Form 4720 sch I 4720 sch I Initial Taxes on Excess Benefit Transactions

Form 4720 (2009)

Page

5

SCHEDULE G—Tax on Excess Lobbying Expenditures (Section 4911)
1

Excess of grassroots expenditures over grassroots nontaxable amount (from Schedule C (Form
990 or 990-EZ), Part II-A, column (b), line 1h). (See page 11 of the instructions before making
entry.)

1

2

Excess of lobbying expenditures over lobbying nontaxable amount (from Schedule C (Form 990
or 990-EZ), Part II-A, column (b), line 1i). (See page 11 of the instructions before making entry.)

2

3

Taxable lobbying expenditures—enter the larger of line 1 or line 2

3

4

Tax—Enter 25% of line 3 here and on page 1, Part I, line 6

4

SCHEDULE H—Taxes on Disqualifying Lobbying Expenditures (Section 4912)
Expenditures and Computation of Tax

Part I
(a) Item
number

(b) Amount

(c) Date paid
or incurred

(d) Description of lobbying expenditures

(e) Tax imposed on organization (f) Tax imposed on organization
managers (if applicable)—
(5% of col. (b))
(5% of col. (b))

1
2
3
4
5
Total—column (e). Enter here and on page 1, Part I, line 7
Total—column (f). Enter total (or prorated amount) here and in Part II, column (c), below

Part II

Summary of Tax Liability of Organization Managers and Proration of Payments
(a) Names of organization managers liable for tax

Part I
(a)
Transaction
number

(b) Item no. from
Part I, col. (a)

(c) Tax from Part I, col. (f), or
prorated amount

(d) Manager’s total tax liability
(add amounts in col. (c))
(see page 11 of the instructions)

SCHEDULE I—Initial Taxes on Excess Benefit Transactions (Section 4958)
Excess Benefit Transactions and Tax Computation
(b) Date of
transaction

(c) Description of transaction

1
2
3
4
5
(d) Amount of excess benefit

(e) Initial tax on disqualified persons
(25% of col. (d))

(f) Tax on organization managers
(if applicable) (lesser of
$20,000 or 10% of col. (d))

Form 4720 (2009)

Form 4720 (2009)

Page

6

SCHEDULE I—Initial Taxes on Excess Benefit Transactions (Section 4958) Continued
Summary of Tax Liability of Disqualified Persons and Proration of Payments

Part II

(a) Names of disqualified persons liable for tax

Part III

(a)
Transaction
number

(d) Disqualified person’s total tax
liability (add amounts in col. (c)) (see
page 13 of the instructions)

(c) Tax from Part I, col. (e),
or prorated amount

Summary of Tax Liability of 501(c)(3) & (4) Organization Managers and Proration of Payments

(a) Names of 501(c)(3) & (4) organization managers liable for tax

Part I

(b) Trans. no. from
Part I, col. (a)

(b) Trans. no. from
Part I, col. (a)

(d) Manager’s total tax liability
(add amounts in col. (c))
(see page 13 of the instructions)

(c) Tax from Part I, col. (f),
or prorated amount

SCHEDULE J—Taxes on Being a Party to Prohibited Tax Shelter Transactions (Section 4965)
Prohibited Tax Shelter Transactions (PTST) and Tax Imposed on the Tax-Exempt Entity
(see page 13 of the instructions)
(b) Transaction
date

(c) Type of transaction
1—Listed
2—Subsequently listed
3—Confidential
4—Contractual protection

(d) Description of transaction

1
2
3
4
5
(e) Did the tax-exempt entity know or
have reason to know this transaction
was a PTST when it became a party to
the trans.? Answer Yes or No

(f) Net income attributable to
the PTST

(g) 75% of proceeds attributable to
the PTST

(h) Tax imposed on the tax-exempt
entity (see page 14 of the instructions)

Total—column (h). Enter here and on page 1, Part I, line 9
Form 4720 (2009)