Form 4720 (1990) Page 5

SCHEDULE G.—Tax on Excess Lobbying Expenditures (Section 4911)

1 Excess of grass roots expenditures over grass roots nontaxable amount (from Schedule A Form 990),
Part VI, column (b), line 43). (See instructions before making entry.) . 1
2 Excess of lobbying expenditures over lobbying nontaxable amount (from Schedule A(Form 990), ‘Part VI,
column (b), line 44). (See instructions before making entry.) . . : 2
3. Taxable lobbying expenditures—enter the larger of line 1 or line 2 3
4_Tax—Enter 25% of line 3 here and on page 1, Part!,line6. 4

SCHEDULE H.—Taxes on Disqualifying Lobbying Expenditures (Section 4912)

Expenditures and Computation of Tax

, , (Tax imposed on organization
(item (b) Amount (c) Date paid | (4) Description of lobbying expenditures | (©) Tax ‘ngposed on ongenization manages t anplcabie)—
} of cal,

Total—column (e). Enter here and on page 1, PartI, line 7

Total—column (f). Enter total (or prorated amount) here and in Part I!, column (c), below_.
Summary of Tax Liability of Organization Managers and Proration of Payments
~ | (a) Manager's total tax liability

i , (0) tem no. from (6) Tax from Part I, col. (),
(a) Names of organization managers liable for tax Part |, col. (a) or prorated amount (ood | amounts ok fed)

Under penalties of perjury, | declare that | have examined this return, including accompanying schedules and statements, and to the best of my knowledge and belief itis true,
correct, and complete. Declaration of preparer (other than taxpayer) is based on all information of which preparer has any knowiedge

Signature of officer or trustee Title Date

Signature (and organization name if applicable) of self-dealer, foundation manager, or organization manager Date
‘Signature (and organization name if applicable) of self-dealer, foundation manager, or organization manager Date
Signature (and organization name if applicable) of self-dealer, foundation manager, or organization manager Date
Signature of individual or firm preparing the return ‘Address of preparer Date

*U.S. Government Printing Office: 1990 — 265-338


Form 4720 (1990) Page 4

SCHEDULE E.—Initial Taxes on Taxable Expenditures (Section 4945)

GET Expenditures and Computation of Tax
(e) Description of expenditure and purposes

(a) Item (b) Amount © Date pais (d) Name and address of recipient for which made

number

@ Question number from Form 990-PF, Part Vil, or C6) intial tax imposed on foundation (h) Initia! tax imposed on foundation managers
Form 5227, Part Vi. applicable to the expenditure (10% of coi. (b)) (if applicable)}— (lesser of $5,000 or 2%% of col. (b))

Total—column (g). Enter here and on page 1,
Parti, line4

Total—column (h). Enter total (or prorated amount) here and in Part ll, column (c), below.
Summary of Tax Liability of Foundation Managers and Proration of Payments

© Managers ttl tax abilty
(b) Item no. from (©) Tax from Part |, col. (h), (
(2) Names of foundation managers liable for tax Pane AY ‘or prorated amount (add amounts eo)

SCHEDULE F.—Initial Taxes on Political Expenditures (Section 4955)
[Part | Expenditures and Computation of Tax

(e) Initial tax imposed on (f) Initial tax Pita ret on managers
(@) item (b) Amount (0) Date paid () Description of political expenditure ‘organization or foundation (if applicable)
(10% of col. (b)) lesser of $4,000 oF 26% of col. (0)

Total—column (e). Enter here and on page 1, Part|, line 5 .

Total—column (f). Enter total (or prorated amount) here and in Part Il, column (c), below...
Summary of Tax Liability of Organization Managers or Foundation Managers and Proration of Payments
(c) Tax from Part 1, col. (N, (6) Manager's total tax liability

(b) Item no. trom
Part, col. (a) or prorated amount {add amour i201 (6)

{a) Names of organization managers or foundation managers liable for tax



Return of Certain Excise Taxes on Charities
and Other Persons Under Chapters 41
and 42 of the Internal Revenue Code

vm 4720

Department of the Treasury

Internal Revenue Service > See separate instructions.

(Sections 4911, 4912, 4941, 4942, 4943, 4944, 4945, and 4955)

OMB No. 1545-0052

1990

For the calendar year 1990 or other tax year beginning

‘Name of foundation or public’ charity

Employer identification number

Number, street, and room or suite no. (or P.O. box if mail is not delivered to street address)

Check box for type of annual return:

(J Form990 ~~] Form 990EZ
City or town, state, and ZIP code (1 Form 990-PF
OO Form 5227
Yes | No

Als the organization a foreign private foundation within the meaning’of section 4948(b)? .

B_ Has corrective action been taken on any transaction that resulted in Chapter 42 taxes being reported on this form? .
icable, enter the fair market value of

If “Yes,” attach a detailed documentation and description of the corrective action taken and, if appli
any property recovered as a result of the correction > $

. For any uncorrected acts,

attach explanation (see instructions).

