Table of Contents
Check only one of the boxes on lines 1 through 11 to indicate the reason the organization is a public charity for the tax year. The reason can be the same as stated in the organization's tax-exempt determination letter from the IRS (“exemption letter”) or subsequent IRS determination letter, or it can be different. An organization that does not check any of the boxes on lines 1 through 11 should not file Form 990, Form 990-EZ, or Schedule A (Form 990 or 990-EZ) for the tax year, but should file Form 990-PF instead.
If an organization believes there is more than one reason why it is a public charity, it should check only one box but can explain the other reasons it qualifies for public charity status in Part IV.
The IRS does not update its records on an organization's public charity status based on a change the organization makes on Schedule A (Form 990 and Form 990-EZ). Thus, an organization that checks a public charity status different from the reason stated in its exemption letter or subsequent determination letter, although not required, may submit a request to the IRS Exempt Organizations Determinations Office for a determination letter confirming that it qualifies for the new public charity status if the organization wants the IRS records to reflect that new public charity status (also refer to private foundation status). See Section 9 of Rev. Proc. 2012-4, 2012-1 I.R.B. 125 (or latest annual update) for instructions. A $400 user fee must be submitted with such a request. See Section 6.08 of Rev. Proc. 2012-8, 2012-1 I.R.B. 235.
A subordinate organization of a group exemption that is filing its own return, but has not received its own tax exemption determination letter from the IRS, should check the public charity status box which most accurately describes its public charity status.
An organization that does not know the public charity status stated in its exemption letter or subsequent determination letter should call the Exempt Organizations Customer Account Services toll free at 1-877-829-5500 or write to:
Internal Revenue Service
TE/GE Customer Account Services
P.O. Box 2508
Cincinnati, OH 45201
See the following examples:
Example 1.
The organization received an exemption letter that it is a public charity under section 170(b)(1)(A)(vi). For the tax year, it meets the requirements for public charity status under section 170(b)(1)(A)(vi). The organization should check the box on line 7 and complete Part II.
Example 2.
The organization received an exemption letter that it is a public charity under section 170(b)(1)(A)(vi). For the tax year, it does not meet the requirements for public charity status under section 170(b)(1)(A)(vi). Instead, it meets the requirements for public charity status under section 509(a)(2). The organization should check the box on line 9 and complete Part III.
Example 3.
The organization received an exemption letter that it is a public charity under section 509(a)(2). For the tax year, it does not meet the requirements for public charity status under section 509(a)(2) or 170(b)(1)(A)(vi). Instead, it meets the requirements for public charity status as a supporting organization under section 509(a)(3). The organization should;
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Check the box on line 11;
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Check the box on either line 11a, 11b, 11c, or 11d;
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Complete lines 11e through 11g; and
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Complete the table on line 11h.
Example 4.
The organization received an exemption letter that it is a supporting organization under section 509(a)(3). Based on Rev. Proc. 2012-10, 2012-2 I.R.B. 273, the organization submitted a request to the IRS to change its classification to public charity status under section 509(a)(2). The organization received a determination letter that it has been reclassified as a public charity under section 509(a)(2). The organization should check the box on line 9 and complete Part III.
Example 5.
The organization received an exemption letter that it is a public charity under section 170(b)(1)(A)(vi). For the tax year, it does not meet the requirements for public charity status under section 170(b)(1)(A)(vi) or 509(a)(2), or as a supporting organization under section 509(a)(3). Nor does it meet the requirements for public charity status under any other provision of the Internal Revenue Code. The organization is a private foundation and should not file Form 990, Form 990-EZ, or Schedule A (Form 990 or 990-EZ) for the tax year but should file Form 990-PF instead.





