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Form 990 (2012) <br />Page 3 <br />Form 9W (2012) <br />Yes <br />No <br />1 Is the organization described in section 501(c)(3) or 4947(a)(1) (other than a private foundation)? If "Yes," <br />complete Schedule A . . . . . . . . . . . . . . . . . . . . . . . . . . . . . <br />1 <br />2 Is the organization required to complete Schedule B, Schedule of Contributors (see instructions)? . . . <br />2 <br />3 Did the organization engage in direct or indirect political campaign activities on behalf of or in opposition to <br />candidates for public office? If "Yes," complete Schedule C, Part I . . . . . . . . . . . . . . <br />3 <br />4 Section 501(c)(3) organizations. Did the organization engage in lobbying activities, or have a section 501(h) <br />election in effect during the tax year? If "Yes," complete Schedule C, Part II . . . . . . . . . . . <br />4 <br />5 Is the organization a section 501(cx4), 501(c)(5), or 501(c)(6) organization that receives membership dues, <br />assessments, or similar amounts as defined in Revenue Procedure 98 -197 If "Yes," complete Schedule C, <br />Part111 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . <br />5 <br />6 Did the organization maintain any donor advised funds or any similar funds or accounts for which donors <br />have the right to provide advice on the distribution or Investment of amounts in such funds or accounts? If <br />"Yes," complete Schedule D. Part I . . . . . . . . . . . . . . . . . . . . . . . . <br />6 <br />7 Did the organization receive or hold a conservation easement, including easements to preserve open space, <br />the environment, historic land areas, or historic structures? If "Yes," complete Schedule D, Part ll . . . <br />7 <br />8 Did the organization maintain collections of works of art, historical treasures, or other similar assets? If "Yes," <br />complete Schedule D, Part //I . . . . . . . . . . . . . . . . . . . . . . . . . . <br />6 <br />9 Did the organization report an amount In Part X, line 21, for escrow or custodial account liability; serve as a <br />custodian for amounts not listed in Part X; or provide credit counseling, debt management, credit repair, or <br />debt negotiation services? If "Yes," complete Schedule D, Part IV . . . . . . . . . . . . . . <br />9 <br />10 Did the organization, directly or through a related organization, hold assets in temporarily restricted <br />endowments, permanent endowments, or quasi - endowments? If "Yes," complete Schedule D, Part V . . <br />10 <br />11 If the organization's answer to any of the following questions is "Yes," then complete Schedule D, Parts VI, <br />VII, Vll 1, IX, or X as applicable. <br />a Did the organization report an amount for land, buildings, and equipment in Part X, line 10? If "Yes," <br />complete Schedule D, Part VI . . . . . . . . . . . . . . . . . . . . . . . . . . <br />118 <br />b Did the organization report an amount for investments —other securities in Part X, line 12 that is 5% or more <br />of its total assets reported in Part X, line 16? If "Yes," complete Schedule D, Part VII . . . . . . . . <br />lib <br />c Did the organization report an amount for investments — program related in Part X, line 13 that is 5% or more <br />of its total assets reported in Part X, line 16? If "Yes," complete Schedule D, Part Wil . . . . . . . . <br />11c <br />d Did the organization report an amount for other assets in Part X, line 15 that is 5% or more of its total assets <br />reported in Part X, line 16? If "Yes," complete Schedule D, Part IX . . . . . . . . . . . . . . <br />ltd <br />e Did the organization report an amount for other liabilities in Part X, line 25? If "Yes," complete Schedule D, Part X <br />lie <br />f Did the organization's separate or consolidated financial statements for the tax year include a footnote that addresses <br />the organization's liability for uncertain tax positions under FIN 48 (ASC 740)? If "Yes," complete Schedule D, Part X . <br />11f <br />12a Did the organization obtain separate, independent audited financial statements for the tax year? If "Yes," complete <br />Schedule D, Parts XI and All . . . . . . . . . . . . . . . . . . . . . . . . . . <br />12a <br />b Was the organization included in consolidated, independent audited financial statements for the tax year? if "Yes," and if <br />the organization answered "No" to line 12a, then completing Schedule D, Parts XI and Xll is optional . . . . . . . <br />12b <br />13 Is the organization a school described in section 170(b)(1)(A)(11)? If "Yes," complete Schedule E . . . . <br />13 <br />14a Did the organization maintain an office, employees, or agents outside of the United States? . . . . . <br />14a <br />b Did the organization have aggregate revenues or expenses of more than $10,000 from grantmaking, <br />fundraising, business, investment, and program service activities outside the United States, or aggregate <br />foreign investments valued at $100,000 or more? If "Yes," complete Schedule F, Parts I and IV. . . . . <br />14b <br />15 Did the organization report on Part IX, column (A), line 3, more than $5,000 of grants or assistance to any <br />organization or entity located outside the United States? If "Yes," complete Schedule F, Parts 11 and IV . . <br />15 <br />16 Did the organization report on Part IX, column (A), line 3, more than $5,000 of aggregate grants or assistance <br />to individuals located outside the United States? If "Yes, "complete Schedule F, Parts Ill and IV . . . . <br />16 <br />17 Did the organization report a total of more than $15,000 of expenses for professional fundraising services on <br />Part IX, column (A), lines 6 and 11 e? If "Yes," complete Schedule G, Part I (see instructions) . . . . . <br />17 <br />18 Did the organization report more than $15,000 total of fundraising event gross income and contributions on <br />Part VIII, lines 1 c and SO If "Yes," complete Schedule G, Part H . . . . . . . . . . . . . . . <br />1g <br />19 Did the organization report more than $15,000 of gross income from gaming activities on Part VIII, line 9a? <br />If "Yes," complete Schedule G, Part III . . . . . . . . . . . . . . . . . . . . . . . <br />19 <br />20 a Did the organization operate one or more hospital facilities? If "Yes," complete Schedule H . . . . . . <br />20a <br />b If "Yes" to line 20a. did the organization attach a coov of its audited financial statements to this return? <br />20b <br />Form 9W (2012) <br />