Form 990-T - Exempt Organization Business Income Tax Return - 2012
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4990-T
Exempt Organization Business Income Tax Return
OMB No. 1545-0687
2012
Form
(and proxy tax under section 6033(e))
For calendar year 2012 or other tax year beginning
, 2012, and
Department of the Treasury
Open to Public Inspection for
ending
, 20
.
See separate instructions.
Internal Revenue Service
▶
501(c)(3) Organizations Only
Check box if
Name of organization (
Check box if name changed and see instructions.)
D Employer identification number
A
address changed
(Employees’ trust, see instructions.)
B Exempt under section
Print
) (
)
Number, street, and room or suite no. If a P.O. box, see instructions.
501(
or
E Unrelated business activity codes
408(e)
220(e)
Type
(see instructions)
City or town, state, and ZIP code
408A
530(a)
529(a)
C Book value of all assets
F Group exemption number (see instructions)
▶
at end of year
G Check organization type
501(c) corporation
501(c) trust
401(a) trust
Other 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? .
.
Yes
No
▶
If “Yes,” enter the name and identifying number of the parent corporation.
▶
J The books are in care of
Telephone number
▶
▶
Part I
Unrelated Trade or Business Income
(A) Income
(B) Expenses
(C) Net
1a Gross receipts or sales
b Less returns and allowances
c Balance
1c
▶
2
Cost of goods sold (Schedule A, line 7) .
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2
3
Gross profit. Subtract line 2 from line 1c .
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4a Capital gain net income (attach Schedule D)
4a
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b Net gain (loss) (Form 4797, Part II, line 17) (attach Form 4797)
4b
c Capital loss deduction for trusts
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4c
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Income (loss) from partnerships and S corporations (attach statement)
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6
Rent income (Schedule C)
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Unrelated debt-financed income (Schedule E) .
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Interest, annuities, royalties, and rents from controlled
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organizations (Schedule F) .
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Investment income of a section 501(c)(7), (9), or (17)
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organization (Schedule G)
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Exploited exempt activity income (Schedule I) .
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Advertising income (Schedule J)
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Other income (see instructions; attach statement) .
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12
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Total. Combine lines 3 through 12
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Part II
Deductions Not Taken Elsewhere (see instructions for limitations on deductions) (except for contributions,
deductions must be directly connected with the unrelated business income)
14
Compensation of officers, directors, and trustees (Schedule K) .
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14
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Salaries and wages
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Repairs and maintenance
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Bad debts
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Interest (attach statement)
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Taxes and licenses .
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Charitable contributions (see instructions for limitation rules) .
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20
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Depreciation (attach Form 4562)
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Less depreciation claimed on Schedule A and elsewhere on return .
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22a
22b
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Depletion .
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23
24
Contributions to deferred compensation plans
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Employee benefit programs .
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26
Excess exempt expenses (Schedule I)
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Excess readership costs (Schedule J)
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Other deductions (attach statement) .
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29
Total deductions. Add lines 14 through 28
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29
30
Unrelated business taxable income before net operating loss deduction. Subtract line 29 from line 13
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Net operating loss deduction (limited to the amount on line 30) .
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32
Unrelated business taxable income before specific deduction. Subtract line 31 from line 30 .
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Specific deduction (generally $1,000, but see line 33 instructions for exceptions)
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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 .
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34
990-T
For Paperwork Reduction Act Notice, see instructions.
Form
(2012)
Cat. No. 11291J
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