Use the information below to determine the supporting organization's type. If the organization checks the box on line 11f, the letter the organization received from the IRS identifies its type. If the box checked on any of lines 11a through 11d is different from the type stated in the letter, provide an explanation in Part IV. If the organization does not check the box on line 11f, it should check the box on lines 11a to 11d that best describes the type of supporting organization it is.
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Type I. A Type I supporting organization is operated, supervised, or controlled by one or more publicly supported organizations. If the organization can answer “Yes” to the following question, check the box for
Type I.Does the governing body, officers or membership of the supported public charity(ies) select a majority of the supporting organization's officers, directors, or trustees?
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Type II. A Type II supporting organization is supervised or controlled in connection with one or more publicly supported organizations. If the organization can answer “Yes” to the following question, check the box for
Type II.Do the same persons, such as directors, trustees, and officers, supervise or control the supported organization(s) and the supporting organization?
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Type III—Functionally Integrated. Check this box if:
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The organization is not described in Type I or Type II above;
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The organization's activities perform the functions of, or carry out the purposes of, the publicly supported organizations; and
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But for the organization's involvement, such activities would normally be engaged in by the publicly supported organizations themselves.
See Regulations section 1.509(a)-4(i)(3)(ii); Rev. Proc. 2011-33, 2011-25 I.R.B. 887; and any further related guidance for more information.
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Type III—Non-Functionally Integrated. Check this box if the organization is not described as a Type I, Type II, or Type III — Functionally Integrated organization.
A section 509(a)(3) supporting organization cannot be controlled by disqualified persons, other than foundation managers. Section 509(a)(1) or (2) organizations and foundation managers who are disqualified persons only as a result of being foundation managers are not treated as disqualified persons.
The organization's exemption letter or subsequent determination letter may state the type of supporting organization it is. If it does, check the box on this line. If the letter does not state the type, leave this line blank.
A grantor to a section 509(a)(3) supporting organization, acting in good faith, can rely on this letter in determining whether the organization is a Type I, Type II, or Type III organization. The grantor also can rely on certain representations made by the organization, or can rely on a written reasoned opinion of counsel of either the grantor or the organization that the organization is a functionally integrated Type III supporting organization. See Rev. Proc. 2011-33, 2011-25 I.R.B. 887, Notice 2006-109 .
This information is necessary to determine whether the organization is controlled by certain donors. Section 509(f)(2), which became effective August 17, 2006, prohibits certain supporting organizations from accepting gifts or contributions from certain persons associated with the supported organization of such supporting organization. For example, if a Type I or Type III supporting organization accepts a gift or contribution from a person who controls the governing body of a supporting organization or from certain related persons, then the supporting organization loses its status as a supporting organization.
An organization checking a box on line 11 must complete the table on line 11h.
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Columns (i) and (ii). Enter the name and employer identification number (EIN) for each supported organization. Enter the total number of supported organizations on the “Total” line in column (i). If the organization had more than five supported organizations during the tax year, enter the additional organizations on duplicate pages of Schedule A, Part I. Use as many duplicate copies as needed, and number each page.
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Column (iii). For each supported organization named in column (i), show which line number (from lines 1 through 9) best describes the supported organization. For example, if the organization supported a hospital, enter "3" in column (iii). If the organization supported a federal, state, local government, or governmental unit, or foreign government, enter "6" in column (iii).
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Column (iv). Check “Yes” if the supported organization named in column (i) is specifically named as a supported organization in the organization's declaration of trust, articles of incorporation, or other governing document. An organization that supports non-designated publicly supported organizations and meets the requirements of Regulations section 1.509(a)-4(d)(2)(i) (relating to designating the publicly supported organizations by class or purpose rather than by name) should not complete column (iv) but should provide a statement in Part IV explaining how it meets these requirements.
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Column (v). Only Type III organizations are required to answer this question. Check “Yes” if the organization notified the supported organization named in column (i) of its support.
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Column (vi). Only Type III organizations are required to answer this question. Check “Yes” if the supported organization named in column (i) is organized in the United States.
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Column (vii). Enter the total amount of monetary support paid to, or for the benefit of, the supported organization named in column (i) during the tax year. Such monetary support may include making payments to or for the use of individual members of the charitable class benefited by the supported organization, and to 501(c)(3) public charities operated, supervised, or controlled directly by or in connection with the supported organization. See Regulations 1.509(a)-4(e). If no monetary support was provided during the tax year, enter “-0-.” Do not report non-monetary support in column (vii). Describe in Part IV any services, facilities, or goods that the organization provided to or purchased for the benefit of the supported organization during the tax year.


