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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)
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