Form 8870 Information Return for Transfers Associated With Certain

Information Return for Transfers Associated
With Certain Personal Benefit Contracts

8870

Form
(Rev. February 2009)

Department of the Treasury
Internal Revenue Service

Page 1 of ___

(Under section 170(f)(10))

For the accounting period beginning
Print or
type.
See
Specific
Instructions.

OMB No. 1545-1702

,

, and ending

,

.

Employer identification number

Name of organization
Number and street (or P.O. box if mail is not delivered to street address)

Telephone number

Room/suite

(
City or town, state or country, and ZIP

Check

)
©

if exemption application
is pending

Type of organization:
Organization exempt under section 501(c)(
) § (insert number)
Section 4947(a)(1) nonexempt charitable trust
Section 664(d)(2) charitable remainder unitrust
Other section 170(c) organization
Section 664(d)(1) charitable remainder annuity trust

Part A. Personal Benefit Contracts
(a)
Item
number

(b)
Contract Issuer
Name, address, and ZIP code

(c)
Policy number

No. 1

No. 2

No. 3

No. 4

No. 5

Part B. Premiums Paid on Personal Benefit Contracts by the Organization Or Treated as Paid by the Organization
(a)
Item number
from Part A

(b)
Date premium
paid by the
organization

(c)
Amount of premium
paid by the
organization

(d)
Date premium
paid by others

(e)
Amount of
premium paid by
others

(f)
Total of amounts in
columns (c) and (e)

No. ____
No. ____
No. ____
No. ____
No. ____
(g) Total of amounts in column (f)

©

(g)

(h) Amount from line (g) of Part B of the Continuation Schedule

©

(h)

(i) Total. (Add lines (g) and (h). Enter total here and include this amount on line 8 of Part I of the
Form 4720.)

©

(i)

For Paperwork Reduction Act Notice, see page 6 of the instructions.

Cat. No. 28906R

Form

8870

(Rev. 2-2009)

Form 8870 (Rev. 2-2009)

Page

2

Part C. Beneficiaries
(a)
Item number
from Part A

(b)
Beneficiary’s name, address, and
ZIP code

(c)
Beneficiary’s SSN or EIN

No. ____

No. ____

No. ____

No. ____

No. ____

Part D. Transferors
(a)
Item number
from Part A

(b)
Transferor’s name, address, and
ZIP code

(c)
Date organization
received transfer

(d)
Amount of
transfer

No. ____

No. ____

No. ____

No. ____

No. ____

Under penalties of perjury, I declare that I have examined this return, including accompanying schedules and statements, and to the best of my knowledge
and belief, it is true, correct, and complete. Declaration of preparer (other than officer) is based on all information of which preparer has any knowledge.

Sign
Here
Paid
Preparer’s
Use Only

©

Signature of officer

Preparer’s
signature

©

Preparer’s name and
address

Date

©

Type or print name and title.
Date

©

ZIP code

©

Form

8870

(Rev. 2-2009)

Form 8870 (Rev. 2-2009)

Page

Continuation Schedule

(You may duplicate this Schedule. See instructions.)

Page

3

of

Part A. Personal Benefit Contracts (cont.)
(a)
Item
number

(b)
Contract Issuer
Name, address, and ZIP code

(c)
Policy number

No. ____

No. ____

No. ____

Part B. Premiums Paid on Personal Benefit Contracts by the Organization Or Treated as Paid by the Organization (cont.)
(a)
Item number
from Part A

(b)
Date premium
paid by the
organization

(c)
Amount of
premium paid by
the organization

(d)
Date premium
paid by others

(e)
Amount of
premium paid
by others

(f)
Total of amounts in
columns (c) and (e)

No. ____
No. ____
No. ____

(g) Total premiums. Add the amounts in column (f). (Enter here and on Part B, page 1, line (h).)

©

(g)

Part C. Beneficiaries (cont.)
(a)
Item number
from Part A

(b)
Beneficiary’s name, address, and
ZIP code

(c)
Beneficiary’s SSN or EIN

No. ____

No. ____

No. ____

Part D. Transferors (cont.)
(a)
Item number
from Part A

(b)
Transferor’s name, address, and
ZIP code

(c)
Date organization
received transfer

(d)
Amount of
transfer

No. ____

No. ____

No. ____
Form

8870

(Rev. 2-2009)

Form 8870 (Rev. 2-2009)

Page

4

Section references are to the Internal Revenue Code unless
otherwise noted.

beneficiary of a life insurance, annuity, or endowment
contract if the trust possesses all of the incidents of
ownership under the contract and is entitled to all payments
under the contract.