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331/3% or more of its total support must come from governmental agencies, contributions from the general public, and contributions or grants from other public charities, or
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10% or more of its total support must come from governmental agencies, contributions from the general public, and contributions or grants from other public charities and the facts and circumstances indicate it is a publicly supported organization.
Note.
An organization will not meet either of these public support tests if almost all of its support comes from gross receipts from related activities and an insignificant amount of its support comes from governmental units and contributions made directly or indirectly by the general public.
Use any reasonable method to determine the value of noncash contributions reported on line 1.
Do not report any donations of services (such as the value of donated advertising space or broadcast air time) or donations of use of materials, equipment, or facilities, on line 1 as gifts, grants, or contributions. Donated services and facilities from a governmental unit are reported on line 3.
If an organization records a loss on an uncollectible pledge that it reported on a prior year's Schedule A, it should deduct that loss from the contribution amount for the year in which it originally counted that contribution as revenue. For example, if the organization reported a pledged contribution of $50,000 during tax year 2010 but learned during tax year 2012 that it would not receive $20,000 of that pledged contribution, it should deduct $20,000 from the amount reported in Part II, line 1, column (c) for tax year 2010.
Include on line 1 support received from a governmental unit. This includes contributions, but not gross receipts from exercising or performing the organization's tax-exempt purpose or function, which should be reported on line 12. An amount received from a governmental unit is treated as gross receipts from exercising or performing the organization's tax-exempt purpose or function if the purpose of the payment is primarily to serve the direct and immediate needs of the payor governmental unit, and is treated as a contribution, if the purpose is primarily to provide a direct benefit to the public. For example, a payment to maintain library facilities that are open to the public should be treated as a contribution. See Regulations section 1.170A-9(f)(8) and Rev. Rul. 81-276, 1981-2 C.B. 128. Refer to the instructions for Form 990, Part VIII, lines 1e and 2 for more examples addressing the distinction between government payments that are contributions and government payments that are gross receipts from activities related to the organization's tax-exempt purpose or function. Medicare and Medicaid payments are treated as gross receipts from patients rather than as contributions from the government payor for purposes of the public support test. See Rev. Rul. 83-153, 1983-2 C.B. 48.
An organization that received any unusual grants during the 5-year period should keep for its records a list showing, for each year, the name of the contributor, the date and amount of the grant, and a brief description of the grant. If the organization used the cash method for the applicable year, show only the amounts the organization actually received during that year. If the organization used the accrual method for the applicable year, show only the amounts the organization accrued for that year. An example of this list is given below.

Line 1. Example
| Year ▶ 2012 | Description |
| Name ▶ Mr. Distinguished Donor | Undeveloped land |
| Date of Grant ▶ January 15, 2012 | |
| Amount of Grant ▶ $60,000 |
Include in Part IV a list showing the amount of each unusual grant actually received each year (if the cash accounting method is used), or accrued each year (if the accrual accounting method is used).

Unusual grants generally are substantial contributions and bequests from disinterested persons and are:
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Attracted because of the organization's publicly supported nature,
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Unusual and unexpected because of the amount, and
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Large enough to endanger the organization's status as normally meeting either the 331/3% public support test or the 10% facts and circumstances test.
For a list of other factors to be considered in determining whether a grant is an unusual grant, see Regulations section 1.509(a)-3(c)(4).
An unusual grant is excluded even if the organization receives or accrues the funds over a period of years.
Do not report gross investment income items as unusual grants. Instead, include all investment income on line 8.
See Rev. Rul. 76-440, 1976-2 C.B. 58; Regulations section 1.170A-9(f)(6)(ii); and Regulations sections 1.509(a)-3(c)(3) and (4) for details about unusual grants.
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Churches described in section 170(b)(1)(A)(i);
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Educational institutions described in section 170(b)(1)(A)(ii);
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Hospitals described in section 170(b)(1)(A)(iii); and
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Organizations operated for the benefit of a college or university owned or operated by a governmental unit described in section 170(b)(1)(A)(iv).

