)             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) 2021



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Schedule G (Form 990) 2021                                                                                                                                             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.
                                                                (a) Event #1                   (b)  Event #2               (c)  Other events       (d) Total events 
                                                                                                                                                 (add col. (a)  through 
                                                                       (event type)            (event type)                (total number)                  col. (c))

                                 1   Gross receipts  .    . . .
               Revenue               
                                 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  .    .

               Direct Expenses   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.
                                                                                           (b) Pull tabs/instant           (c) Other gaming      (d) Total gaming (add 
                                                                       (a) Bingo      bingo/progressive bingo                                    col. (a) through col. (c))

               Revenue
                                 1   Gross revenue  .     . . .

                                 2   Cash prizes  .     . . . .

                                 3   Noncash prizes       . . .

                                 4   Rent/facility costs  . . .
               Direct Expenses
                                 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)    .       . .  . . .     .    . . .   ▶

                                 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) 2021



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Schedule G (Form 990) 2021                                                                                                 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) 2021






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