Form 990 Part V

Enter the number reported in box 3 of Form 1096. Enter -0- if not applicable

Line 1a. The organization must use Form 1096, Annual Summary and Transmittal of U.S. Information Returns, to transmit to the IRS paper Forms 1099, 1098, 5498, and W-2G. Report all such returns filed for the calendar year ending with or within the organization’s tax year. If the organization transmits any of these forms electronically, add this number to the total reported. Examples of payments requiring Form 1099 reporting include certain payments to independent contractors for services rendered. Report on this line any such forms filed by reporting agents, including common paymasters and payroll agents. Enter -0- if the organization didn’t file any such forms for the calendar year ending with or within its tax year.

Enter the number of Forms W-2G included on line 1a. Enter -0- if not applicable

Line 1b. Form W-2G pertains to certain gambling winnings.

Did the organization comply with backup withholding rules for reportable payments to vendors and reportable gaming (gambling) winnings to prize winners?

Part V Line 1c. Enter “Yes” if the organization complied with backup withholding rules for reportable payments it made during the year.

For more information on backup withholding, see Pub. 1281, Backup Withholding for Missing and Incorrect Name/TIN(s). If backup withholding rules didn’t apply to the organization because it didn’t make a reportable payment to a vendor or provide reportable gaming (gambling) winnings to a prize winner, then leave line 1c blank.

Enter the number of employees reported on Form W-3, Transmittal of Wage and Tax Statements, filed for the calendar year ending with or within the year covered by this return

Line 2a. Include on this line the number of the organization’s employees (not the number of Forms W-2) reported on a Form W-3, Transmittal of Wage and Tax Statements, by both the filing organization and its reporting agents for the calendar year ending with or within the filing organization’s tax year. Enter -0- if the organization didn’t have any employees during that period.

If at least one is reported on line 2a, did the organization file all required federal employment tax returns?

Line 2b. If the organization reported at least one employee on line 2a, answer whether the organization or its reporting agents filed all required federal employment tax returns (which include Form 940, Employer’s Annual Federal Unemployment (FUTA) Tax Return; and Form 941, Employer’s QUARTERLY Federal Tax Return) relating to such employees. For more information, see the discussion of employment taxes in Pub. 557. The organization may leave line 2b blank if it didn’t report any employees on line 2a.

Did the organization have unrelated business gross income of $1,000 or more during the year?

Line 3a. Check “Yes” on line 3a if the organization’s total gross income from all of its unrelated trades or businesses is $1,000 or more for the tax year. See Pub. 598, Tax on Unrelated Business Income of Exempt Organizations, for a description of unrelated business income and the Form 990-T filing requirements for organizations having such income.

If “Yes,” has it filed a Form 990-T for this year?

Line 3b. Answer “Yes” if the organization checked “Yes” on line 3a and filed Form 990-T by the time this Form 990 is filed. Check “No” if the organization answered “Yes” on line 3a but hasn’t filed Form 990-T by the time this Form 990 is filed, even if the organization has applied for an extension to file Form 990-T. If “No” on line 3b, provide an explanation on Schedule O (Form 990).

At any time during the calendar year, did the organization have an interest in, or a signature or other authority over, a financial account in a foreign country (such as a bank account, securities account, or other financial account)?

Line 4a. Answer “Yes” if either (1) or (2) below applies.

1. At any time during the calendar year ending with or within the organization’s tax year, the organization had an interest in, or signature or other authority over, a financial account in a foreign country (such as a bank account, securities account, or other financial account); and
   
   
   
   • The combined value of all such accounts was more than $10,000 at any time during the calendar year; and
   
   
   • The accounts weren’t with a U.S. military banking facility operated by a U.S. financial institution.
   
   
2. The organization owns more than 50% of the stock in any corporation that would answer “Yes” to item 1 above.

If “Yes,” electronically file FinCEN Form 114, Report of Foreign Bank and Financial Accounts (FBAR), with the Department of the Treasury using FinCEN’s BSA E-Filing System. Because FinCEN Form 114 isn’t a tax form, don’t file it with Form 990. See FinCEN.gov for more information.

