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Form 990sa: Public Charity Status and Public Support

Use Tax Form 990sa: Public Charity Status and Public Support as a stand alone tax form calculator to quickly calculate specific amounts for your 2017 tax return. Form 990sa: Public Charity Status and Public Support is also integrated into our comprehensive US Tax Calculator where you can complete and save your calculations for later use. Alternatively you can use one of our Combined Federal and State Tax Estimator to quickly calculate your salary, tax and take home pay.

Public Charity Status and Public Support
Part I Reason for Public Charity Status (All organizations must complete this part.) See instructions.
The organization is not a private foundation because it is: (For lines 1 through 12, check only one box.)
1
2
3
4
5
6
7
8
9
10
11
12
a
b
c
d
e
f
gProvide the following information about the supported organization(s).
Name of supported organization EIN Type of organization (described on lines 1–10 above (see instructions))(iv) Is the organization listed in your governing document? Amount of monetary support (see instructions) Amount of other support (see instructions)
(A)
(B)
(C)
(D)
(E)
Total
Part II Support Schedule for Organizations Described in Sections 170(b)(1)(A)(iv) and 170(b)(1)(A)(vi) (Complete only if you checked the box on line 5, 7, or 8 of Part I or if the organization failed to qualify under Part III. If the organization fails to qualify under the tests listed below, please complete Part III.)
Section A. Public Support
Calendar year (or fiscal year beginning in) ▸
1
2
3
4
5
6
Section B. Total Support
Calendar year (or fiscal year beginning in) ▸
7
8
9
10
11
1212
13
1414 %
1515 %
16a
b
17a
b
18
Part III Support Schedule for Organizations Described in Section 509(a)(2) (Complete only if you checked the box on line 10 of Part I or if the organization failed to qualify under Part II. If the organization fails to qualify under the tests listed below, please complete Part II.)
Section A. Public Support
Calendar year (or fiscal year beginning in) ▸
1
2
3
4
5
6
7a
b
c
8
Section B. Total Support
Calendar year (or fiscal year beginning in) ▸
9
10a
b
c
11
12
13
14
Section C. Computation of Public Support Percentage
1515 %
1616 %
Section D. Computation of Investment Income Percentage
1717 %
1818 %
19a
b
20
Part IV Supporting Organizations (Complete only if you checked a box in line 12 on Part I. If you checked 12a of Part I, complete Sections A and B. If you checked 12b of Part I, complete Sections A and C. If you checked 12c of Part I, complete Sections A, D, and E. If you checked 12d of Part I, complete Sections A and D, and complete Part V.)
Section A. All Supporting Organizations
11
22
3a3a
b3b
c3c
4a4a
b4b
c4c
5a5a
b5b
c5c
66
77
88
9a9a
b9b
c9c
10a10a
b10b
11Has the organization accepted a gift or contribution from any of the following persons?
a11a
b11b
c11c
Section B. Type I Supporting Organizations
11
22
Section C. Type II Supporting Organizations
11
Section D. All Type III Supporting Organizations
11
22
33
Section E. Type III Functionally Integrated Supporting Organizations
1Check the box next to the method that the organization used to satisfy the Integral Part Test during the year (see instructions).
a
b
c
2Activities Test. Answer (a) and (b) below.
a2a
b2b
3Activities Test. Answer (a) and (b) below.
a3a
b3b
Part V Type III Non-Functionally Integrated 509(a)(3) Supporting Organizations
1
Section A - Adjusted Net Income(A) Prior Year(B) Current Year (optional
11
22
33
44
55
66
77
88
Section B - Minimum Asset Amount(A) Prior Year(B) Current Year (optional
1Aggregate fair market value of all non-exempt-use assets (see instructions for short tax year or assets held for part of year):
a1a
b1b
c1c
d1d
eDiscount claimed for blockage or other factors (explain in detail in Part VI):
22
33
44
55
66
77
88
Section C - Distributable AmountCurrent Year
11
22
33
44
55
66
7
Section D - DistributionsCurrent Year
1
2
3
4
5
6
7
8
9
10
1
2
3Excess distributions carryover, if any, to 2016:
a
b
c
d
e
f
g
h
iCarryover from 2011 not applied (see instructions)
j
4 $
a
b
c
5
6
7
8Breakdown of line 7:
a
b
c
d
e
Part VI Supplemental Information. Provide the explanations required by Part II, line 10; Part II, line 17a or 17b; Part III, line 12; Part IV, Section A, lines 1, 2, 3b, 3c, 4b, 4c, 5a, 6, 9a, 9b, 9c, 11a, 11b, and 11c; Part IV, Section B, lines 1 and 2; Part IV, Section C, line 1; Part IV, Section D, lines 2 and 3; Part IV, Section E, lines 1c, 2a, 2b, 3a, and 3b; Part V, line 1; Part V, Section B, line 1e; Part V, Section D, lines 5, 6, and 8; and Part V, Section E, lines 2, 5, and 6. Also complete this part for any additional information. (See instructions.)

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