ORIX USA EMPLOYEE MATCHING GIFTS PROGRAM (page 1)

ORIX Foundation (the "Foundation") is an Internal Revenue Code Section 501(c)(3) public charity. The primary programs of the Foundation are (i) the Charitable Giving Program, through which the Foundation directly gives to partner charities and other charities consistent with the Foundation's mission statement, and (ii) the Employee Matching Program, through which the Foundation matches funds raised for, or donated to, certain charities by ORIX USA employees. The Foundation is proud that its Employee Matching Program has steadily grown, with more ORIX USA employees getting involved each year. In October 2009, the Foundation kicked off its first holiday charity campaign, benefiting the North Texas Food Bank. Through events like this, as well as involvement with partner charities, the Foundation hopes to continue to foster a charitable giving environment among ORIX USA employees, their families and the local communities where they live and work.
For employees who want to make a donation and have their contribution eligible for a charitable contribution deduction and employer match, employees must make checks payable to ORIX Foundation, which may be used as discretionary funding for ORIX Foundation in support of its partner charities, or designated to a specific charity of the employee's choosing. In addition, ORIX USA is making available an option for automatic payroll deduction. This option would constitute an after-tax deduction from an employee's salary and the employee's contribution would be eligible for a charitable contribution deduction and employer match as well. Participation in any of these options is not mandatory and is completely at the discretion of the employee. 		WHO CAN PARTICIPATE: Any person employed by ORIX USA for at least 6 months. HOW THE PROGRAM WORKS:
1. Complete both PART A (Donor Information) and PART B (Recipient Information) on page 2 of this document
2. Supply any requested supporting documentation.
3. Return all information to the attention of:

Lore Everingham
Marketing Coordinator, HR Corp Services
ORIX USA
1717 Main Street
Suite 900
Dallas, TX 75201

You may also fax your request to 214-237-2043
PROGRAM PROVISIONS: ORIX Foundation will match employee gifts ranging from a minimum of $25 to a maximum of $5,000 per fiscal year on a one-to-one basis. To be eligible under the terms of this program, an organization must be a 501(c)(3) tax-exempt entity as defined by the Internal Revenue Service in section 170 (b)(1)(A) of the tax code (http://www.irs.gov/app/pub-78). Additionally, donations raised for a qualified charity by an ORIX USA employee in connection with runs or other sporting events in which the employee is participating are eligible for a one to one match. This match is independent from, and in addition to matches of the direct dollar donation by an employee.
CONTRIBUTION ELIGIBILITY: A gift must be an actual contribution made, not pledged (payroll deductions will be distributed on a quarterly basis). Gifts must be in the form of payroll deduction or check made payable to ORIX Foundation. Match is limited to the portion of the donor's gift that is tax deductible.
INELIGIBLE CONTRIBUTIONS:
  • Gifts made in lieu of tuition payment
  • Gifts to other Community Trusts, Foundations, United Way Federations, or other pass-through entities *
  • Gifts that provide a direct benefit to the donor, their family, or any other individual
  • Subscription fees for publications
  • Partisan political organizations or campaign contributions
  • Sectarian organizations whose services are limited to one religious group or include a missionary purpose
  • Trips or tours
* EXCEPTION: Contributions made to these organizations for the purpose of funding disaster relief efforts


ORIX USA EMPLOYEE MATCHING GIFTS PROGRAM (page 2)

PART A: DONOR INFORMATION (please check the appropriate box)

WAYS TO CONTRIBUTE:

Payroll deduction:        

Effective with the next available pay period, deduct
$ __________.00 per pay period

Effective with the next available pay period, deduct a one-time amount of
$ ____________.00 from my regular pay

YOU MAY ONLY DESIGNATE ONE QUALIFIED CHARITY WHEN USING THE PAYROLL DEDUCTION OPTION

Check:        

I am enclosing a check payable to the ORIX Foundation
for $ __________.00

Credit Card:        

Please visit www.orixfoundation.org and click the "How to Give" link to make a donation. You may either designate your gift to the ORIX Foundation or another qualified charity when using this option.

Other:        

If you previously made a gift directly to the charity of your choice and are seeking a matching contribution of that gift, please check this box and see NOTE #3 on the lower right side of this page.

Employee Name:
___________________________________________________________________________
Home Address:
___________________________________________________________________________
___________________________________________________________________________
___________________________________________________________________________

Work Phone:
___________________________________________________________________________

BENEFICIARY: ORIX Foundation;                    

Other qualified charity                                    

                                    Or
           Direct a portion of your gift to ORIX Foundation as well as to another charity:
ORIX Foundation _______% Other charity ________%
_______________________________________
Date of gift

NOTE: If you would like to designate multiple outside charities, please complete both parts of this form for each qualified charity. Also, if you choose at any time to opt out of payroll deduction, please contact Shvon Evans at 214-237-2238 for assistance. 		PART B: RECIPIENT INFORMATION

FOR ANY PORTION OF YOUR GIFT INTENDED TO BENEFIT A CHARITY OTHER THAN THE ORIX FOUNDATION, PLEASE PROVIDE THE FOLLOWING:


CHARITY _____________________________________________________________

PHONE ______________________________________________________________

ADDRESS
_____________________________________________________________________

_____________________________________________________________________

_____________________________________________________________________

Verification of charity's tax exempt status:

Please contact your designated charity to request a copy of their W9 or 501 (c)(3) letter, and submit with this completed form.


Donor Recognition:

Please elect below whether or not you would like your personal information released to the outside recipient organization. If you choose not to make a selection, only your name will be released, and the charity will not be able to send you an acknowledgement of your gift.


______ Release my name and home address

______ Release my name only

______ I wish to remain anonymous

___________________________________________
Employee Signature

NOTE #1: In addition to the above information, if the funds you are seeking to be matched are connected with a run or other charity event where pledges were collected, please provide a confirmation of receipt from the charity indicating the total amount you raised.

NOTE #2: In addition to the above information, if the donation you would like matched will benefit an educational institution, please have that institution complete the required "Educational Institutional Letter".

NOTE #3: In addition to the above information, we will match an employee's gift to a nonprofit that was directly paid by personal credit card, if the employee provides proof of receipt of that gift from the charity.

NOTE #4: All matching requests must be submitted within the same fiscal year that the original contribution was made.