Form Schedule K (Form 9 Schedule K (Form 9 Supplemental Information on Tax Exempt Bonds

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I.R.S. SPECIFICATIONS

TO BE REMOVED BEFORE PRINTING

INSTRUCTIONS TO PRINTERS
SCHEDULE K (FORM 990), PAGE 1 of 2
MARGINS: TOP 13mm (1⁄ 2 "), CENTER SIDES.
PAPER: WHITE, WRITING, SUB. 20.
FLAT SIZE: 216mm (81⁄ 2 ") 3 279mm (11")
PERFORATE: NONE

Bond Issues (Required for 2008)
(a) Issuer name

A
B
C
D
E

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Proceeds (Optional for 2008)

(c) CUSIP #

(b) Issuer EIN

(d) Date issued

1
2
3
4
5
6
7
8

Total proceeds of issue
Gross proceeds in reserve funds
Proceeds in refunding or defeasance escrows
Other unspent proceeds
Issuance costs from proceeds
Working capital expenditures from proceeds
Capital expenditures from proceeds
Year of substantial completion

9

Were the bonds issued as part of a current refunding issue?

Yes

11
12

OMB No. 1545-0047

2008

No

Yes

No

Yes

Open to Public
Inspection
Employer identification number

(f) Description of purpose

(e) Issue price

B

A

10

Revised proofs
requested

To be completed by organizations that answered “Yes” to Form 990, Part IV, line 24a.
Provide descriptions, explanations, and any additional information in Schedule O.

Name of the organization

Part II

Signature

Supplemental Information on Tax Exempt Bonds

Department of the Treasury
Internal Revenue Service

Part I

Date

O.K. to print

PRINTS: HEAD TO HEAD
INK: BLACK

DO NOT PRINT — DO NOT PRINT — DO NOT PRINT — DO NOT PRINT

SCHEDULE K
(Form 990)

Action

Yes

No

Yes

(h) On
behalf of
issuer

Yes No Yes No

C

No

(g) Defeased

E

D

No

Yes

No

Yes

No

Yes

No

Yes

No

Were the bonds issued as part of an advance
refunding issue?
Has the final allocation of proceeds been made?
Does the organization maintain adequate books and
records to support the final allocation of proceeds?

Part III

Private Business Use (Optional for 2008)
B

A
1

Was the organization a partner in a partnership, or a
member of an LLC, which owned property financed by
tax-exempt bonds?

2

Are there any lease arrangements with respect to the
financed property which may result in private business use?

Yes

For Paperwork Reduction Act Notice, see the Instructions for Form 990.

C

Cat. No. 50193E

E

D

No

Schedule K (Form 990) 2008

2
I.R.S. SPECIFICATIONS
TO BE REMOVED BEFORE PRINTING
INSTRUCTIONS TO PRINTERS
SCHEDULE K (FORM (990), PAGE 2 OF 2
MARGINS; TOP 13mm (1⁄ 2 "), CENTER SIDES.
PRINTS: HEAD TO HEAD
PAPER: WHITE WRITING, SUB. 20.
INK: BLACK
FLAT SIZE: 216mm (81⁄ 2 ") x 279mm (11")
PERFORATE: NONE
DO NOT PRINT — DO NOT PRINT — DO NOT PRINT — DO NOT PRINT

Schedule K (Form 990) 2008

Part III

Private Business Use (Continued)

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4
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B

A

3a Are there any management or service contracts with
respect to the financed property which may result in
private business use?
3b Are there any research agreements with respect to the
financed property which may result in private business
use?
3c Does the organization routinely engage bond counsel
or other outside counsel to review any management or
service contracts or research agreements relating to
the financed property?
4

Enter the percentage of financed property used in a
private business use by entities other than a 501(c)(3)
organization or a state or local government

5

Enter the percentage of financed property used in a
private business use as a result of unrelated trade or
business activity carried on by your organization, another
501(c)(3) organization, or a state or local government
Total of lines 4 and 5

6
7

Yes

No

Yes

No

E

D

Yes

No

Yes

No

Arbitrage (Optional for 2008)
B

A

2

Yes

2

Has the organization adopted management practices
and procedures to ensure the post-issuance
compliance of its tax-exempt bond liabilities?

Part IV
1

C

No

Page

Has a Form 8038-T been filed with respect to the
bond issue?
Is the bond issue a variable rate issue?

Yes

No

Yes

C
No

Yes

E

D
No

Yes

No

Yes

No

3a Has the organization or the governmental issuer
identified a hedge with respect to the bond issue on
its books and records?
b Name of provider
c Term of hedge
4a Were gross proceeds invested in a GIC?
b Name of provider
c Term of GIC
d Was the regulatory safe harbor for establishing the fair
market value of the GIC satisfied?
5

Were any gross proceeds invested beyond an
available temporary period?

6

Did the bond issue qualify for an exception to rebate?
Schedule K (Form 990) 2008