Form Schedule L Form 99 Schedule L Form 99 Transactions With Interested Persons

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

Part I

3

OMB No. 1545-0047

2011

▶ 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.
▶ Attach to Form 990 or Form 990-EZ. ▶ See separate instructions.

Open To Public
Inspection

Employer identification number

f
o
s
a
1
t
1
f
0
a
2
r
/
D /07
6
0

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.

1
(1)
(2)
(3)
(4)
(5)
(6)
2

Transactions With Interested Persons

(a) Name of disqualified person

(c) Corrected?

(b) Description of transaction

Yes

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

Part II

(b) Loan to or from
the organization?

To

Part III

.

.

.

.

.

.

.

▶

$
$

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

(1)
(2)
(3)
(4)
(5)
(6)
(7)
(8)
(9)
(10)
Total

.

No

.

(c) Original
principal amount

(d) Balance due

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

From

No

Yes

No

(g) Written
agreement?
Yes

No

. . . . . . . . . . . . . . . . . . . . . ▶ $
Grants or Assistance Benefiting Interested Persons.
Complete if the organization answered “Yes” on Form 990, Part IV, line 27.
(a) Name of interested person

(b) Relationship between interested person and the
organization

(c) Amount and type of assistance

(1)
(2)
(3)
(4)
(5)
(6)
(7)
(8)
(9)
(10)
For Paperwork Reduction Act Notice, see the Instructions for Form 990 or 990-EZ.

Cat. No. 50056A

Schedule L (Form 990 or 990-EZ) 2011

Schedule L (Form 990 or 990-EZ) 2011

Part IV

(a) Name of interested person

(1)
(2)
(3)
(4)
(5)
(6)
(7)
(8)
(9)
(10)

Part V

Page

2

Business Transactions Involving Interested Persons.
Complete if the organization answered “Yes” on Form 990, Part IV, line 28a, 28b, or 28c.
(b) Relationship between
interested person and the
organization

(c) Amount of
transaction

(d) Description of transaction

f
o
s
a
1
t
1
f
0
a
2
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/
D /07
6
0

(e) Sharing of
organization’s
revenues?
Yes

No

Supplemental Information
Complete this part to provide additional information for responses to questions on Schedule L (see instructions).

Schedule L (Form 990 or 990-EZ) 2011