Exempt Organization Business Income Tax Return

Form 990-T

 See separate instructions. Department of the Treasury

Internal Revenue Service

D Employer 

(Employees’ t

on page 7.) Please

Print or

Type

Number, street, and room or suite no. (If a P.O. box, see page 7 of instructions.)

E New unre

(See instruc

City or town, state, and ZIP code

B Exempt under section

Check box if A address changed

G Check organization type  501(c) corporation

F Group exemption number (see instructions for Block F on page 7) 

501(c) trust 401(a) trus

501( )( )

408(e)

Cat. No. 11291J

H

I

Describe the organization’s primary unrelated business activity. 

During the tax year, was the corporation a subsidiary in an affiliated group or a parent-subsidiary controlled group? 

If “Yes,” enter the name and identifying number of the parent corporation. 

Unrelated Trade or Business Income

1c

1a

Less returns and allowances c Balance 

Gross receipts or sales

2 Cost of goods sold (Schedule A, line 7) 2

3 Gross profit (subtract line 2 from line 1c) 3

4a Capital gain net income (attach Schedule D) 4a

Net gain (loss) (Form 4797, Part II, line 17) (attach Form 4797) 4b b

c Capital loss deduction for trusts 4c

5 Income (loss) from partnerships and S corporations (attach statement) 5

6 Rent income (Schedule C) 6

7 Unrelated debt-financed income (Schedule E) 7

8

Investment income of a section 501(c)(7), (9), or (17)

organization (Schedule G)

8

9

Interest, annuities, royalties, and rents from controlled

organizations (Schedule F)

9

10 Exploited exempt activity income (Schedule I) 10

11 Advertising income (Schedule J) 11

12 Other income (see page 9 of the instructions—attach schedule) 12

13 Total (combine lines 3 through 12) 13

Deductions Not Taken Elsewhere (See page 9 of the instructions for limitations on deduction

(Except for contributions, deductions must be directly connected with the unrelated business 

14 Compensation of officers, directors, and trustees (Schedule K) 14

15 Salaries and wages 15

16 Repairs and maintenance 16

17 Bad debts 17

18 Interest (attach schedule) 18

19 Taxes and licenses 19

20 Charitable contributions (see page 11 of the instructions for limitation rules) 20

21 21 Depreciation (attach Form 4562)

22 Less depreciation claimed on Schedule A and elsewhere on return 22a 22b

23 Depletion 23

24 Contributions to deferred compensation plans 24

Employee benefit programs 25

28 Other deductions (attach schedule)

26

29 Total deductions (add lines 14 through 28)

27

28

29

30 Unrelated business taxable income before net operating loss deduction (subtract line 29 from line 13) 30

31 Net operating loss deduction 31

32 Unrelated business taxable income before specific deduction (subtract line 31 from line 30) 32

33 Specific deduction (Generally $1,000, but see line 33 instructions for exceptions)

34 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

Part I

Part II

Excess readership costs (Schedule J)

Excess exempt expenses (Schedule I)

25

26

27

33

34

b

(A) Income (B) Expenses 

For Privacy Act and Paperwork Reduction Act Notice, see instructions.

C Book value of all assets

at end of year

(and proxy tax under section 6033(e))

J The books are in care of  Telephone number  ( 

220(e)

408A 530(a)

529(a)

For calendar year 2004 or other tax year beginning

Name of organization ( check box if name changed and see instructions)

, 2004, and ending , 20 
Form 990-T (2004) Page 2

Statements Regarding Certain Activities and Other Information (See instructions on page 15.)

Yes No 1 At any time during the 2004 calendar year, did the organization have an interest in or a signature or other authority over

a financial account in a foreign country (such as a bank account, securities account, or other financial account)?

2 During the tax year, did the organization receive a distribution from, or was it the grantor of, or transferor to, a foreign trust?

If “Yes,” see page 15 of the instructions for other forms the organization may have to file.