If “Yes,” enter the name of the foreign country:

See instructions for filing requirements for FinCEN Form 114, Report of Foreign Bank and Financial Accounts (FBAR).

Line 4b. Enter the name of each foreign country in which a foreign account described on line 4a is located. Use Schedule O (Form 990) if more space is needed.

Was the organization a party to a prohibited tax shelter transaction at any time during the tax year?

Line 5a. Answer “Yes” if the organization was a party to a prohibited tax shelter transaction as described in § 4965(e) at any time during the organization’s tax year. A prohibited tax shelter transaction is any listed transaction (as defined in § 6707A(c)(2)) and any prohibited reportable transaction (a confidential transaction or a transaction with contractual protection). For more information, visit IRS.gov.

Did any taxable party notify the organization that it was or is a party to a prohibited tax shelter transaction?

Line 5b. Answer “Yes” if any taxable party notified the organization that it was or is a party to a prohibited tax shelter transaction. The definition of the transaction is the same as for line 5a.

If “Yes” to line 5a or 5b, did the organization file Form 8886-T?

Line 5c. If the organization answered “Yes” to line 5a or 5b, it must file Form 8886-T, Disclosure by Tax-Exempt Entity Regarding Prohibited Tax Shelter Transaction. The organization may also have to file Form 4720, Return of Certain Excise Taxes, and pay an excise tax imposed by § 4965. For more details, see the instructions for these forms.

Does the organization have annual gross receipts that are normally greater than $100,000, and did the organization solicit any contributions that were not tax deductible as charitable contributions?

Line 6a. Answer “Yes” on this line only if the organization has annual gross receipts that are normally greater than $100,000 and if it solicited contributions not deductible under § 170 during the tax year.

All organizations that qualify under § 170(c) to receive contributions that are deductible as charitable contributions (such as most domestic § 501(c)(3) organizations) should answer “No” on this line.

If “Yes,” [to 6a] did the organization include with every solicitation an express statement that such contributions or gifts were not tax deductible?

Line 6b. Any fundraising solicitation (including solicitation of member dues) by or on behalf of any § 501(c) or § 527 organization that isn’t eligible to receive contributions deductible as charitable contributions for federal income tax purposes must include an explicit statement that contributions or gifts to it aren’t deductible as charitable contributions. The statement must be in an easily recognizable format whether the solicitation is made in written or printed form, by television or radio, or by telephone.

Organizations that may receive deductible contributions under section 170(c).

Line 7. is directed only to organizations that can receive deductible charitable contributions under § 170(c). For a description of such organizations, see Pub. 526, Charitable Contributions. All other organizations should leave lines 7a through 7h blank and go to line 8.

Did the organization receive a payment in excess of $75 made partly as a contribution and partly for goods and services provided to the payor?

Line 7a. If a donor makes a payment in excess of $75 partly as a contributions and partly in consideration for goods or services provided by the organization, the organization must generally notify the donor of the value of goods and services provided.

If “Yes,” did the organization notify the donor of the value of the goods or services provided?

Line 7b. If a donor makes a payment in excess of $75 partly as a contributions and partly in consideration for goods or services provided by the organization, the organization must generally notify the donor of the value of goods and services provided.

Example: A donor gives a charity $100 in consideration for a concert ticket valued at $40 (a quid pro quo contribution). In this example, $60 would be deductible. Because the donor’s payment exceeds $75, the organization must furnish a disclosure statement even though the taxpayer’s deductible amount doesn’t exceed $75. Separate payments of $75 or less made at different times of the year for separate fundraising events won’t be aggregated for purposes of the $75 threshold.

Did the organization sell, exchange, or otherwise dispose of tangible personal property for which it was
required to file Form 8282?

Line 7c. If the organization is required to file Form 8282, Donee Information Return, to report information to the IRS and to donors about dispositions of certain donated property made within 3 years after the donor contributed the property, it must answer “Yes” on line 7c and indicate the number of Forms 8282 filed on line 7d.

