Instructions For Form 4720 - 2016 (Page 17 of 19) in pdf

How To Get Forms and

The CHNA must take into account input

online, visit the IRS website at

from persons who represent the broad

Publications

interests of the community served by

the hospital facility, including people

Internet. You can access the IRS

Paid Preparer Authorization

with special knowledge of or expertise

website 24 hours a day, 7 days a week,

On the “Sign Here” line, check “Yes,” if

in public health. The CHNA must be

at IRS.gov to:

the IRS can contact the paid preparer

made widely available to the public.

Download forms, including talking tax

who signed the return to discuss the

forms, instructions, and publications.

2. To adopt an implementation

return. This authorization applies only to

Order IRS products online.

strategy to meet the community health

the individual whose signature appears

Research your tax questions online.

needs identified through the CHNA.

in the Paid Preparer Use Only section of

Search publications online by topic or

Form 4720. It doesn't apply to the firm, if

See Notice 2011-52, 2011-30 I.R.B.

keyword.

any, shown in that section.

60; Proposed Regulations,

REG-130266-11, 78 F.R. 20523,

tax news by email.

By checking the “Yes box,” the

2012-32 I.R.B. 126; Notice 2014-2,

organization is authorizing the IRS to

By phone and in person. You can

2014-3 I.R.B. 407; Notice 2014-3,

contact the paid preparer to answer any

order forms and publications by

2014-3 I.R.B. 408; as well as any future

questions that arise during the

downloading from the IRS website at

related guidance for details. For

processing of the return. The

You can also

additional information on the CHNA

organization is also authorizing the paid

get most forms and publications at your

requirements, see Schedule H (Form

preparer to:

local IRS office.

990), Hospitals, Part V, Section B.

Give the IRS any information missing

Specific Instructions

IRS eServices Makes

from the return,

Call the IRS for information about

Taxes Easier

Part I. For each hospital facility, list the

processing the return, and

following information in the relevant

Now more than ever before, businesses

Respond to certain IRS notices about

column: (b) name of facility, (c)

can enjoy the benefits of filing and

math errors, offsets, and return

description of the failure to meet section

paying their federal taxes electronically.

preparation.

501(r)(3), (d) tax year hospital facility

Whether you rely on a tax professional

The organization isn't authorizing the

last conducted a CHNA, and (e) tax

or handle your own taxes, the IRS offers

paid preparer to bind the organization to

year hospital facility last adopted an

you convenient programs to make taxes

anything or otherwise represent the

implementation strategy.

easier. Use these electronic options to

organization before the IRS.

make filing and paying easier.

Part II. On line 1 enter the number of

You can e-file your Form 990 or Form

hospital facilities operated by the

The authorization will automatically

990-PF; Form 940 and 941 employment

hospital organization that failed to meet

end no later than the due date

tax returns; Forms 1099; and other

the CHNA requirements of section

(excluding extensions) for filing of the

information returns. Visit

501(r)(3). Enter $50,000 multiplied by

organization's 2017 Form 4720. If the

efile

for details.

line 1 on line 2 and on Part 1, line 12.

organization wants to expand the paid

You can pay taxes online or by phone

This is the CHNA excise tax under

preparer's authorization or revoke it

using the free Electronic Federal Tax

section 4959.

before it ends, see Pub. 947, Practice

Payment System (EFTPS). Visit

Before the IRS and Power of Attorney.

Paid Preparer

or call 1-800-555-4477

Check “No,” if the IRS should contact

for details. Electronic Funds Withdrawal

Generally, anyone who is paid to

the organization listed on the first page

(EFW) from a checking or savings

prepare the return must sign the return

of the Form 4720, rather than the paid

account also is available to those who

and fill in the other blanks in the Paid

preparer.

file electronically.

Preparer Use Only area. An employee

of the filing organization isn't a paid

Phone Help

Privacy Act and Paperwork Reduc

preparer.

tion Act Notice.

If you have questions and/or need help

We ask for the information on this form

completing this form, please call

The paid preparer must:

to carry out the Internal Revenue laws of

1-877-829-5500. This toll-free

Sign the return in the space provided

the United States. We need it to ensure

telephone service is available Monday

for the preparer's signature,

that you are complying with these laws

through Friday.

Enter the preparer information,

and to allow us to figure and collect the

Enter the preparer tax identification

Photographs of Missing

right amount of tax. Certain individuals

number (PTIN), and

who owe tax under Chapter 41 or 42 of

Children

Give a copy of the return to the

the Internal Revenue Code, and who

organization, in addition to the copy to

The Internal Revenue Service is a proud

don't sign the Form 4720 of the

be filed with the IRS.

partner with the

National Center for

foundation or organization, must file a

Any paid preparer whose

Missing & Exploited Children®

separate Form 4720 showing the tax

identifying number must be

(NCMEC). Photographs of missing

owed and the name of the foundation or

listed on Form 990-PF can

children selected by the Center may

organization for which they owe tax.

CAUTION

apply for and obtain a PTIN. You can

appear in instructions on pages that

Sections 6001 and 6011 of the Internal

apply for a PTIN online or by filing Form

would otherwise be blank. You can help

Revenue Code require you to provide

W-12, IRS Paid Preparer Tax

bring these children home by looking at

the requested information if the tax

Identification Number (PTIN)

the photographs and calling

applies to you. Section 6109 requires

Application and Renewal. For more

1-800-THE-LOST (1-800-843-5678) if

you to provide your identifying number.

information about applying for a PTIN

you recognize a child.

Form 4720 Instructions

Instructions For Form 4720 - 2016 Page 17

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