4501 Employee Matching Gifts Form
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U.S. Bancorp Foundation
EMPLOYEE MATCHING GIFT
PROGRAM GUIDELINES
U.S. Bancorp employees everywhere Matching gift requests must be – gifts that fulfill a prior obligation
are contributing to our communities with received within one year of the gift – items purchased at or donated to a
service, leadership — and through date. Requests received after that will silent auction, raffle or other
charitable contributions. These not be honored. fundraising event
partnerships help make better places for
• Gifts to United Way or other
everyone to live, work, and grow. With EMPLOYEE ELIGIBILITY
campaigns in which workplace
the Employee Matching Gift Program, All regular full-time and part-time solicitations are permitted and
the U.S. Bancorp Foundation supports employees of U.S. Bancorp who have supported by the Company, payroll
employees in their efforts to improve the been employed for at least one year deduction is permitted and the
community. are eligible to apply. Foundation also contributes directly
MATCHING GIFT ALLOTMENT to the campaign
ORGANIZATION ELIGIBILITY
Employee Gift Matching: The • Gifts for political concerns or to
Community Organizations organizations whose stated purpose
U.S. Bancorp Foundation will match
The U.S. Bancorp Foundation will includes lobbying, political activity,
an employee’s personal charitable
match fully tax-deductible gifts to litigation, or advocacy
contributions of cash (including check
organizations that are tax-exempt public
or credit card payments) or stock in the • Gifts to units of government (except
charities pursuant to IRS section
amount of $50 or more. The maximum public schools)
501(c)(3) located in the United States.
aggregate match per employee is
Eligible organizations include the areas • Gifts to organizations whose primary
$1,000 per calendar year.
of: health and human services; arts and purpose is religious, unless the
Nonprofit Board Members: culture; environment; museums; public organization is nondenominational in
An employee who serves on the radio and television; zoos; food banks; nature and benefits a broad range of
governing board of an eligible 501(c)(3) and youth development programs. the community (such as a soup
nonprofit may apply for an additional kitchen or homeless shelter)
contribution amount matching his or her Schools and Colleges
personal charitable cash contribution to The Foundation will match fully tax- • Gifts from donor-advised funds
that organization, up to an additional deductible gifts to an accredited
• Gifts to private foundations
$2,000 per calendar year. The maximum public or private K-12 school, college
aggregate match for employees on (including junior college) or university • Gifts to individuals or designated for
nonprofit boards is $3,000 per calendar that is tax-exempt pursuant to IRS the benefit of specific individuals
year. section 501(c)(3) and located in the
United States. • Gifts to organizations whose activities
represent a conflict of interest
TWO WAYS TO APPLY Ineligible Gifts and Organizations • Gifts to any organization whose
Quick and Easy Online Process: U.S. Bancorp Foundation will not practices are not in keeping with the
• Employees may request a matching gift match the following: corporation’s equal opportunity or
online at the U.S. Bancorp Foundation • Gifts that result in the employee or a diversity policies
Employee Matching Gift Program web member of his or her family receiving
site: www.easymatch.com/usbank. a material benefit from the • “Pooled” gifts, in which a number of
or organization. Examples of these employees or individuals combine
Paper-Form Process: benefits include: gifts to form a “group donation” to
a nonprofit organization. Each
• Employees complete the Employee – tuition relief employee contributing to the
Application section of the attached – study, research or travel organization must complete his or
form, sign it, and mail it to the reimbursement her own matching gift form
nonprofit organization.
– extracurricular expense
• The organization then completes and The U.S. Bancorp Foundation reserves
reimbursement
signs the Gift Verification section the right to alter, suspend, or terminate
– dues for alumni, athletic or any the program and to determine the
and mails the entire form to the
other organizations or associations eligibility of organizations to receive
U.S. Bancorp Foundation Employee
Matching Gift Program. – event admissions, tickets, or funds.
registration fees, including any fees
Eligible requests are processed on for participation in a charity event
the following quarterly schedule: For more information, please visit
– admissions to dinners, lunches,
the program website at
Received by: 3/1 6/1 9/1 12/1 or other gatherings
www.easymatch.com/usbank
Processed by: 3/31 6/30 9/30 12/31 – preferential seating, parking, etc. or call 1-866-243-6925.
U.S. Bancorp Foundation
EMPLOYEE MATCHING GIFT FORM
EMPLOYEE APPLICATION NONPROFIT GIFT VERIFICATION
Please complete this column and Please complete this column and return to the
mail this form to the nonprofit organization. U.S. Bancorp Foundation Employee Matching Gift Program.
Please provide all requested information and sign the form. I certify that the nonprofit organization named below has
Incomplete forms will be returned to you. received a fully tax-deductible personal charitable contribution
from:
Employee Name ________________________________________________ ______________________________________________________
(U.S. Bancorp Employee)
6-Digit Employee ID ____________________________________________
of $ _______________ (cash or fair market value of stock gift)
Mail Code ________________________________________________________
on ____ /_____ /_____ (date gift received).
Daytime Phone __________________________________________________
Is this donor an active member of your governing board?
Email Address __________________________________________________
_______Yes ______No
Hire Date ________________________________________________________
If yes, enter the start date of board service _______ /________
(month) (year)
I am applying for the following matching gift to:
I further certify that this gift does not entitle the employee
Organization Name __________________________________________ or a member of his or her family to any material benefit
Organization City, State ____________________________________ from our organization.
Restriction/Purpose (if any) __________________________________ This institution is recognized by the U.S. Treasury Department
as one to which contributions are deductible by the donor for
Gift Type: Ë Cash/Check/Credit Card Ë Stock federal income tax purposes.
__________________________________________________ _______Yes ______No
If Securities, Number of Shares and Name of Security
Select and check one of the following options: REQUIRED: Attach a copy of your 501(c)(3) status letter
from the IRS.
K Employee Matching Gift
I have paid or am enclosing a fully tax-deductible personal ___________________________________________________________________
charitable contribution of $___________ (cash or stock value) Organization
to the organization named above and request the U.S. Bancorp ___________________________________________________________________
Foundation to match $___________ of this contribution Federal Tax ID (EIN)
(minimum: $50 per donation, limit: $1,000 per calendar year). ___________________________________________________________________
or Address
K Nonprofit Board Member (if applicable) ___________________________________________________________________
I am an active, participating member of the governing board of City, State, Zip
the nonprofit organization named above. I have paid or am
___________________________________________________________________
enclosing a fully tax-deductible personal charitable contribution Telephone
of $___________ (cash or stock value) to this organization and
request the U.S. Bancorp Foundation to match $___________ ___________________________________________________________________
of this contribution (limit: $3,000 per calendar year). Fax
___________________________________________________________________
I certify that I have read the program guidelines and have Website Address
made an eligible gift. ___________________________________________________________________
Name (please print)
I authorize the above-named recipient organization to report
this gift to U.S. Bancorp for the purpose of applying for a ___________________________________________________________________
matching gift. Email Address
Signature ________________________________________________________ ___________________________________________________________________
Signature
Date ______________________________________________________________ Please return this entire form to:
Employees: Mail this form to the recipient nonprofit U.S. Bancorp Foundation
Employee Matching Gift Program
organization to complete the Nonprofit Gift Verification section.
P.O. Box 8857 • Princeton, NJ 08543-8857
Forms received by the U.S. Bancorp Foundation Employee
Matching Gift Program after December 1 will be paid the If you have questions about this program or application,
following year. please call 1-866-243-6925. 4501A (9/09)
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