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Form 990sd: Supplemental Financial Statements

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Supplemental Financial Statements
Part I Organizations Maintaining Donor Advised Funds or Other Similar Funds or Accounts.
Complete if the organization answered “Yes” on Form 990, Part IV, line 6.
(a) Donor advised funds(b) Funds and other accounts
1
2
3
4
5 Yes   No
6 Yes   No
Part II Conservation Easements.
Complete if the organization answered “Yes” on Form 990, Part IV, line 7.
1Purpose(s) of conservation easements held by the organization (check all that apply).


2Complete lines 2a through 2d if the organization held a qualified conservation contribution in the form of a conservation easement on the last day of the tax year.Held at the End of the Tax Year
a2a
b2b
c2c
d2d
3
4
5 Yes   No
6
7 ▸ $
8 Yes   No
9In Part XIII, describe how the organization reports conservation easements in its revenue and expense statement, and balance sheet, and include, if applicable, the text of the footnote to the organization’s financial statements that describes the organization’s accounting for conservation easements.
Part III Organizations Maintaining Collections of Art, Historical Treasures, or Other Similar Assets.
Complete if the organization answered “Yes” on Form 990, Part IV, line 8.
1aIf the organization elected, as permitted under SFAS 116 (ASC 958), not to report in its revenue statement and balance sheet works of art, historical treasures, or other similar assets held for public exhibition, education, or research in furtherance of public service, provide, in Part XIII, the text of the footnote to its financial statements that describes these items.
bIf the organization elected, as permitted under SFAS 116 (ASC 958), to report in its revenue statement and balance sheet works of art, historical treasures, or other similar assets held for public exhibition, education, or research in furtherance of public service, provide the following amounts relating to these items:
(i)
(ii)
2If the organization received or held works of art, historical treasures, or other similar assets for financial gain, provide the following amounts required to be reported under SFAS 116 (ASC 958) relating to these items:
a
b
3Using the organization’s acquisition, accession, and other records, check any of the following that are a significant use of its collection items (check all that apply):
a d
b e
c
4Provide a description of the organization’s collections and explain how they further the organization’s exempt purpose in Part XIII.
5 Yes   No
Part IV Escrow and Custodial Arrangements.
Complete if the organization answered “Yes” on Form 990, Part IV, line 9, or reported an amount on Form 990, Part X, line 21.
1a Yes   No
b If “Yes,” explain the arrangement in Part XIII and complete the following table:Amount
c1c
d1d
e1e
f1f
2a Yes   No
b
Part V Endowment Funds.
Complete if the organization answered “Yes” on Form 990, Part IV, line 10.
(a) Current year(b) Prior year(c) Two years back(d) Three years back(e) Four years back
1a
b
c
d
e
f
g
2Provide the estimated percentage of the current year end balance (line 1g, column (a)) held as:
a %
b %
c %
The percentages on lines 2a, 2b, and 2c should equal 100%.
3aAre there endowment funds not in the possession of the organization that are held and administered for the organization by:YesNo
(i)3a(i)
(ii)3a(ii)
b3b
4Describe in Part XIII the intended uses of the organization’s endowment funds.
Part VI Land, Buildings, and Equipment.
Complete if the organization answered “Yes” on Form 990, Part IV, line 11a. See Form 990, Part X, line 10.
Description of property(a) Cost or other basis (investment)(b) Cost or other basis (other)(c) Accumulated depreciation(d) Book value
1a
b
c
d
e
Part VII Investments—Other Securities.
Complete if the organization answered “Yes” on Form 990, Part IV, line 11b. See Form 990, Part X, line 12.
(a) Description of security or category
(including name of security)
(b) Book value(c) Method of valuation:
Cost or end-of-year market value
(1)
(2)
(3)
(A)
(B)
(C)
(D)
(E)
(F)
(G)
(H)
Part VIII Investments—Program Related.
Complete if the organization answered “Yes” on Form 990, Part IV, line 11c. See Form 990, Part X, line 13.
(a) Description of investment(b) Book value(c) Method of valuation:
Cost or end-of-year market value
(1)
(2)
(3)
(4)
(5)
(6)
(7)
(8)
(9)
Part IX Other Assets.
Complete if the organization answered “Yes” on Form 990, Part IV, line 11d. See Form 990, Part X, line 15.
(a) Description(b) Book value
(1)
(2)
(3)
(4)
(5)
(6)
(7)
(8)
(9)
Part X Other Liabilities.
Complete if the organization answered “Yes” on Form 990, Part IV, line 11e or 11f. See Form 990, Part X, line 25.
1   (a) Description of liability(b) Book value
(1)Federal income taxes
(2)
(3)
(4)
(5)
(6)
(7)
(8)
(9)
Part XI Reconciliation of Revenue per Audited Financial Statements With Revenue per Return.
Complete if the organization answered “Yes” on Form 990, Part IV, line 12a.
11
2Amounts included on line 1 but not on Form 990, Part VIII, line 12:
a2a
b2b
c2c
d2d
e2e
33
4Amounts included on Form 990, Part VIII, line 12, but not on line 1:
a4a
b4b
c4c
55
Part XII Reconciliation of Expenses per Audited Financial Statements With Expenses per Return.
Complete if the organization answered “Yes” on Form 990, Part IV, line 12a.
11
2Amounts included on line 1 but not on Form 990, Part IX, line 25:
a2a
b2b
c2c
d2d
e2e
33
4Amounts included on Form 990, Part IX, line 25, but not on line 1:
a4a
b4b
c4c
55
Part XIII Supplemental Information.
Provide the descriptions required for Part II, lines 3, 5, and 9; Part III, lines 1a and 4; Part IV, lines 1b and 2b; Part V, line 4; Part X, line 2; Part XI, lines 2d and 4b; and Part XII, lines 2d and 4b. Also complete this part to provide any additional information.

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