Form 990-T Exempt Organization Business Income Tax Return (and prox

990-T

Form

Department of the Treasury
Internal Revenue Service
Check box if
address changed
B Exempt under section
)(
)
501(
A

408(e)

220(e)

408A

530(a)

Exempt Organization Business Income Tax Return

OMB No. 1545-0687

(and proxy tax under section 6033(e))

2016

For calendar year 2016 or other tax year beginning
, 2016, and ending
, 20
.
▶ Information about Form 990-T and its instructions is available at www.irs.gov/form990t.
Open to Public Inspection for
▶ Do not enter SSN numbers on this form as it may be made public if your organization is a 501(c)(3).
501(c)(3) Organizations Only
Name of organization (

Check box if name changed and see instructions.)

Print
Number, street, and room or suite no. If a P.O. box, see instructions.
or
Type
City or town, state or province, country, and ZIP or foreign postal code

D Employer identification number
(Employees’ trust, see instructions.)

E Unrelated business activity codes
(See instructions.)

529(a)
C Book value of all assets
at end of year

F Group exemption number (See instructions.) ▶
G Check organization type ▶
501(c) corporation
501(c) trust
401(a) trust
H Describe the organization’s primary unrelated business activity. ▶
I During the tax year, was the corporation a subsidiary in an affiliated group or a parent-subsidiary controlled group? . . ▶
If “Yes,” enter the name and identifying number of the parent corporation. ▶
J The books are in care of ▶
Telephone number ▶

Part I
1a
b
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3
4a
b
c
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13

Part II
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29
30
31
32
33
34

Unrelated Trade or Business Income

Gross receipts or sales
Less returns and allowances
c Balance ▶
Cost of goods sold (Schedule A, line 7) . . . . . . .
Gross profit. Subtract line 2 from line 1c . . . . . . .
Capital gain net income (attach Schedule D) . . . . .
Net gain (loss) (Form 4797, Part II, line 17) (attach Form 4797)
Capital loss deduction for trusts . . . . . . . . .
Income (loss) from partnerships and S corporations (attach statement)
Rent income (Schedule C) . . . . . . . . . . .
Unrelated debt-financed income (Schedule E) . . . . .
Interest, annuities, royalties, and rents from controlled organizations (Schedule F)
Investment income of a section 501(c)(7), (9), or (17) organization (Schedule G)
Exploited exempt activity income (Schedule I) . . . . .
Advertising income (Schedule J) . . . . . . . . .
Other income (See instructions; attach schedule) . . . . .
Total. Combine lines 3 through 12
. . . . . . . .

(A) Income

(B) Expenses

Other trust
Yes

No

(C) Net

1c
2
3
4a
4b
4c
5
6
7
8
9
10
11
12
13

Deductions Not Taken Elsewhere (See instructions for limitations on deductions.) (Except for contributions,
deductions must be directly connected with the unrelated business income.)

Compensation of officers, directors, and trustees (Schedule K) . . . . . . . . . . . .
Salaries and wages . . . . . . . . . . . . . . . . . . . . . . . . . .
Repairs and maintenance . . . . . . . . . . . . . . . . . . . . . . . .
Bad debts
. . . . . . . . . . . . . . . . . . . . . . . . . . . . .
Interest (attach schedule)
. . . . . . . . . . . . . . . . . . . . . . . .
Taxes and licenses . . . . . . . . . . . . . . . . . . . . . . . . . . .
Charitable contributions (See instructions for limitation rules) . . . . . . . . . . . . .
Depreciation (attach Form 4562) . . . . . . . . . . . . .
21
Less depreciation claimed on Schedule A and elsewhere on return . .
22a
Depletion . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
Contributions to deferred compensation plans
. . . . . . . . . . . . . . . . .
Employee benefit programs . . . . . . . . . . . . . . . . . . . . . . . .
Excess exempt expenses (Schedule I) . . . . . . . . . . . . . . . . . . . .
Excess readership costs (Schedule J) . . . . . . . . . . . . . . . . . . . .
Other deductions (attach schedule) . . . . . . . . . . . . . . . . . . . . .
Total deductions. Add lines 14 through 28
. . . . . . . . . . . . . . . . . .
Unrelated business taxable income before net operating loss deduction. Subtract line 29 from line 13
Net operating loss deduction (limited to the amount on line 30) . . . . . . . . . . . .
Unrelated business taxable income before specific deduction. Subtract line 31 from line 30 . . .
Specific deduction (Generally $1,000, but see line 33 instructions for exceptions) . . . . . .
Unrelated business taxable income. Subtract line 33 from line 32. If line 33 is greater than line 32,
enter the smaller of zero or line 32 . . . . . . . . . . . . . . . . . . . . . .

