8870 Information Return for Transfers Associated With Certain

8870

Information Return for Transfers Associated
With Certain Personal Benefit Contracts

Form
(Rev. August 2013)
Department of the Treasury
Internal Revenue Service

OMB No. 1545-1702

Page 1 of

(Under section 170(f)(10))

▶ Information about Form 8870 and its instructions is at www.irs.gov/form8870.
,
, and ending
For the accounting period beginning

Print or
type.
See
Specific
Instructions.

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.

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

if exemption application
is pending

Check ▶

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

Part A. Personal Benefit Contracts
(b)
Contract Issuer
Name, address, and ZIP code

(a)
Item
number

(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

(e)
(f)
Amount of
Total of amounts in
premium paid by
columns (c) and (e)
others

(d)
Date premium
paid by others

No.
No.
No.
No.
No.
(g)

Total of amounts in column (f)

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▶

(g)

(h)

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

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▶

(h)

(i)

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

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For Paperwork Reduction Act Notice, see the instructions.

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Cat. No. 28906R

Form

8870

(Rev. 8-2013)

Form 8870 (Rev. 8-2013)

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.

Signature of officer

Print/Type preparer’s name

Firm’s name

▶

Firm’s address ▶

Date
Preparer’s signature

▲

Paid
Preparer
Use Only

▲

Sign
Here

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.

Type or print name and title.
Date

Check
if
self-employed

PTIN

Firm's EIN ▶
Phone no.
Form

8870

(Rev. 8-2013)

Form 8870 (Rev. 8-2013)

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).)

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▶

(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. 8-2013)

Form 8870 (Rev. 8-2013)

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

Future Developments
For the latest information about developments related to
Form 8870 and its instructions, such as legislation enacted after
they were published, go to www.irs.gov/form8870.

Who Must File
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.

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4

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
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.

When To File
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.
• 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. 8-2013)

Page

Amended Return

Phone Help

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.

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.

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.

Paid Preparer Use Only
Anyone who prepares the return but does not charge the
organization should not sign the return. Certain others who
prepare the return should not sign. For example, a regular,
full-time employee of the lender, such as a clerk, secretary, etc.,
should not sign.
Generally, anyone who is paid to prepare a return must sign it
and fill in the other blanks in the Paid Preparer Use Only area of
the return. A paid preparer cannot use a social security number
in the Paid Preparer Use Only box. The paid preparer must use
a preparer tax identification number (PTIN). If the paid preparer
is self-employed, the preparer should enter his or her address in
the box. The paid preparer must:
• Sign the return in the space provided for the preparer’s
signature,
• Enter the preparer information, and
• Give a copy of the return to the 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.

5

Specific Instructions
Completing the Heading of Form 8870
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. 8-2013)

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 B. Premiums Paid on Personal Benefit Contracts
by the Organization Or Treated as Paid by the
Organization
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
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.
Line (i). Carry this total to Form 4720, line 8, Part I, to report the
excise tax due.

Part C. Beneficiaries
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.

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6

Part D. Transferors
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.
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.

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.
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.
Learning about the
law or the form
. . . . . . . . . . 2 hrs., 22 min.
Preparing, copying, assembling, and
sending the form to the IRS . . . . . . 2 hrs., 39 min.
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:M:S, 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.