Form Schedule L (Form 9 Schedule L (Form 9 Transactions with Interested Persons

SCHEDULE L
(Form 990 or 990-EZ)
Department of the Treasury
Internal Revenue Service

1

2009

Complete if the organization answered
“Yes” on Form 990, Part IV, line 25a, 25b, 26, 27, 28a, 28b, or 28c,
or Form 990-EZ, Part V, line 38a or 40b.
䊳 Attach to Form 990 or Form 990-EZ. 䊳 See separate instructions.

Name of the organization

Part I

OMB No. 1545-0047

Transactions
With Interested Persons
䊳

Open To Public
Inspection

Employer identification number

Excess Benefit Transactions (section 501(c)(3) and section 501(c)(4) organizations only).
Complete if the organization answered “Yes” on Form 990, Part IV, line 25a or 25b, or Form 990-EZ, Part V, line 40b.
(a) Name of disqualified person

(c) Corrected?

(b) Description of transaction

Yes

No

2 Enter the amount of tax imposed on the organization managers or disqualified persons during the year
䊳 $
under section 4958
䊳 $
3 Enter the amount of tax, if any, on line 2, above, reimbursed by the organization

Part II

Loans to and/or From Interested Persons.
Complete if the organization answered “Yes” on Form 990, Part IV, line 26, or Form 990-EZ, Part V, line 38a.

(a) Name of interested person and purpose

(b) Loan to or from
the organization?

To

Total

Part III

(d) Balance due

From

(e) In default? (f) Approved
by board or
committee?
Yes

No

Yes

No

(g) Written
agreement?

Yes

No

䊳 $
Grants or Assistance Benefiting Interested Persons.
Complete if the organization answered “Yes” on Form 990, Part IV, line 27.

(a) Name of interested person

Part IV

(c) Original
principal amount

(b) Relationship between interested person and the
organization

(c) Amount and type of assistance

Business Transactions Involving Interested Persons.
Complete if the organization answered “Yes” on Form 990, Part IV, line 28a, 28b, or 28c.

(a) Name of interested person

(b) Relationship between
interested person and the
organization

(c) Amount of
transaction

(d) Description of transaction

(e) Sharing of
organization’s
revenues?
Yes

For Privacy Act and Paperwork Reduction Act Notice, see the
Instructions for Form 990 or 990-EZ.

Cat. No. 50056A

No

Schedule L (Form 990 or 990-EZ) 2009