If “Yes,” indicate the number of Forms 8282 filed during the year.

Line 7d. If the organization is required to file Form 8282, Donee Information Return, to report information to the IRS and to donors about dispositions of certain donated property made within 3 years after the donor contributed the property, it must answer “Yes” on line 7c and indicate the number of Forms 8282 filed on line 7d.

Did the organization receive any funds, directly or indirectly, to pay premiums on a personal benefit contract?

Line 7e. If, in connection with a transfer to or for the use of the organization, the organization directly or indirectly pays premiums on any personal benefit contract, or there is an understanding that any person will directly or indirectly pay such premiums, the organization must report on Form 8870, Information Return for Transfers Associated With Certain Personal Benefit Contracts. The organization must also report and pay an excise tax on Form 4720.

Did the organization, during the year, pay premiums, directly or indirectly, on a personal benefit contract?

Line 7f. If, in connection with a transfer to or for the use of the organization, the organization directly or indirectly pays premiums on any personal benefit contract, or there is an understanding that any person will directly or indirectly pay such premiums, the organization must report on Form 8870, Information Return for Transfers Associated With Certain Personal Benefit Contracts. The organization must also report and pay an excise tax on Form 4720.

If the organization received a contribution of qualified intellectual property, did the organization file Form 8899 as required?

Line 7g. Form 8899, Notice of Income From Donated Intellectual Property, must be filed by certain organizations that received a charitable gift of qualified intellectual property that produces net income. If the organization didn’t receive such a contribution, leave this line blank.

If the organization received a contribution of cars, boats, airplanes, or other vehicles, did the organization file a Form 1098-C?

Line 7h. A donor of a motor vehicle, boat, or airplane cannot claim a deduction in excess of $500 unless the donee organization provides the donor with a Form 1098-C, Contributions of Motor Vehicles, Boats, and Airplanes. If the organization didn’t receive such a contribution, leave this line blank.

Sponsoring organizations maintaining donor advised funds. Did a donor advised fund maintained by the sponsoring organization have excess business holdings at any time during the year?

Line 8. A sponsoring organization of a donor advised fund must answer “Yes” if any one of its donor advised funds had excess business holdings at any time during the organization’s tax year. All other organizations should leave this line blank and go to line 9. If “Yes,” see the instructions for Schedule C of Form 4720 to determine whether the organization is subject to the excess business holdings tax under § 4943 and is required to file Form 4720.

For purposes of the excise tax on excess business holdings under § 4943, a donor advised fund is treated as a private foundation.

Sponsoring organizations maintaining donor advised funds.

Line 9. is required to be completed only by sponsoring organizations that maintain a donor advised fund. All other organizations can leave this line blank and go to line 10.

Did the sponsoring organization make any taxable distributions under section 4966?

Line 9a. Answer “Yes” if the organization made any taxable distributions under § 4966 during the organization’s tax year. If “Yes,” complete and file Form 4720, Schedule K, to calculate and pay the tax.

Under § 4966, a taxable distribution includes a distribution from a donor advised fund to an individual. It also includes a distribution to any other entity unless:

• The distribution is for a purpose described in § 170(c)(2)(B) (for example, a charitable purpose), and


• The organization exercises expenditure responsibility for the distribution.

This does not apply to distributions to organizations described in § 170(b)(1)(A) (other than a disqualified supporting organization), to the sponsoring organization itself, or to any other donor advised fund.

Did the sponsoring organization make a distribution to a donor, donor advisor, or related person?

Line 9b. Answer “Yes” if the organization made a distribution from a donor advised fund to a donor, donor advisor, or related person during the organization’s tax year. A related person includes a family member or a 35% controlled entity (as defined in § 4958(f)). If “Yes,” complete and file Form 4720 and Schedule L (Form 990).

Section 501(c)(7) organizations. Enter:

Line 10. Answer lines 10a and 10b only if the organization is exempt under § 501(c)(7).