Who Must File

When To File

General Instructions

Code section 170(f)(10) requires a charitable organization
described in section 170(c) or a charitable remainder trust
described in section 664(d) to complete and file Form 8870 if
it paid premiums after February 8, 1999, on certain life
insurance, annuity, and endowment contracts (personal
benefit contracts).
Note. Section 170(f)(10)(A) denies a charitable contribution
deduction for a transfer to a “charitable organization” if the
charitable organization pays any premium on a personal
benefit contract with respect to the transferor. If there is an
understanding or expectation that any other person will pay
any premium on the personal benefit contract, that payment
is treated as made by the organization.
Section 170(f)(10)(F)(iii) requires a charitable organization to
report annually:
1. The amount of any premiums it paid, on a personal
benefit contract to which section 170(f)(10) applies;
2. The name and taxpayer identification number (TIN) of
each beneficiary under each contract to which the premiums
relate; and
3. Any other information the Secretary may require.

Definitions
Charitable organization. A charitable organization is an
organization described in section 170(c). For purposes of this
form, a charitable remainder trust, as defined in section
664(d), is also a charitable organization.
Personal benefit contract. In general, section 170(f)(10)(B)
defines a “personal benefit contract,” with respect to the
transferor, as any life insurance, annuity, or endowment
contract that benefits, directly or indirectly, the transferor, a
member of the transferor’s family or any other person
designated by the transferor (other than an organization
described in section 170(c)).
Exception for charitable gift annuity. Under section
170(f)(10)(D), a person receiving payments under a charitable
gift annuity (as defined in section 501(m)) funded by an
annuity contract purchased by a charitable organization is
not treated as an indirect beneficiary of a personal benefit
contract if the timing and amount of the payments under the
annuity contract are substantially the same as the charitable
organization’s obligations under the charitable gift annuity.
For this exception to apply, the charitable organization
must possess all the incidents of ownership and be entitled
to all the payments under the annuity contract.
Exception for charitable remainder trusts. Under section
170(f)(10)(E), a person receiving annuity or unitrust payments
from a charitable remainder trust is not treated as an indirect

A charitable organization, other than a charitable remainder
trust described in section 664(d), that paid premiums on a
personal benefit contract, must file Form 8870 by the
fifteenth day of the fifth month after the end of the tax year.
A charitable remainder trust described in section 664(d) must
file Form 8870 by April 15 following the calendar year during
which it paid the premiums.
If the regular due date falls on a Saturday, Sunday, or legal
holiday, file on the next business day. A business day is any
day that is not a Saturday, Sunday, or legal holiday.
If the return is not filed by the due date (including any
extension granted), attach a statement giving the reasons for
not filing on time.

Where To File
Send the return to the Department of the Treasury, Internal
Revenue Service, Ogden, UT 84201-0027.
Private delivery services. You can use certain private
delivery services designated by the IRS to meet the “timely
mailing as timely filing/paying” rule for tax returns and
payments. The private delivery services include only the
following:
● DHL Express (DHL): DHL Same Day Service, DHL Next
Day 10:30 am, DHL Next Day 12:00 pm, DHL Next Day 3:00
pm, and DHL 2nd Day Service.
● Federal Express (FedEx): FedEx Priority Overnight, FedEx
Standard Overnight, FedEx 2Day, FedEx International Priority,
and FedEx International First.
● United Parcel Service (UPS): UPS Next Day Air, UPS Next
Day Air Saver, UPS 2nd Day Air, UPS 2nd Day Air A.M., UPS
Worldwide Express Plus, and UPS Worldwide Express.
The private delivery service can tell you how to get written
proof of the mailing date.

Extension of Time To File
A charitable organization, including a charitable remainder
trust, may obtain an extension of time to file Form 8870 by
filing Form 8868, Application for Extension of Time To File an
Exempt Organization Return, on or before the due date of
the return.
Generally, the IRS will not grant an extension of time for
more than 90 days. If more time is needed, file a second
Form 8868 for an additional 90-day extension. In no event
will an extension of more than 6 months be granted to any
domestic organization.

