Enlarge image | 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 |
Enlarge image | 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 |
Enlarge image | 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 |