990 Schedule K Supplemental Information on Tax-Exempt Bonds

SCHEDULE K
(Form 990)

OMB No. 1545-0047

Supplemental Information on Tax-Exempt Bonds
▶ Complete

Department of the Treasury
Internal Revenue Service

2021

if the organization answered “Yes” on Form 990, Part IV, line 24a. Provide descriptions,
explanations, and any additional information in Part VI.
▶ Attach to Form 990.
▶ Go to www.irs.gov/Form990 for instructions and the latest information.

Open to Public
Inspection
Employer identification number

Name of the organization

Part I

Bond Issues
(a) Issuer name

(b) Issuer EIN

(c) CUSIP #

(d) Date issued

(e) Issue price

(f) Description of purpose

(g) Defeased

(h) On
behalf of
issuer

(i) Pooled
financing

Yes No Yes No Yes No

A
B
C
D

Part II

Proceeds
A

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

Amount of bonds retired . . . . . . .
Amount of bonds legally defeased
. . .
Total proceeds of issue . . . . . . .
Gross proceeds in reserve funds . . . .
Capitalized interest from proceeds . . .
Proceeds in refunding escrows . . . . .
Issuance costs from proceeds . . . . .
Credit enhancement from proceeds . . .
Working capital expenditures from proceeds
Capital expenditures from proceeds . . .
Other spent proceeds . . . . . . . .
Other unspent proceeds . . . . . . .
Year of substantial completion . . . . .

14

Were the bonds issued as part of a refunding issue of tax-exempt bonds (or,
if issued prior to 2018, a current refunding issue)? . . . . . . . . .
Were the bonds issued as part of a refunding issue of taxable bonds (or, if
issued prior to 2018, an advance refunding issue)? . . . . . . . . .

15
16
17

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B

C

D

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Yes

No

Yes

No

Yes

No

Yes

No

Has the final allocation of proceeds been made? . . . . . . . . . .
Does the organization maintain adequate books and records to support the
final allocation of proceeds?
. . . . . . . . . . . . . . . .

For Paperwork Reduction Act Notice, see the Instructions for Form 990.

Cat. No. 50193E

Schedule K (Form 990) 2021

Page 2

Schedule K (Form 990) 2021

Part III

Private Business Use
A

1

Was the organization a partner in a partnership, or a member of an LLC,
which owned property financed by tax-exempt bonds? . . . . . . . .
2
Are there any lease arrangements that may result in private business use of
bond-financed property? . . . . . . . . . . . . . . . . . .
3a Are there any management or service contracts that may result in private
business use of bond-financed property? . . . . . . . . . . . .
b If “Yes” to line 3a, does the organization routinely engage bond counsel or other outside
counsel to review any management or service contracts relating to the financed property?
c Are there any research agreements that may result in private business use of
bond-financed property? . . . . . . . . . . . . . . . . . .
d If “Yes” to line 3c, does the organization routinely engage bond counsel or other
outside counsel to review any research agreements relating to the financed property?
4
Enter the percentage of financed property used in a private business use by entities
other than a section 501(c)(3) organization or a state or local government . . . ▶
5

Enter the percentage of financed property used in a private business use as a
result of unrelated trade or business activity carried on by your organization,
another section 501(c)(3) organization, or a state or local government . . . ▶

6
7
8a

Total of lines 4 and 5 . . . . . . . . . . . . . . . . . . .
Does the bond issue meet the private security or payment test? . . . . .
Has there been a sale or disposition of any of the bond-financed property to a
nongovernmental person other than a 501(c)(3) organization since the bonds were issued?
If “Yes” to line 8a, enter the percentage of bond-financed property sold or
disposed of . . . . . . . . . . . . . . . . . . . . . .
If “Yes” to line 8a, was any remedial action taken pursuant to Regulations
sections 1.141-12 and 1.145-2? . . . . . . . . . . . . . . .

b
c

Has the organization established written procedures to ensure that all
nonqualified bonds of the issue are remediated in accordance with the
requirements under Regulations sections 1.141-12 and 1.145-2? . .

9

Part IV

.

Yes

B
No

Yes

Yes

D
No

Yes

No

%

%

%

%

%
%

%
%

%
%

%
%

%

%

%

%

.

Arbitrage
A

Has the issuer filed Form 8038-T, Arbitrage Rebate, Yield Reduction and
Penalty in Lieu of Arbitrage Rebate? . . . . . . . . . . . . . .

1

C
No

Yes

B
No

Yes

C
No

Yes

D
No

Yes

No

2

If “No” to line 1, did the following apply?
a Rebate not due yet? . . . . . . .
b Exception to rebate? . . . . . . .
c No rebate due? . . . . . . . . .
If “Yes” to line 2c, provide in Part VI the
performed . . . . . . . . . .

3

Is the bond issue a variable rate issue? .

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date
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the
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rebate computation
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was
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Schedule K (Form 990) 2021

Page 3

Schedule K (Form 990) 2021

Part IV

Arbitrage (continued)
A

4a

Has the organization or the governmental issuer entered into a qualified
hedge with respect to the bond issue? . . . . . . . . . . . . .

b
c
d
e
5a
b
c
d
6
7

Name of provider . . . . . . . . . . . . . . . . . . . .
Term of hedge . . . . . . . . . . . . . . . . . . . . .
Was the hedge superintegrated? . . . . . . . . . . . . . . .
Was the hedge terminated? . . . . . . . . . . . . . . . . .
Were gross proceeds invested in a guaranteed investment contract (GIC)? .
Name of provider . . . . . . . . . . . . . . . . . . . .
Term of GIC . . . . . . . . . . . . . . . . . . . . . .
Was the regulatory safe harbor for establishing the fair market value of the GIC satisfied?
Were any gross proceeds invested beyond an available temporary period? .
Has the organization established written procedures to monitor the
requirements of section 148? . . . . . . . . . . . . . . . .

Part V

Yes

B
No

Yes

No

Yes

Yes

No

Yes

D
No

Yes

No

Yes

No

Procedures To Undertake Corrective Action
A

Has the organization established written procedures to ensure that violations
of federal tax requirements are timely identified and corrected through the
voluntary closing agreement program if self-remediation isn’t available under
applicable regulations? . . . . . . . . . . . . . . . . . .

Part VI

C
No

Yes

B

C

D
No

Supplemental Information. Provide additional information for responses to questions on Schedule K. See instructions.

Schedule K (Form 990) 2021

Schedule K (Form 990) 2021

Part VI

Page 4

Supplemental Information. Provide additional information for responses to questions on Schedule K. See instructions. (continued)

Schedule K (Form 990) 2021