Sample Form 990-Pf - Return Of Private Foundation - 2015 Page 12
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1312
Form 990-PF (2015)
Page
Part XVI-A
Analysis of Income-Producing Activities
Unrelated business income
Excluded by section 512, 513, or 514
Enter gross amounts unless otherwise indicated.
(e)
Related or exempt
(a)
(b)
(c)
(d)
function income
Business code
Amount
Exclusion code
Amount
(See instructions.)
1 Program service revenue:
a
Community Healthcare/Education Support
6260
b
Community Patriotism
2090
c
d
e
f
g Fees and contracts from government agencies
2 Membership dues and assessments
.
.
.
.
3 Interest on savings and temporary cash investments
5
4 Dividends and interest from securities .
.
.
.
5 Net rental income or (loss) from real estate:
a Debt-financed property
.
.
.
.
.
.
.
b
Not debt-financed property
.
.
.
.
.
.
532000
173866
0
173866
6 Net rental income or (loss) from personal property
7 Other investment income .
.
.
.
.
.
.
.
8 Gain or (loss) from sales of assets other than inventory
9 Net income or (loss) from special events .
.
.
10 Gross profit or (loss) from sales of inventory .
.
722320
44121
0
44121
11 Other revenue: a
b
c
d
e
12 Subtotal. Add columns (b), (d), and (e) .
.
.
.
217987
0
217987
13 Total. Add line 12, columns (b), (d), and (e)
.
.
.
.
.
.
.
.
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.
13
217987
(See worksheet in line 13 instructions to verify calculations.)
Part XVI-B
Relationship of Activities to the Accomplishment of Exempt Purposes
Line No.
Explain below how each activity for which income is reported in column (e) of Part XVI-A contributed importantly to the
accomplishment of the foundation’s exempt purposes (other than by providing funds for such purposes). (See instructions.)
▼
1
Restricted Donations Educational Expenses/Veterans Services
3
All funds generated less expenses provide the facilities used by charitable organizations for charitable purposes
5
All funds generated less expenses provide the facilities used by charitable organizations for charitable purposes
9
All funds generated less expenses provide the facilities used by charitable organizations for charitable purposes
10
All funds generated less expenses provide the facilities used by charitable organizations for charitable purposes
11
All funds generated less expenses provide the facilities used by charitable organizations for charitable purposes
990-PF
Form
(2015)
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