Transactions With Interested Persons
SCHEDULE L
OMB No. 1545-0047
2012
(Form 990 or 990-EZ)
Complete if the organization answered
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“Yes” on Form 990, Part IV, line 25a, 25b, 26, 27, 28a, 28b, or 28c,
Department of the Treasury
or Form 990-EZ, Part V, line 38a or 40b.
Open To Public
Internal Revenue Service
Inspection
Attach to Form 990 or Form 990-EZ.
See separate instructions.
▶
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Name of the organization
Employer identification number
Part I
Excess Benefit Transactions (section 501(c)(3) and section 501(c)(4) organizations only).
Complete if the organization answered “Yes” on Form 990, Part IV, line 25a or 25b, or Form 990-EZ, Part V, line 40b.
(d) Corrected?
(b) Relationship between disqualified person and
1
(a) Name of disqualified person
(c) Description of transaction
organization
Yes
No
(1)
(2)
(3)
(4)
(5)
(6)
2
Enter the amount of tax incurred by the organization managers or disqualified persons during the year
under section 4958 .
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$
3
Enter the amount of tax, if any, on line 2, above, reimbursed by the organization
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$
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Part II
Loans to and/or From Interested Persons.
Complete if the organization answered “Yes” on Form 990-EZ, Part V, line 38a or Form 990, Part IV, line 26; or if the
organization reported an amount on Form 990, Part X, line 5, 6, or 22.
(a) Name of interested person
(b) Relationship
(c) Purpose of
(d) Loan to or
(e) Original
(f) Balance due
(g) In default? (h) Approved
(i) Written
with organization
loan
from the
principal amount
by board or
agreement?
organization?
committee?
Yes
No
Yes
No
Yes
No
To
From
(1)
(2)
(3)
(4)
(5)
(6)
(7)
(8)
(9)
(10)
$
Total
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Part III
Grants or Assistance Benefiting Interested Persons.
Complete if the organization answered “Yes” on Form 990, Part IV, line 27.
(a) Name of interested person
(b) Relationship between interested
(c) Amount of assistance
(d) Type of assistance
(e) Purpose of assistance
person and the organization
(1)
(2)
(3)
(4)
(5)
(6)
(7)
(8)
(9)
(10)
For Paperwork Reduction Act Notice, see the Instructions for Form 990 or 990-EZ.
Schedule L (Form 990 or 990-EZ) 2012
Cat. No. 50056A