For Paperwork Reduction Act Notice, see instructions.

Cat. No. 11291J

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22b
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Form 990-T (2016)

Page 2

Form 990-T (2016)

Part III
35

Tax Computation

Organizations Taxable as Corporations. See instructions for tax computation. Controlled group
members (sections 1561 and 1563) check here ▶
See instructions and:
a

Enter your share of the $50,000, $25,000, and $9,925,000 taxable income brackets (in that order):
(2) $
(3) $
(1) $
b Enter organization’s share of: (1) Additional 5% tax (not more than $11,750)
$
(2) Additional 3% tax (not more than $100,000) . . . . . . . . .
$
c Income tax on the amount on line 34 . . . . . . . . . . . . . . . . . . . . ▶
36
Trusts Taxable at Trust Rates. See instructions for tax computation. Income tax on
the amount on line 34 from:
Tax rate schedule or
Schedule D (Form 1041) . . . . . ▶
37
Proxy tax. See instructions . . . . . . . . . . . . . . . . . . . . . . . ▶
38
Alternative minimum tax . . . . . . . . . . . . . . . . . . . . . . . . .
39
Tax on Non-Compliant Facility Income. See instructions . . . . . . . . . . . . .
40
Total. Add lines 37, 38 and 39 to line 35c or 36, whichever applies . . . . . . . . . . .

Part IV
41a
b
c
d
e
42
43
44
45a
b
c
d
e
f
g

35c
36
37
38
39
40

Tax and Payments

Foreign tax credit (corporations attach Form 1118; trusts attach Form 1116)
Other credits (see instructions) . . . . . . . . . . . . . .
General business credit. Attach Form 3800 (see instructions) . . . .
Credit for prior year minimum tax (attach Form 8801 or 8827) . . . .
Total credits. Add lines 41a through 41d . . . . . . . . . .
Subtract line 41e from line 40 . . . . . . . . . . . . . .
Other taxes. Check if from:

Form 4255

Form 8611

Form 8697

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.

Form 8866

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41a
41b
41c
41d
. . .
. . .

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Other (attach schedule) .

41e
42
43
44

Total tax. Add lines 42 and 43 . . . . . . . . . . . . . . . . . . . . . . .
Payments: A 2015 overpayment credited to 2016
. . . . . . . .
45a
2016 estimated tax payments . . . . . . . . . . . . . . . . 45b
Tax deposited with Form 8868 . . . . . . . . . . . . . . .
45c
Foreign organizations: Tax paid or withheld at source (see instructions) .
45d
Backup withholding (see instructions) . . . . . . . . . . . .
45e
Credit for small employer health insurance premiums (Attach Form 8941) .
45f
Other credits and payments:
Form 2439
Form 4136
Other
Total ▶
45g
46
Total payments. Add lines 45a through 45g . . . . . . . . . . . . . . . . . .
46
47
Estimated tax penalty (see instructions). Check if Form 2220 is attached . . . . . . . . ▶
47
▶
48
Tax due. If line 46 is less than the total of lines 44 and 47, enter amount owed . . . . . .
48
▶
49
Overpayment. If line 46 is larger than the total of lines 44 and 47, enter amount overpaid . .
49
Enter the amount of line 49 you want: Credited to 2017 estimated tax ▶
50
Refunded ▶ 50
Part V
Statements Regarding Certain Activities and Other Information (see instructions)
At any time during the 2016 calendar year, did the organization have an interest in or a signature or other authority
51
over a financial account (bank, securities, or other) in a foreign country? If YES, the organization may have to file
FinCEN Form 114, Report of Foreign Bank and Financial Accounts. If YES, enter the name of the foreign country
here ▶
52
53