Form 8870 (Rev. 2-2009)

Page

Amended Return

Specific Instructions

The organization may file an amended return at any time to
change or add to the information reported on a previously
filed return for the same period.
An amended return must provide all the information called
for by the form and instructions, not just the new or
corrected information. Write “Amended Return” at the top of
an amended Form 8870.

Completing the Heading of Form 8870

Signature
To make the return complete, an officer of the organization
authorized to sign it must sign in the space provided. For a
corporation or association, this officer may be the president,
vice president, treasurer, assistant treasurer, chief accounting
officer, or other corporate or association officer, such as a
tax officer. A receiver, trustee, or assignee must sign any
return he or she files for a corporation or association. For a
trust, the authorized trustee(s) must sign.
Generally, anyone who is paid to prepare the return must
sign it in the Paid Preparer’s Use Only area.
The paid preparer must:
● Sign the return in the space provided for the preparer’s
signature.
● Complete the required preparer information.
Leave the paid preparer’s space blank if the return was
prepared by a regular employee of the filing organization.

Penalties
Returns required by section 170(f)(10)(F)(iii) are subject to the
penalties applicable to returns required under section 6033.
There are also criminal penalties for willful failure to file and
for filing fraudulent returns and statements. See sections
7203, 7206, and 7207.

Other Returns You May Need To File
Excise tax return. Section 170(f)(10)(F)(i) imposes on a
charitable organization an excise tax equal to the premiums
paid by the organization on any personal benefit contract, if
the payment of premiums is in connection with a transfer for
which a deduction is not allowed under section 170(f)(10)(A).
For purposes of this excise tax, section 170(f)(10)(F)(ii)
provides that premium payments made by any other person,
pursuant to an understanding or expectation described in
section 170(f)(10)(A), are treated as made by the charitable
organization.
A charitable organization liable for excise taxes under
section 170(f)(10)(F)(i) must file a return on Form 4720, Return
of Certain Excise Taxes Under Chapters 41 and 42 of the
Internal Revenue Code, to report and pay the taxes due.
Information returns. Generally, an organization described in
section 170(c) files either Form 990, Return of Organization
Exempt From Income Tax, Form 990-EZ, Short Form Return
of Organization Exempt From Income Tax, or Form 990-PF,
Return of Private Foundation or Section 4947(a)(1)
Nonexempt Charitable Trust Treated as a Private Foundation.
A charitable remainder trust described in section 664(d)
files Form 5227, Split-Interest Trust Information Return.

Phone Help
If you have questions and/or need help completing Form
8870, please call 1-877-829-5500. This toll-free telephone
service is available Monday through Friday.

5

Accounting period. Use Form 8870 to report either on a
calendar year accounting period or on an accounting period
other than a calendar year (either a fiscal year or a short
period (less than 12 months)). This information should be the
same information as reported on your Form 990, 990-EZ,
990-PF, or 5227.
Name and address. Include the suite, room, or other unit
number after the street address. If the Post Office does not
deliver mail to the street address, and the organization has a
P.O. box, show the box number instead of the street
address.
For foreign addresses, enter information in the following
order: city, province or state, and the name of the country.
Follow the foreign country’s practice in placing the postal
code in the address. Please do not abbreviate the country
name.
If a change in address occurs after the return is filed, use
Form 8822, Change of Address, to notify the IRS of the new
address.
Employer identification number. The organization should
have only one federal employer identification number (EIN). If
it has more than one and has not been advised which to use,
notify the Department of the Treasury, Internal Revenue
Service, Ogden, UT 84201-0027. State what numbers the
organization has, the name and address to which each
number was assigned, and the address of its principal office.
The IRS will advise the organization which number to use.
Telephone number. Enter a telephone number of the
organization that the IRS may use during normal business
hours to contact the organization. If the organization does
not have a telephone number, enter the telephone number of
the appropriate organization official.
Application pending. If the organization’s application for
exemption is pending, check this box and complete the
return.
Type of organization. If the organization is exempt under
section 501(c), check the applicable box and insert, within
the parentheses, the number that identifies the type of
section 501(c) organization the filer is. Private foundations
should enter “3” to indicate that they are a section 501(c)(3)
organization. If the organization is a section 4947(a)(1)
nonexempt charitable trust, a section 664 charitable
remainder trust, or other section 170(c) organization, check
the applicable box.