3 Enter the amount of tax-exempt interest received or accrued during the tax year  $

Schedule A—Cost of Goods Sold — Enter method of inventory valuation 

1 Inventory at beginning of year 1 6 Inventory at end of year 6

2 Purchases 2 Cost of goods sold. Subtract line

6 from line 5. (Enter here and on

line 2, Part I.)

7

3 Cost of labor 3

7 Additional section 263A costs

(attach schedule)

4a

4a Do the rules of section 263A (with respect to Yes No

property produced or acquired for resale) apply

to the organization?

8

b Other costs (attach schedule) 4b

5 Total—Add lines 1 through 4b 5

If “Yes,” the organization may have to file Form TD F 90-22.1. If “Yes,” enter the name of the foreign country

here 

Part V

Organizations Taxable as Corporations (see instructions for tax computation on page 12).

Controlled group members (sections 1561 and 1563)—check here . See instructions and:

35

a Enter your share of the $50,000, $25,000, and $9,925,000 taxable income brackets (in that order):

(1) $ (2) $

$

b

36

Income tax on the amount on line 34  35c

Trusts Taxable at Trust Rates (see instructions for tax computation on page 13). Income tax on

the amount on line 34 from: Tax rate schedule or Schedule D (Form 1041)  36

40a Foreign tax credit (corporations attach Form 1118; trusts attach Form 1116) 40a

b Other credits (see page 14 of the instructions) 40b

General business credit—Check here and indicate which forms are attached:

Form 3800 Form(s) (specify) 

c

40c

d Credit for prior year minimum tax (attach Form 8801 or 8827) 40d

Total credits (add lines 40a through 40d) 40e

41 Subtract line 40e from line 39 41

42 Other taxes. Check if from: Form 4255 Form 8611 Form 8697 Form 8866 Other (attach schedule) 42

38 Alternative minimum tax 38

43 Total tax (add lines 41 and 42) 43

44a Payments: A 2003 overpayment credited to 2004 44a

b 2004 estimated tax payments 44b

c Tax deposited with Form 8868 44c

d Foreign organizations—Tax paid or withheld at source (see instructions) 44d

45 Total payments (add lines 44a through 44f) 45

46 Estimated tax penalty (see page 4 of the instructions). Check  if Form 2220 is attached 46

47 Tax due—If line 45 is less than the total of lines 43 and 46, enter amount owed  47

48 Overpayment—If line 45 is larger than the total of lines 43 and 46, enter amount overpaid  48

49 Enter the amount of line 48 you want: Credited to 2005 estimated tax  Refunded  49

c

Part III

Part IV

Tax Computation

37 Proxy tax (see page 13 of the instructions) 

Tax and Payments

37

(3) $

Enter organization’s share of: (1) additional 5% tax (not more than $11,750) $

(2) additional 3% tax (not more than $100,000)

e

39 Total (add lines 37 and 38 to line 35c or 36, whichever applies) 39

e Backup withholding (see instructions) 44e

Under penalties of perjury, I declare that I have examined this return, including accompanying schedules and statements, and to the best of my knowledge and belief, it is true,

correct, and complete. Declaration of preparer (other than taxpayer) is based on all information of which preparer has any knowledge. Sign

Here

Signature of officer Date Title

Date Preparer’s SSN or PTIN Preparer’s

signature

Check if

self-employed

Paid

Preparer’s

Use Only

Firm’s name (or

yours if self-employed),

address, and ZIP code

EIN

Phone no. ( )

Form 990-T (2004)

May the IRS discuss this return with

the preparer shown below (see

instructions)? Yes No









Form 4136 Other Total  44f

f Other credits and payments: Form 2439
Form 990-T (2004) 

Schedule C—Rent Income (From Real Property and Personal Property Leased With Real Prope

(See instructions on page 16.)

1 Description of property

Total income (Add totals of columns 2(a) and 2(b). Enter

here and on line 6, column (A), Part I, page 1.)  

Schedule E—Unrelated Debt-Financed Income (See instructions on page 17.)