No

During the tax year, did the organization receive a distribution from, or was it the grantor of, or transferor to, a foreign trust? .
If YES, see instructions for other forms the organization may have to file.
Enter the amount of tax-exempt interest received or accrued during the tax year ▶ $
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 taxpayer) is based on all information of which preparer has any knowledge.
▲

▲

Sign
Here

Yes

Signature of officer

Paid
Preparer
Use Only

Date

Print/Type preparer’s name

Firm’s name

▶

Firm’s address ▶

Preparer’s signature

May the IRS discuss this return
with the preparer shown below
(see instructions)? Yes
No

Title
Date

Check
if
self-employed

PTIN

Firm’s EIN ▶
Phone no.

Form 990-T (2016)

Page 3

Form 990-T (2016)

Schedule A—Cost of Goods Sold. Enter method of inventory valuation
1
2
3
4a

Inventory at beginning of year
Purchases . . . . . .
Cost of labor . . . . . .
Additional section 263A costs
(attach schedule) . . . .

b Other costs (attach schedule)
Total. Add lines 1 through 4b

5

1
2
3

6
7

4a
4b
5

8

▶

Inventory at end of year
Cost of goods sold.
line 6 from line 5. Enter
in Part I, line 2 . . .

6

. . .
Subtract
here and
. . .

7
Do the rules of section 263A (with respect to
property produced or acquired for resale) apply
to the organization? . . . . . . . . .

Yes

No

Schedule C—Rent Income (From Real Property and Personal Property Leased With Real Property)
(see instructions)
1. Description of property
(1)
(2)
(3)
(4)
2. Rent received or accrued
(a) From personal property (if the percentage of rent
for personal property is more than 10% but not
more than 50%)

3(a) Deductions directly connected with the income
in columns 2(a) and 2(b) (attach schedule)

(b) From real and personal property (if the
percentage of rent for personal property exceeds
50% or if the rent is based on profit or income)

(1)
(2)
(3)
(4)

Total

Total

(b) Total deductions.
Enter here and on page 1,
Part I, line 6, column (B) ▶

(c) Total income. Add totals of columns 2(a) and 2(b). Enter
▶
here and on page 1, Part I, line 6, column (A) . . .

Schedule E—Unrelated Debt-Financed Income (see instructions)
2. Gross income from or
allocable to debt-financed
property

1. Description of debt-financed property

3. Deductions directly connected with or allocable to
debt-financed property
(a) Straight line depreciation
(b) Other deductions
(attach schedule)
(attach schedule)

(1)
(2)
(3)
(4)
4. Amount of average
acquisition debt on or
allocable to debt-financed
property (attach schedule)

5. Average adjusted basis
of or allocable to
debt-financed property
(attach schedule)

6. Column
4 divided
by column 5

8. Allocable deductions
(column 6 × total of columns
3(a) and 3(b))

Enter here and on page 1,
Part I, line 7, column (A).

Enter here and on page 1,
Part I, line 7, column (B).

