04/06
Who is Eligible
• Full or part-time (at least 20 hours/week) employees with twelve consecutive
months of service at American Express Company or one of its business units
and who participate in a standard American Express benefit package.
• Retirees who were age 55 years or older with ten years or more of service with
American Express at retirement.
• Current non-employee directors of American Express Company.
What is Eligible
Nonprofit organizations that are certified as tax-exempt by the U.S. Internal
Revenue Service under Section 501(c)(3) and 509(a)(1, 2 or 3)
of the Internal
Revenue Code.
Eligible organizations and contributions include:
• Public and private colleges, universities, junior colleges, secondary and
elementary schools. Nursery schools and kindergartens if they are part of a
qualified elementary school. Alumni associations must have a 501(c)(3) and
509(a)(1, 2 or 3) letter separate from the school.
• Scholarship funds, public radio and TV stations.
• Environmental, child care, literacy, AIDS and drug prevention programs;
hospitals and health care organizations; museums, libraries, performing and
visual arts organizations, botanical, historical, zoological and literary
societies.
• Contributions out of a charitable gift, donor advised, community foundation
or family fund to an eligible nonprofit distributed from an established fund
set up by the employee in his or her name.
• Ongoing and independently run programs affiliated with religious
organizations if the gift is restricted to a nonsectarian project that provides
needed social services to the community at large on a nondiscriminatory
basis without any religious teaching, directive or requirements to
receive services (e.g., a soup kitchen, a homeless shelter, a food bank, etc.).
What is Not Eligible
• Contributions from spouses, consultants, interns and temporary employees.
• Contributions which result in you or a family member receiving a benefit
(e.g., boosters, auction items, dinner, raffle and/or sporting event tickets,
dinner/journal ads, sponsorships, golf tour
naments (including
par
ticipation), parking privileges, memberships, tuition, etc.).
•
Gifts to houses of worship (e.g., chur
ches, synagogues, etc.).
• Contributions to religious programs or organizations whose principal purpose
is pr
opagating a par
ticular r
eligious faith, cr
eed or doctrine (e.g., ministries,
missions, church planting projects, religious orders, etc.).
•
Dues and subscription fees.
•
Gifts to frater
nities, sor
orities, their af
filiated foundations, political
organizations and individuals.
•
Grouped and pooled donations (e.g., contributions made by a group of
employees or other persons, and claimed as one gift from a single eligible
donor).
•
Contributions ear
marked to an alr
eady established or to establish an
employee’s charitable gift, donor advised fund, community foundation or family
fund.
• Deferred gifts (e.g., annuities, charitable remainder trusts, etc.), bequests
and insurance pr
emiums that name the or
ganization as beneficiar
y
.
• Tuition fees, loan repayments and payments in lieu of tuition.
• Organizations, private foundations or programs that fund terrorist groups or
activities.
If you have any questions, contact the American Express Gift Matching Program toll-free at 888
-
297
-
6282.
H
ow to Contribute
• Contributions must be a personal donation (not made from a business account or
merely pledged) of at least $25, in check, credit/charge cards, money orders or
negotiable securities (securities will be valued at the average price on the gift date).
Any short- or long-term pledge made to a nonprofit should be paid by your personal
contribution only, and not include matching funds, e.g., a $2,000 pledge should not
include the $1,000 gift matching contribution.
• Employees must complete part A of the form and forward it, along with the
contribution, to the nonprofit organization.
• The nonprofit organization must complete part
B and return the form to the address
designated on the back. For contributions of $1,000 or more, the organization must
provide satisfactory substantiation of the gift: copy of check or money order,
credit/charge card receipt or evidence of securities transfer.
Forms must contain original signatures. Completed forms received from the nonprofit
organization will be batched and processed in the following estimated timeframe:
How the Match Works
The American Express Foundation will match up to a maximum of $8,000, per calendar year,
per employee, to any number of eligible organizations. Contributions made in a calendar
year will be applied toward your gift matching maximum for the same calendar year. Forms
must be submitted and received for matching within six months of the date of gift.
As part of the $8,000 match, to recognize employee volunteerism, the Foundation will
double match with a Volunteer/Board Service Match up to $1,000 annually of your
contributions if you currently serve on the board of directors or have volunteered 50 hours
or more during the past 12 months to the organization.
* The maximum combined Foundation match is $8,000 per calendar year, per employee.
For example: If you contribute $600 to an organization at which you volunteered
60 hours, the Foundation match will be $1,200; your remaining balance is $6,800. If you
then give $3,000 to an educational institution where you do not volunteer or are on the
board, the Foundation match will be $3,000, with a calendar year balance of $3,800.
The American Express Foundation, in its sole discretion, reserves the right to discontinue,
audit, amend or decide any questions of eligibility under the Gift Matching program. Its
decisions on these matters are final.
A N
ot
e t
o Emplo
yees
This pr
ogram is meant to encourage
personal contributions and
not
to suppor
t dir
ect
business development. Contributions made from a business account are considered
business contributions. Also, you cannot use this program to suppor
t sponsorship
commitments for golf tournaments, auctions or any other events or pr
ojects, nor can you
claim a business deduction for these contributions. It is important to make this distinction
because of IRS r
egulations.
In addition, or
ganizations will be sent and r
equir
ed to
complete an American Express compliance form. Failure to complete this form will
r
esult in declination of the match.
Abuse of this pr
ogram will r
esult in per
manent termination of your gift matching privileges
and may lead to other disciplinary action.