Initiation fees and capital contributions included on Part VIII, line 12.

Line 10a. Enter the amount of initiation fees, capital contributions, and unusual amounts of income included on Part VIII, line 12, but not included in the definition of gross receipts for § 501(c)(7) exemption purposes as discussed in Appendix C. However, if the organization is a college fraternity or sorority that charges membership initiation fees but not annual dues, don’t include such initiation fees.

Gross receipts, included on Form 990, Part VIII, line 12, for public use of club facilities.

Line 10b. Enter the amount of gross receipts included on Part VIII, line 12, derived from the general public for use of the organization’s facilities, that is, from persons other than members or their spouses, dependents, or guests.

Section 501(c)(12) organizations. Enter:

Line 11. Answer lines 11a and 11b only if the organization is exempt under § 501(c)(12).

One of the requirements that an organization must meet to qualify under § 501(c)(12) is that at least 85% of its gross income consists of amounts collected from members for the sole purpose of meeting losses and expenses. For purposes of § 501(c)(12), the term “gross income” means gross receipts without reduction for any cost of goods sold.

Member income for purposes of this 85% Member Income Test is income derived directly from the members to pay for services that form the basis for tax exemption, and includes payments for purchases of water, electricity, and telephone service. Member income doesn’t include interest income, gains from asset or security sales, or dividends from another cooperative (unless that cooperative is also a member).

When calculating the member income percentage to determine whether an organization meets the 85% Member Income Test, the organization may exclude specific sources of income from both the numerator and the denominator of the fraction. For example, if an organization is a corporation and it receives an amount that qualifies as a contribution to capital under § 118, then that amount isn’t included because it isn’t considered to be income for tax purposes. However, the payment must meet the following conditions (see Rev. Rul. 93-16) to qualify as a contribution to capital:

• It must become a permanent part of the organization’s working capital.


• It must not be compensation for specific quantifiable services.


• It must be bargained for.


• It must benefit the organization commensurately with its value.


• It must ordinarily be used in or contribute to the production of additional income.

Gross income for mutual or cooperative electric companies is figured by excluding any income received or accrued from the following:

1. Qualified pole rentals.


2. Any provision or sale of electric energy transmission services or ancillary services if the services are provided on a nondiscriminatory, open-access basis.


3. The provision or sale of electric energy distribution services or ancillary services under certain conditions.


4. From any nuclear decommissioning transaction.


5. From any asset exchange or conversion transaction.

For a mutual or cooperative telephone company, gross income doesn’t include amounts received or accrued from other telephone companies for completing long distance calls, from qualified pole rentals, from the sale of display listings in a directory, or from prepayment of a loan under the Rural Electrification Act of 1936.

Gross income from members or shareholders.

Line 11a. Gross income from members or shareholders.

Gross income from other sources. (Do not net amounts due or paid to other sources against amounts due or received from them.)

Line 11b. Gross income from other sources. (Do not net amounts due or paid to other sources against amounts due or received from them.)

Section 4947(a)(1) non-exempt charitable trusts. Is the organization filing Form 990 in lieu of Form 1041?

Line 12a. All organizations that aren’t § 4947(a)(1) trusts are to leave line 12 blank. The following instructions apply only to such trusts.

If a § 4947(a)(1) nonexempt charitable trust has no taxable income under subtitle A, its filing of Form 990 can be used to meet its income tax return filing requirement under § 6012. Such a trust must, if it answers “Yes” on line 12a, report its tax-exempt interest received or accrued during the tax year on line 12b

§ 4947(a)(1) trusts must complete all sections of the Form 990 and schedules that § 501(c)(3) organizations must complete. All references to a § 501(c)(3) organization on the Form 990, schedules, and instructions shall include a § 4947(a)(1) trust (for instance, such a trust must complete Schedule A (Form 990), unless expressly excepted).

If “Yes,” enter the amount of tax-exempt interest received or accrued during the year.