%
%
%
%

(1)
(2)
(3)
(4)

Totals
. . . . . . . . . . . . . . . .
Total dividends-received deductions included in column 8

7. Gross income reportable
(column 2 × column 6)

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Form

990-T (2016)

Page 4

Form 990-T (2016)

Schedule F—Interest, Annuities, Royalties, and Rents From Controlled Organizations (see instructions)
Exempt Controlled Organizations
1. Name of controlled
organization

2. Employer
identification number

3. Net unrelated income
(loss) (see instructions)

4. Total of specified
payments made

5. Part of column 4 that is
included in the controlling
organization’s gross income

6. Deductions directly
connected with income
in column 5

10. Part of column 9 that is
included in the controlling
organization’s gross income

11. Deductions directly
connected with income in
column 10

Add columns 5 and 10.
Enter here and on page 1,
Part I, line 8, column (A).

Add columns 6 and 11.
Enter here and on page 1,
Part I, line 8, column (B).

(1)
(2)
(3)
(4)

Nonexempt Controlled Organizations
8. Net unrelated income
(loss) (see instructions)

7. Taxable Income

9. Total of specified
payments made

(1)
(2)
(3)
(4)

Totals

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Schedule G—Investment Income of a Section 501(c)(7), (9), or (17) Organization (see instructions)
1. Description of income

2. Amount of income

3. Deductions
directly connected
(attach schedule)

5. Total deductions
and set-asides (col. 3
plus col. 4)

4. Set-asides
(attach schedule)

(1)
(2)
(3)
(4)

Enter here and on page 1,
Part I, line 9, column (A).
Totals

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Enter here and on page 1,
Part I, line 9, column (B).

▶

Schedule I—Exploited Exempt Activity Income, Other Than Advertising Income (see instructions)
1. Description of exploited activity

2. Gross
unrelated
business income
from trade or
business

3. Expenses
directly
connected with
production of
unrelated
business income

Enter here and on
page 1, Part I,
line 10, col. (A).

Enter here and on
page 1, Part I,
line 10, col. (B).

4. Net income (loss)
from unrelated trade
or business (column
2 minus column 3).
If a gain, compute
cols. 5 through 7.

5. Gross income
from activity that
is not unrelated
business income

6. Expenses
attributable to
column 5

7. Excess exempt
expenses
(column 6 minus
column 5, but not
more than
column 4).

(1)
(2)
(3)
(4)

Totals

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Enter here and
on page 1,
Part II, line 26.

. ▶

Schedule J—Advertising Income (see instructions)
Part I
Income From Periodicals Reported on a Consolidated Basis
2. Gross
advertising
income

1. Name of periodical

3. Direct
advertising costs

4. Advertising
gain or (loss) (col.
2 minus col. 3). If
a gain, compute
cols. 5 through 7.

5. Circulation
income

6. Readership
costs

7. Excess readership
costs (column 6
minus column 5, but
not more than
column 4).

(1)
(2)
(3)
(4)

Totals (carry to Part II, line (5))

.

. ▶
Form

990-T (2016)

Page 5
Income From Periodicals Reported on a Separate Basis (For each periodical listed in Part II, fill in columns
2 through 7 on a line-by-line basis.)

Form 990-T (2016)

Part II

1. Name of periodical

4. Advertising
gain or (loss) (col.
2 minus col. 3). If
a gain, compute
cols. 5 through 7.

2. Gross
advertising
income

3. Direct
advertising costs

Enter here and on
page 1, Part I,
line 11, col. (A).

Enter here and on
page 1, Part I,
line 11, col. (B).

5. Circulation
income

6. Readership
costs

7. Excess readership
costs (column 6
minus column 5, but
not more than
column 4).

(1)
(2)
(3)
(4)

Totals from Part I .

.

Totals, Part II (lines 1-5)

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Enter here and
on page 1,
Part II, line 27.

. ▶

Schedule K—Compensation of Officers, Directors, and Trustees (see instructions)
1. Name

3. Percent of
time devoted to
business

2. Title

%
%
%
%

(1)
(2)
(3)
(4)

Total. Enter here and on page 1, Part II, line 14

4. Compensation attributable to
unrelated business

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▶
Form

990-T (2016)