Part A. Personal Benefit Contracts
Note. In Parts A through D, you will be reporting on personal
benefit contracts for which you paid premiums or received
transfers during the tax year.
Use the Continuation Schedule if you have more than five
personal benefit contracts to report. You may duplicate the
Continuation Schedule and attach as many schedules as you
need to Form 8870. Complete the Continuation Schedule
following the Specific Instructions for Parts A through D.
However, complete line (g) on only one Continuation
Schedule. The figure on that Continuation Schedule should
be the combined total of all your Continuation Schedules.
Follow the line (g) instruction on page 3 of the form to carry
the line (g) total amount to Part B, page 1, line (h).

Form 8870 (Rev. 2-2009)

Page

6

To avoid filing an incomplete return or having to respond to
requests for missing information, complete all applicable line
items. Make an entry (including a zero when appropriate).
Column (a). Designate the first personal benefit contract you
are reporting as item No. 1. Refer to the second personal
benefit contract you are reporting as item No. 2, etc. In the
Parts that follow, you are to provide more information for the
personal benefit contract you identified as No. 1, No. 2, etc.

Part D. Transferors

Part B. Premiums Paid on Personal Benefit
Contracts by the Organization Or Treated as Paid
by the Organization

Column (b). Report the name, address, and ZIP code of
each transferor of funds, transferred directly or indirectly, for
use as premiums on each personal benefit contract.

If, in connection with any transfer to a charitable
organization, the organization directly or indirectly pays
premiums on any personal benefit contract, or there is an
understanding or expectation that any person will directly or
indirectly pay such premiums, the organization must report
the following information.
Premiums paid by the organization
Note. Complete Part B for all premiums paid during the tax
year for which the organization is filing Form 8870.
Column (a). Identify all personal benefit contracts by the
same item number you used in Part A. List these contracts in
the consecutive order they were reported in Part A.
Premiums paid by others but treated as paid by the
organization

Report in Part D all transfers made during the tax year to the
organization in connection with each personal benefit
contract listed in Part A.
Column (a). Identify all personal benefit contracts with the
same item number you used in Part A. List these contracts in
consecutive order.

Paperwork Reduction Act Notice
We ask for the information on this form to carry out the
Internal Revenue laws of the United States. You are required
to give us the information. We need it to ensure that you are
complying with these laws.
The organization is not required to provide the information
requested on a form that is subject to the Paperwork
Reduction Act unless the form displays a valid OMB control
number.
Books or records relating to a form or its instructions must
be retained as long as their contents may become material in
the administration of any Internal Revenue law. Generally, tax
returns and tax return information are confidential, as
required by 26 U.S.C. 6103.

Column (f). Enter the total premiums from columns (c) and
(e) paid by the organization, directly or indirectly, and other
persons during the tax year, on each personal benefit
contract.

The time needed to complete and file this form and related
schedules will vary depending on individual circumstances.
The estimated average times are:
Recordkeeping

9 hrs., 48 min.

Line (i). Carry this total to Form 4720, line 8, Part I, to report
the excise tax due.

Learning about the
law or the form

2 hrs., 22 min.

Part C. Beneficiaries

Preparing, copying, assembling, and
sending the form to the IRS

2 hrs., 39 min.

Column (a). Identify all personal benefit contracts by the
same item number you used in Part A. List these contracts in
consecutive order.
Column (b). Report the name, address, and ZIP code of the
beneficiary under each personal benefit contract.
Column (c). Enter the social security number (SSN) or
employer identification number (EIN) of the beneficiary,
entered in column (b), of each personal benefit contract.

If you have comments concerning the accuracy of these
time estimates or suggestions for making this form simpler,
we would be happy to hear from you. You can write to the
Internal Revenue Service, Tax Products Coordinating
Committee, SE:W:CAR:MP:T:T:SP, 1111 Constitution Ave.
NW, IR-6526, Washington, DC 20224. Do not send the form
to this address. Instead, see Where To File on page 4.