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A trade or business in which substantially all work is performed by volunteers (such as book fairs and sales of gift wrap paper). See section 513(a)(1).
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A trade or business carried on by the organization primarily for the convenience of its members, students, patients, officers, or employees. See section 513(a)(2).
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A trade or business which is the selling of merchandise, substantially all of which the organization received as gifts or contributions. See section 513(a)(3).
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“Qualified public entertainment activities” or “qualified convention and trade show activities” of certain organizations. See section 513(d).
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Furnishing certain hospital services. See section 513(e).
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A trade or business consisting of conducting bingo games, but only if the conduct of such games is lawful. See section 513(f).
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Qualified pole rentals by a mutual or cooperative telephone or electric company. See section 513(g).
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The distribution of certain low cost articles and exchange and rental of members lists. See section 513(h).
Example.
An organization receives an exemption letter from the IRS that it is exempt from tax under section 501(c)(3) and qualifies as a public charity under section 170(b)(1)(A)(vi) effective March 25, 2012, its date of incorporation. The organization uses a calendar year accounting period. When the organization prepares Part II for 2012 through 2016, it should check the box on line 13 and should not complete the rest of Part II. When the organization prepares Part II for 2017 and subsequent years, it should not check the box on line 13 and should complete the rest of Part II.

| Assumption: 2% of the amount on Schedule A (Form 990 or 990-EZ), Part II, line 11, column (f) is $12,000 | |||||||
| Contributors whose total gifts from 2008 through 2012 were in excess of the 2% limitation | |||||||
| (a) | (b) | (c) | (d) | (e) | (f) | (g) | |
| Name | 2008 | 2009 | 2010 | 2011 | 2012 | Total | Excess contributions (col. (f) minus the 2% limitation) |
| XYZ Foundation | $59,000 | $3,000 | $18,000 | $80,000 | $68,000 | ||
| Banana Office Supply | $12,000 | 3,000 | 1,000 | 16,000 | 4,000 | ||
| Plum Corporation | 15,000 | 15,000 | 30,000 | 18,000 | |||
| John Smith | 5,000 | $5,000 | 5,000 | 1,000 | 16,000 | 4,000 | |
| Sue Adams | 10,000 | 10,000 | 10,000 | 30,000 | 18,000 | ||
| Raisin Trade Assoc. | 20,000 | 7,000 | 27,000 | 15,000 | |||
| Total. Add the items in column (g). Enter the total here and on Part II, column (f), line 5 | $127,000 | ||||||
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Explain whether the organization maintains a continuous and bona fide program for solicitation of funds from the general public, community, membership group involved, governmental units or other public charities.
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List all other facts and circumstances, including the sources of support, whether the organization has a governing body which represents the broad interests of the public, and whether the organization generally provides facilities or services directly for the benefit of the general public on a continuing basis.
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If the organization is a membership organization, explain whether the solicitation for dues-paying members is designed to enroll a substantial number of persons from the community, whether dues for individual members have been fixed at rates designed to make membership available to a broad cross-section of the interested public, and whether the activities of the organization will likely appeal to persons having some broad common interest or purpose.
Note.
The alternative test for organizations experiencing substantial and material changes in its sources of support, other than from unusual grants, has been eliminated.




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More than 331/3% of its support must come from contributions, membership fees, and gross receipts from activities related to its exempt functions or from amounts which are not unrelated trades or businesses under section 513, and
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No more than 331/3% of its support must come from gross investment income and net unrelated business income (less section 511 tax) from businesses acquired by the organization after June 30, 1975.
Use any reasonable method to determine the value of noncash contributions reported on line 1.
Do not report any donations of services (such as the value of donated advertising space or broadcast air time) or donations of use of materials, equipment, or facilities, on line 1 as gifts, grants, or contributions. Donated services and facilities from a governmental unit are reported on line 5.
If an organization records a loss on an uncollectible pledge that it reported on a prior year's Schedule A, it should deduct that loss from the contribution amount for the year in which it originally counted that contribution as revenue. For example, if the organization reported a pledged contribution of $50,000 during tax year 2010 but learned during tax year 2012 that it would not receive $20,000 of that pledged contribution, it should deduct $20,000 from the amount reported in Part III, line 1, column (c) for tax year 2010.
Include on line 1 support received from a governmental unit. This includes contributions, but not gross receipts from exercising or performing the organization's tax-exempt purpose or function, which should be reported on line 2. Contributions are sometimes difficult to distinguish from such gross receipts—the label on the agreement is not controlling. An amount received from a governmental unit is treated as gross receipts from exercising or performing the organization's tax-exempt purpose or function if the purpose of the payment is primarily to serve the direct and immediate needs of the payor governmental unit, and is treated as a contribution if the purpose is primarily to provide a direct benefit to the public. For example, if a state government agency pays an organization to operate an institute to train agency employees in the principles of management and administration, the funds received should be included on line 2 as gross receipts. See Regulations section 1.509(a)-3(g). Refer to the instructions for Form 990, Part VIII, lines 1e and 2 for more examples addressing the distinction between government payments that are contributions and government payments that are gross receipts from activities related to the organization's tax-exempt purpose or function. Medicare and Medicaid payments are treated as gross receipts from patients rather than as contributions from the government payor for purposes of the public support test. See Rev. Rul. 83-153, 1983-2 C.B. 48.
An organization that received any unusual grants during the 5-year period, should keep for its records a list showing, for each year, the name of the contributor, the date and amount of the grant, and a brief description of the grant. If the organization used the cash method for the applicable year, show only amounts the organization actually received during that year. If the organization used the accrual method for the applicable year, show only amounts the organization accrued for that year. An example of this list is given below.