American Express
Gift Matching
Program
Min $25
Max $8,000*
(1:1)
If you serve as a board member or
have volunteered 50 hours or more
during the past 12 months, you can
choose to have your contributions
double matched. (2:1)
CONTRIBUTION COMPANY MATCH
Min $25 Matched min $50
Max $1,000 Matched max $2,000
RECEIVED BY
PROCESSED BY
2/28
3/31
5/31
6/30
8/31
9/30
11/30
12/31
04/06
NOTE: Please attach a copy of your IRS Federal Tax Exempt Letter and a brochure
describing your programs and mission. In addition, organizations will be sent and
r
equired to complete an AXP compliance form every 24 months. Failure to complete
this AXP compliance form will result
in declination of the match.
TAX-EXEMPT ORGANIZATION NAME: (
Required)
FEDERAL TAX I.D.
(
9-DIGIT EIN#
)
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STREET:
CITY, STATE, ZIP:
PHONE NUMBER: (
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E-MAIL ADDRESS:
WEB ADDRESS:
MONETARY CONTRIBUTION : *$
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*
If the gift is $1,000 or more, in order for this form to be processed you must provide
satisfactory substantiation: copy of check or money order, credit/charge card
receipt or evidence of securities transfer.
GIFT DATE: (mm/dd/yyyy)
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RESTRICTION OR GIFT DESIGNATION: (If Any)
TAX DEDUCTIBLE AMOUNT: (Required) $
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I hereby certify that:
• In the case where I have requested the Foundation to DOUBLE MATCH (Volunteer/Board
Service match) my contribution, I have served on the board of directors or volunteered
50 hours or mor
e during the past 12 months to this or
ganization.
• The above donation is entirely
my personal contribution, not made from a business
account or not in whole or in part the gift of another individual or the sum of the gifts
of other individuals.
• All information is accurate, contributions are
not in lieu of tuition, fees or other
personal obligations, and neither I nor a family member has received any personal
benefits in exchange
(e.g., boosters, auction items, dinner, raffle and/or sporting event
tickets, sponsorships, golf tournaments, parking privileges, memberships, etc.).
• To the best of my knowledge this nonprofit, its staff and its programs conform to the
eligibility guidelines of the American Express Gift Matching program and do not in any
way fund or assist terrorist gr
oups or activities.
I understand that abuse or failur
e to comply with any of the above may r
esult in
permanent termination of my gift matching privileges and may lead to other disciplinar
y
action.
SIGNATURE: DATE OF GIFT
(Required)
Please print or type. Failure to complete any part of this form will result in significant delays.
To Be Completed By Employee
Employees must complete part A only. Mail this form, together with your
contribution, to the nonprofit organization.
A
EMPLOYEE I.D. #
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LAST NAME:
FIRST NAME:
S
TREET ADDRESS:
CITY, STATE, ZIP:
PHONE NUMBER:
(
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E-MAIL ADDRESS:
DATE OF HIRE:
DIVISION NAME:
(
Check One)
STATUS: (
Check One)
q AXP BANK (AEB) q FULL-TIME
q CORPORATE HQ (CHQ) q PART-TIME (AT LEAST 20 HOURS/WK)
q TRAVEL RELATED SERVICES (TRS) q RETIREE
q OTHER: q NON-EMPLOYEE DIRECTOR OF AXP
WORK SITE:
(Check One)
q FT. LAUDERDALE q GREENSBORO q NEW YORK
q PHOENIX q SALT LAKE CITY
q OTHER:
TAX-EXEMPT ORGANIZATION NAME:
(Required)
RESTRICTION OR PURPOSE OF GIFT: (If any)
MONETARY CONTRIBUTION:
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PAYMENT METHOD FOR GIFT: q CHECK q CREDIT CARD q STOCK
# OF SHARES COMPANY NAME
REQUESTED FOUNDATION MATCH
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I AM REQUESTING A: q SINGLE MATCH
q DOUBLE MATCH
If you have any questions, contact the American Express Gift Matching Program toll-free at 888
-
297
-
6282.
Mail completed form to: American Express Gift Matching Program, P.O. Box 3409, Princeton, NJ 08543-3409
I hereby certify that:
• We received the above stated contribution from the above employee and that the
donation represents a charitable contribution and the donor derives no material
benefit (e.g., boosters, auction items, dinner, raffle and/or sporting event tickets,
dinner/journal ads, sponsorships, golf tournaments (including participation),
parking privileges, memberships, tuition, etc.) as a result of this gift.
•
In the case when a DOUBLE MATCH (Volunteer/Board Service Match) has been
requested this employee has served on the board of directors or has volunteered
50 hours or more during the past 12 months to this organization.
• This gift is not, in whole or in part, the gift of another individual or the sum of gifts
of other individuals.
• This organization complies with the eligibility guidelines of the American Express
Gift Matching program and adheres to accepted financial and record-keeping
practices and will furnish upon request an annual report, financial statements or a
list of subcontractors and affiliates.
• This organization takes reasonable steps to ensure that grant funds or resources
are not ultimately distributed to terrorist organizations or used to support
terrorist activities.
I understand that abuse or failure to comply with any of the above may result in
per
manent termination of the organization’s gift matching privileges.
NAME:
TITLE:
SIGNA
TURE:
DA
TE
(Requir
ed)
T
o Be Completed by Nonprofit Organization
The nonprofit organization must fill out part B and forward the form to the
American Express Gift Matching program at the address below.
B
(Note: check both if you qualify
for a double match and your
contribution exceeds $1,000.)
(I currently serve on the board of director or
have volunteered 50 hours or more during
the past 12 months to this organization.)
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