3 Deductions directly connected w

debt-financed prope

2 Gross income from or

allocable to debt-financed

property

1 Description of debt-financed property (b) 

(a

(a) Straight line depreciation

(attach schedule)

6 Column 4

divided by

column 5

5 Average adjusted basis of

or allocable to

debt-financed property

(attach schedule)

4 Amount of average

acquisition debt on or

allocable to debt-financed

property (attach schedule)

7 Gross income reportable

(column 2  column 6)

8 Al

(column 

%

%

%

%

Totals 

Total dividends-received deductions included in column 8 

(1)

(2)

(3)

(4)

(a) From personal property (if the percentage of rent

for personal property is more than 10% but not

more than 50%)

(b) From real and personal property (if the

percentage of rent for personal property exceeds

50% or if the rent is based on profit or income)

3 Deductions directly connecte

columns 2(a) and 2(b) (att

Total deductions. Enter

here and on line 6, column

(B), Part I, page 1  

Total Total

2 Rent received or accrued

(1)

(2)

(3)

(4)

Enter here and on line 7,

column (A), Part I, page 1.

Enter h

column 

(1)

(2)

(3)

(4)

(1)

(2)

(3)

(4)

3 Net unrelated income

(loss) (see instructions)

4 Total of specified

payments made

5 Part of column (4) that is

included in the controlling

organization’s gross income

2 Employer

Identification Number

6 

co

1 Name of Controlled

Organization

(1)

(2)

(3)

(4)

9 Total of specified

payments made

10 Part of column (9) that is

included in the controlling

organization’s gross income

11 D

connec

8 Net unrelated income

(loss) (see instructions) 7 Taxable Income

(1)

(2)

(3)

(4)

Add columns 5 and 10. Enter

here and on line 8, Column (A),

Part I, page 1.

Add colu

here and 

Part I, p

Nonexempt Controlled Organizations

Schedule F—Interest, Annuities, Royalties, and Rents From Controlled Organizations (See instruct

Exempt Controlled Organizations

Totals 
Form 990-T (2004) 

Schedule I—Exploited Exempt Activity Income, Other Than Advertising Income

(See instructions on page 18.)

3 Expenses

directly

connected with

production of

unrelated

business income

4 Net income

(loss) from

unrelated trade

or business

(column 2 minus

column 3). If a

gain, compute

cols. 5 through 7.

5 Gross income

from activity that

is not unrelated

business income

2 Gross

unrelated

business income

from trade or

business

6 Expenses

attributable to

column 5

1 Description of exploited activity

Schedule J—Advertising Income (See instructions on page 19.)

Income From Periodicals Reported on a Consolidated Basis

4 Advertising

gain or (loss) (col.

2 minus col. 3). If

a gain, compute

cols. 5 through 7.

6 Readership

costs

5 Circulation

income

3 Direct

advertising costs

2 Gross

advertising

income

1 Name of periodical

Income From Periodicals Reported on a Separate Basis (For each periodical listed 

columns 2 through 7 on a line-by-line basis.)

Schedule K—Compensation of Officers, Directors, and Trustees (See instructions on page 19.)

3 Percent of

time devoted to

business

4 Compens

unrela

1 Name 2 Title

%

%

%

%

Total—Enter here and on line 14, Part II, page 1 

Part I

Part II

Enter here and on

line 10, col. (A),

Part I, page 1.

Enter here and on

line 10, col. (B),

Part I, page 1.

(1)

(2)

(3)

(4)

Totals 

(1)

(2)

(3)

(4)

(1)

(2)

(3)

(4)

Totals, Part II (lines 1-5) 

Enter here and on

line 11, col. (A),

Part I, page 1.

Enter here and on

line 11, col. (B),

Part I, page 1.

Schedule G—Investment Income of a Section 501(c)(7), (9), or (17) Organization

(See instructions on page 18.)

5 

and 

4 Set-asides

(attach schedule)

3 Deductions

directly connected

(attach schedule)

1 Description of income 2 Amount of income

(1)

(2)

(3)

(4)

Enter here and on line 9,

column (A), Part I, page 1.

Enter h

column 

Totals 

Totals (carry to Part II,

line (5)) 

(5) Totals from Part I