Line 1. Example
| Year ▶ 2012 | Description |
| Name ▶ Mr. Distinguished Donor | Undeveloped land |
| Date of Grant ▶ January 15, 2012 | |
| Amount of Grant ▶ $60,000 |
Include in Part IV a schedule showing the amount of each unusual grant actually received each year (if the cash accounting method is used), or accrued each year (if the accrual accounting method is used).

Unusual grants generally are substantial contributions and bequests from disinterested persons and are:
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Attracted because of the organization's publicly supported nature,
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Unusual and unexpected because of the amount, and
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Large enough to endanger the organization's status as normally meeting the 331/3% public support test.
For a list of other factors to be considered in determining whether a grant is an unusual grant, see Regulations section 1.509(a)-3(c)(4).
An unusual grant is excluded even if the organization receives or accrues the funds over a period of years.
Do not report gross investment income items as unusual grants. Instead, include all investment income on line 10a.
See Rev. Rul. 76-440, 1976-2 C.B. 58; Regulations section 1.170A-9(f)(6)(ii); and Regulations sections 1.509(a)-3(c)(3) and 1.509(a)-3(c)(4) for details about unusual grants.
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A trade or business in which substantially all work is performed by volunteers (such as book fairs and sales of gift wrap paper). See section 513(a)(1).
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A trade or business carried on by the organization primarily for the convenience of its members, students, patients, officers, or employees. See section 513(a)(2).
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A trade or business which is the selling of merchandise, substantially all of which the organization received as gifts or contributions. See section 513(a)(3).
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“Qualified public entertainment activities” or “qualified convention and trade show activities” of certain organizations. See section 513(d).
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Furnishing certain hospital services. See section 513(e).
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A trade or business consisting of conducting bingo games, but only if the conduct of such games is lawful. See section 513(f).
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Qualified pole rentals by a mutual or cooperative telephone or electric company. See section 513(g).
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The distribution of certain low cost articles and exchange and rental of members lists. See section 513(h).
| Disqualified Person | (a) 2008 | (b) 2009 | (c) 2010 | (d) 2011 | (e) 2012 | (f) Total |
|---|---|---|---|---|---|---|
| David Smith | $7,000 | $6,000 | $2,000 | $15,000 | ||
| Anne Parker | $5,000 | $7,000 | 4,000 | 16,000 | ||
| Total | $7,000 | $6,000 | $5,000 | $7,000 | $6,000 | $31,000 |


Example.
An organization receives an exemption letter from the IRS that it is exempt from tax under section 501(c)(3) and qualifies as a public charity under section 509(a)(2) effective March 25, 2012, its date of incorporation. The organization uses a calendar year accounting period. When the organization prepares Part III for 2012 through 2016, it should check the box on line 14 and should not complete the rest of Part III. When the organization prepares Part III for 2017 and subsequent years, it should not check the box on line 14 and should complete the rest of Part III.

Note.
The alternative test for organizations experiencing substantial and material changes in its sources of support, other than from unusual grants, has been eliminated.


Use Part IV to provide the narrative explanations required, if applicable, by Part II, line 10, Part II, line 17a or 17b, and Part III, line 12. Also use Part IV to provide other narrative information required by these instructions or to supplement responses to questions on Schedule A (Form 990 or 990-EZ). Identify the specific part and line number that the response supports, in the order in which they appear on Schedule A (Form 990 or 990-EZ). Part IV can be duplicated if more space is needed.

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