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3a Did the organization have unrelated business gross Income of $1,000 or more during the year' ..........................................
<br />b If "Yes," has it filed a Form 990 T for Nis year? If "No,' to line 36, provide an explanation in Schedule O __.... .....................
<br />4e At any time during the calendar year, did the organization have an interest in, or a signature or other authority war,a
<br />financial account in a foreign country (such as a bank account, securities account, or other financial account)? .....................
<br />to If'Yea,"enter the name of the foreign country:►
<br />See Instructions for filing requirements for FinCEN Form 114, Report of Foreign Bank and Financial Accounts (FGAR).
<br />So Was the organization a party to a prohibited tax shelter transaction at any time during the tax year?...................................
<br />b Did any taxable party notify the organization that it was or is a party to a prohibited tax shelter transaction?...........................
<br />c If"Yel to line 5a or 5b, did the organization file Form Ill._,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,_.....................................
<br />6a Does the organization have annual gross receipts that are normally greater than $100,000, and did the organization solicit
<br />any contributions that were not tax deductible as charitable contributions?........................................................................
<br />b If "Yes," tlid the organization include with every solicitation an express statement that such contributions or gifts
<br />were not tax deductible?
<br />........................ .... ....._._...._ _._............ ......... ........._.
<br />7 Organlzatlons Nat may receive deductible contributions under section 170(c).
<br />a Did the organization receive a payment in excess of$75madepartly as a conticutien and padlyfor goods and services provided to the payer?
<br />b If "Yes," did the organization notify the donor of the value of the goods or services provided?
<br />.............................................
<br />c Did the organization sell, exchange, or otherwise dispose of tangible personal property for which it was required
<br />tofile Form 8282?..................................--.....................................................................................................................
<br />d If "Yes,' indicate the number of Forms 8282 filed during the year................................................ 17d
<br />e Did the organization receive any funds. directly or indirectly, to pay premiums on a personal benefit contract?
<br />.....................
<br />f Did the organization, during the year, pay premiums, directly or indirectly, on a personal benefit contract? ...........................
<br />g If the organization received a contribution of qualified Intellectual property, did the organization file Form 8899 as required?._.
<br />h If Ne organization received a contribution of cars, boats, airplanes, or other vehicles, did the organization file a Form 10981
<br />8 Sponsoring organizations maintaining donor advised funds. Did a donor advised fund maintained by the
<br />sponsoring organization have excess business holdings at any time during the year' ..............
<br />8 Sponsoring organizations maintaining donor advised funds.
<br />a Did the sponsoring organization make any taxable distributions under section 4966?.........................................................
<br />b Did the sponsoring organization make a distribution to a donor, donor advisor, or related person? .......................................
<br />10 Section 501(c)(7) organizations. Enter.
<br />a Initiation fees and capital contributions included on Part VIII, Tina 12,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, 10a
<br />b Gross receipts, included on Form 990, Part VIII, line 12, for public use of club facili ies .................. lob
<br />II Section ti01(el(12) organizations. Fater.
<br />a Gross income from members or shareholders ............................................................................. Ila
<br />am
<br />b Gross income from other sources (Do not meounts due or paid to.other sources against
<br />amounts due or received from them.).......................................................................................... 111,
<br />12a Section 4947(a)(1) non-exempt charitable trusts. lathe organization filing Fonn 990 in Imu of Form 1041?
<br />b If'Yes," enterthe amount of taxexempt interest received or accrued during the year .................. I 12b
<br />13 Section 501(c)(29) qualified nonprofit health insurance issuers.
<br />a Is the organization licensed to issue qualified health plans in more than one state?...............................................................
<br />NOW. See Ne instructions for additional information the organization must report on Schedule O.
<br />b Enter Ne amount of reserves the organization is required to maintain by the states in which Ne
<br />organization is licensed to issue qualified health plans .....................................................13b
<br />.............
<br />c Enter the amount of reserves on hand.......................................................................................... 13c
<br />14a Did the organization receive any payments for indoortanning services during the tax year?
<br />Form
<br />Mill 11-11-10 Attachment number 21n
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