If a § 4947(a)(1) nonexempt charitable trust has no taxable income under subtitle A, its filing of Form 990 can be used to meet its income tax return filing requirement under § 6012. Such a trust must, if it answers “Yes” on line 12a, report its tax-exempt interest received or accrued during the tax year on line 12b

Section 501(c)(29) qualified nonprofit health insurance issuers.

Line 13. Answer lines 13a, 13b, and 13c only if the organization has received a loan or grant under the Department of Health and Human Services CO-OP program.

Is the organization licensed to issue qualified health plans in more than one state?
Note: See the instructions for additional information the organization must report on Schedule O.

Line 13a. If the organization is licensed to issue qualified health plans in more than one state, check “Yes.” If the organization is licensed to issue qualified health plans in only one state, check “No.” In either case, report on Schedule O (Form 990) each state in which the organization is licensed to issue qualified health plans, the dollar amount of reserves each state requires the organization to maintain, and the dollar amount of reserves the organization maintains and reports to each state.

Enter the amount of reserves the organization is required to maintain by the states in which the organization is licensed to issue qualified health plans.

Line 13b. Report the highest dollar amount of reserves the organization is required to maintain by any of the states in which the organization is licensed to issue qualified health plans.

Enter the amount of reserves on hand.

Line 13c. Report the highest dollar amount of reserves the organization maintains on hand and reports to a state in which the organization is licensed to issue qualified health plans.

Did the organization receive any payments for indoor tanning services during the tax year?

Line 14a. Answer “Yes” on line 14a if the organization received any payments during the year for indoor tanning services.

“Indoor tanning services” are services employing any electronic product designed to incorporate one or more ultraviolet lamps and intended for the irradiation of an individual by ultraviolet radiation, with wavelengths in air between 200 and 400 nanometers, to induce skin tanning.

If “Yes,” has it filed a Form 720 to report these payments?

If “No,” provide an explanation on Schedule O.

Line 14b. If an organization received a payment for services for indoor tanning services during the year, it must collect from the recipient of the services a tax equal to 10% of the amount paid for such service, whether paid by insurance or otherwise, and remit such tax quarterly to the IRS by filing Form 720, Quarterly Federal Excise Tax Return. If the organization filed Form 720 during the year, it should check “Yes” on line 14b. If it answers “No” on line 14b, it should explain on Schedule O (Form 990) why it didn’t file Form 720.

Is the organization subject to the section 4960 tax on payment(s) of more than $1,000,000 in remuneration or excess parachute payment(s) during the year?

If “Yes,” see the instructions and file Form 4720, Schedule N.

Line 15. See the instructions for Form 4720, Schedule N, to determine if you paid to any covered employee more than $1 million in remuneration or paid an excess parachute payment during the year. Remuneration paid to a covered employee includes any remuneration paid by a related organization.

Is the organization an educational institution subject to the section 4968 excise tax on net investment income?

If “Yes,” complete Form 4720, Schedule O.

Line 16. Line 16 applies to private colleges and universities subject to the excise tax on net investment income under § 4968. All other organizations, including state colleges and universities described in § 511(a)(2)(B), aren’t subject to this tax, and therefore check the “No” box on line 16, and go to Part VI. A private college or university will be subject to the excise tax on net investment income under § 4968 only if four threshold tests are met.

1. The organization must be an eligible educational institution as defined in § 25A(f)(2).


2. The organization must have had at least 500 tuition-paying students, based upon a daily average student count, during the preceding tax year.


3. More than 50% of those students must have been located in the United States.


4. The aggregate FMV, at the end of the preceding tax year, of the assets not used directly in carrying out the organization’s exempt purpose, held by the organization and related organizations, must be at least $500,000 per student.

Section 501(c)(21) organizations.

Did the trust, or any disqualified person or other person, engage in any activities that would result in the imposition of an excise tax under § 4951, § 4952, or § 4953? If “Yes,” complete Form 6069.

Did the trust, or any disqualified person or other person, engage in any activities that would result in the imposition of an excise tax under § 4951, § 4952, or § 4953? If “Yes,” complete Form 6069.