Taxes on Private Foundation or Public Charity (Sections 4911(a), 4912(a), 4942(a), 4943(a), 4944(a)(1),

4945(a)(1), and 4955(a)(1))

1 Taxon undistributed income—Schedule B, fine 4. . (2
2 Taxon excess business holdings—Schedule C, line 7. . - L2
3 Tax on investments that jeopardize charitable purpose—Schedule D. Part i column | (e) - Ls
4 Taxon taxable expenditures—Schedule E, Part I, column (g) . rs . L4
5 Taxon political expenditures—Schedule F, Part |, column (e) . . pS fo
6 Taxon excess lobbying expenditures—ScheduleG,line4 . . . . . Ls
7 Taxon disqualifying lobbying expenditures Schedule H, Parti, column © . . LZ
8 Total(addlines1-7). . . . 8
i<4Simay Taxes on Self- dealers, Foundation “Managers, and ‘Organization Managers (ections 4912(b), 4941(a),
4944(aX(2), 4945(a)(2), and 4955(aX(2))
(#) Name and address of person subject to tax ide thre atetber
a
b
c
d
© Taxon self-dealing— (@) Tax on investments that jeopardize Tax on taxable expenditures-— 7 litical expenditures—
Schedile Fart ea, chanable prpse— Schedule, © Sehoouetstorica.c) |” Schade Part col 0)
a — ——
b
c
r]
Total
{) Tax on disqualifying lobbying expenditures— Schedule H, Part, col. (d) (h) Total—Add cols. (c) through (2)
a a
b
Cc
d
Total

Summary of Taxes (See General Instructions on Tax Payments)

Enter the total taxes listed in Part I-A, column (h), that apply to foundation managers, self-dealers,
and organization managers who sign this form. If alt sign, enter the total amount from Part Il-A,
column (h).

Total tax. Add Part |, line 28, “and Part M- B, tine 1. ‘ake check o or money order payable to Internal
Revenue Service.) .

1

2

For Paperwork Reduction Act Notice, see page 1 of the instructions.

Form 4720 (1990)


Form 4720 (1990)

Page 2

SCHEDULE A.—Initial Taxes on Self-dealing (Section 4941)

GREED Acts of Self-dealing and Tax Computation

(a) Act (b) Date
number of act

(€) Description of act

(@ Question number from Form 990-PF, Part VII,
or Form 5227, Part VI,
applicable to'the act

{e) Amount involved in act

(8) Initial tax on self-dealing
(5% of col. (e))

(@) Tax on foundation managers
a plicable) (lesser of
$10, or 2%4% of col. (e))

GAT Summary of Tax Liability of Self-dealers and Proration of Payments

(a) Names of self-deaters liable for tax

{b) Act no. from
Part I, col. (2)

(c) Tax from Part |, col. (f),
or prorated amount

(@) Self-dealer’s total tax
liability (add amounts
in col. (c)) (See instructions)

GERD summary of Tax Liability of Foundation Managers and Proration of Payments

(a) Names of foundation managers liable for tax

{b) Act no, from
Part |, col. (a)

(c) Tax trom Part |, col. (@),
or prorated amount

(@) Manager's total tax fability
(add amounts in col. (c))
(see instructions)

SCHEDULE B.—Initial Tax on Undistributed Income (Section

4942)

1 Undistributed income for years before 1989 (from Form 990-PF for 1990, Part XIV, line 6d):
a Enteryear _22 ooo. se Be
b Enteryear __. 1b
¢ Enteryear . bo le
2 Undistributed income for 1989 (from Form! 990- PF for 1990, Part xy, ‘line 6e) . wee 2
3 Total undistributed income at end of current tax year beginning i in 1990 and subject to tax under
section 4942 (add lines 1a, b, c, and 2). . . on ce ee ee ee LB
4 Tax—Enter 15% of line 3 here and on page 1, PartI, line 1 4



Form 4720 (1990) Page_3

SCHEDULE C.—Initial Tax on Excess Business Holdings (Section 4943)

Business Holdings and Computation of Tax

If you have taxable excess holdings in more than one business enterprise, attach a separate schedule for each enterprise.
Refer to the instructions for each line item before making any entries.

Name and address of business enterprise

Employer identification number . oa woe ee

Form of enterprise (corporation, partnership, trust, joint venture, sole proprietorship, etc.)

Votingstock ) o
Nonvoting stock

Seeiety | (srs
1 Foundation holdings in business enterprise . 1 %
2. Permitted holdings in business enterprise %
3 Value of excess holdings in business enterprise. . 3

Value of excess holdings disposed of within 90 days;

or, other value of excess holdings not subject to

section 4943 tax (attach explanation). 4
5 Taxable excess holdings in business enterprise—line

3 minus line 4 co ee DB
6 Tax—Enter 5% oflineS. |. & Wy Wy

y Yy

7 Total tax—Add amounts on line 6, columns (a), (b). Y/ 7] YY

and (c); enter total here and on page 1, Part! line2 . | 7 WY)

SCHEDULE D.—Initial Taxes on Investments That Jeopardize Charitable Purpose ‘Section “0a

Investments and Tax Computation

(2) Initiat tax on (Initia! tax on foundation
(a)investment {b) Date of (©) Descriotion of investment (@) Amount of foundation Tanagers (if applicable}—
(5% of col. (d)) | (lesser of $5,000 or 5% of col. (d))

Tota!—column (e). Enter here and on page 1, Part, line 3
Total—column (f). Enter total (or prorated amount) here and in Part iL column ©. below

Summary of Tax Liability of Foundation Managers and Proration of Payments

(b) Investment no. (€) Tax from Part |, col. (f), (4) Manager's total tax liability
(a) Names of foundation managers liable for tax ¢ (edd amounts in col. (c))
from Part |, cal. (a) or prorated amount (cee instructions)