Exempt Organization Business Income Tax Return OMB No. 1545-0687

Form 990-T

For calendar year 1991 or other tax year beginning , 1991, and ending , 19

Department of the Treasury

Internal Revenue Service For Paperwork Reduction Act Notice, see page 1 of separate instructions.

Name of organization A Employer identification number

(Employees’ trust, see instructions for Block A)

Please

Print or

Type

Number, street, and room or suite no. (If a P.O. box, see page 3 of instructions.)

B Unrelated business activity codes

City or town, state, and ZIP code (See instructions for Block B)

C Check box if address changed © D Exempt under section ©

E Check type of organization © Corporation

F Group exemption number (see instructions for Block F) ©

© If the unrelated trade or business gross income is $10,000 or less, complete only page 1 and Part III on page 2, and sign the return.

© If the unrelated trade or business gross income is over $10,000, complete all applicable parts of the form (except lines 1 through 4 on page 1).

1 Unrelated trade or business gross income (see instructions) (state sources © ) 1

2 Deductions (including net operating loss) (see instructions) 2

3 Unrelated business taxable income before Specific deduction (line 1 minus line 2) 3

4 Specific deduction (see instructions) 4

5 Unrelated business taxable income (line 3 minus line 4 or enter amount from line 33, page 2.

Taxable Income

If line 4 is greater than line 3, enter the smaller of -0- or line 3.) 5

Organizations Taxable as Corporations (see instructions for tax computation)

6 Controlled group members (sections 1561 and 1563)—Check here: and:

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

(i) $ (ii) $

b Enter your share of the additional 5% tax (not to exceed $11,750) $

7 Income tax on the amount on line 5 7

Trusts Taxable at Trust Rates (see instructions for tax computation)

Tax Computation

8 Income tax on the amount on line 5 from: Tax rate schedule or Schedule D (Form 1041) 8

All Organizations (see instructions)

9a Foreign tax credit (corporations attach Form 1118; trusts attach Form 1116) 9a

b Other credits (see instructions) 9b

Form 3800 or Form (specify) ©

c General business credit—Check if from:

9c

d Credit for prior year minimum tax (attach Form 8801 or 8827) 9d

10 Total (add lines 9a through 9d) 10

11 Line 7 or line 8 minus line 10 11

12 Recapture taxes. Check if from: Form 4255 Form 8611 12

13a Alternative minimum tax b Environmental tax 13c

14 Total tax (add lines 11, 12, and 13c) 14

15 Payments: a 1990 overpayment credited to 1991 15a

b 1991 estimated tax payments 15b

c Subtotal (add lines 15a and 15b) 15c

Tax and Payments

d Tax deposited with Form 7004 or Form 2758 15d

e Foreign organizations—Tax paid or withheld at source (see instructions) 15e

15f f Other credits and payments (see instructions)

16 Total credits and payments (add lines 15c through 15f) 16

17 Penalty for underpayment of estimated tax. Check © if Form 2220 is attached 17

18 Tax due —If the total of lines 14 and 17 is larger than line 16, enter amount owed © 18

19 Overpayment —If line 16 is larger than the total of lines 14 and 17, enter amount overpaid © 19

20 Enter the amount of line 19 you want: Refunded © 20

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

Please 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 or fiduciary Date Title

Check if

selfemployed ©

Date Preparer’s social security number Preparer’s Paid signature

Preparer’s

Use Only Firm’s name (or yours, 

if self-employed)

and address

E.I. No. ©

ZIP code ©

Form 990-T (1991)

Trust Section 401(a) trust Section 408(a) trust

501 ( ) ( ) OR © 408(e)

Credited to 1992 estimated tax ©

© ©

©

©
Form 990-T (1991) Page 2

Unrelated Trade or Business Income (See instructions on pages 6 through 9.)

1a Gross receipts or sales b Less returns and allowances c Balance © 1c

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

Gross profit (line 1c minus line 2) 3 3

4a Capital gain net income (attach separate Schedule D) (see instructions) 4a

b Net gain or (loss) from Form 4797, Part II, line 18 (attach Form 4797) 4b

c Capital loss deduction for trusts 4c

5 5 Income (loss) from partnerships (attach statement)

Rent income (Schedule C) 6 6

Unrelated debt-financed income (Schedule E, line 2) 7 7

8 8 Investment income of a section 501(c)(7), (9), (17), or (20) organization (Schedule F)

9 9 Interest, annuities, royalties, and rents from controlled organizations (Schedule G)

Exploited exempt activity income (Schedule H) 10 10

Advertising income (Schedule I, Part III 11 11 –A)

12 Other income (see instructions for line 12—attach schedule) 12

13 TOTAL—Unrelated trade or business income (add lines 3 through 12) 13

Deductions Not Taken Elsewhere (See instructions on pages 9 through 11 for limitations on deductions.)

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

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

15 Salaries and wages 15

16 Repairs (see instructions) 16

17 Bad debts (see instructions) 17

18 Interest (attach schedule) 18

19 Taxes (see instructions) 19

20 Contributions (see instructions) 20

21 Depreciation (attach Form 4562) 21

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

23 Depletion 23

24a Contributions to deferred compensation plans (see instructions) 24a

b Employee benefit programs (see instructions) 24b

25 Other deductions (attach schedule) 25

26 TOTAL DEDUCTIONS (add lines 14 through 25) 26

27 Unrelated business taxable income before allowable advertising loss (subtract line 26 from line 13) 27

28 Advertising loss (Schedule I, Part III–B) 28

29 Unrelated business taxable income before net operating loss deduction (subtract line 28 from line 27) 29

30 Net operating loss deduction (see instructions) 30

31 Unrelated business taxable income before Specific deduction (subtract line 30 from line 29) 31

32 Specific deduction (see instructions for line 4, page 1) 32

33 Unrelated business taxable income (Subtract line 32 from line 31. If line 32 is greater than line 31,

enter the smaller of -0- or line 31.) Enter here and on page 1, line 5 33

Statements Regarding Certain Activities and Other Information (See instructions on page 11.)

Yes No 1 At any time during the tax 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 Was the organization the grantor of, or transferor to, a foreign trust that existed during the current tax year,

whether or not the organization had any beneficial interest in it?

If “ Yes,” the organization may have to file Forms 3520, 3520-A, or 926.

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

SCHEDULE A—COST OF GOODS SOLD (See instructions for line 2 on page 6.)

Method of inventory valuation (specify) ©

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

The books are in care of © Telephone number © ( )

(See page 11 of the instructions for exceptions and filing requirements for Form TD F 90-22.1.) If “Yes,” write the

name of the foreign country here ©

Part III

Part I

Part II
Form 990-T (1991) Page 3

SCHEDULE C—RENT INCOME FROM REAL PROPERTY AND PERSONAL PROPERTY LEASED WITH REAL PROPERTY

(see instructions for line 6 on page 7)

2. Rent received or accrued 3. Percentage of rent for

personal property 1. Description of property

%

%

%

%

%

4. Complete for any item if the entry in column 3 is more than 50%, or

if the rent is based on profit or income 5. Complete for any item if the entry in column 3 is more than 10% but not more than 50%

(a) Gross income reportable

(column 2 3 column 3)

(b) Income includible (column 2 minus

column 4(a))

(a) Deductions directly

connected (attach schedule)

(c) Income includible (column

5(a) minus column 5(b))

Total (Add columns 4(b) and 5(c). Enter total here and on line 6, Part I, page 2.) © 

SCHEDULE E—UNRELATED DEBT-FINANCED INCOME (see instructions for line 7 on page 7)

3. Deductions directly connected with or allocable to

debt-financed property 2. Gross income from or

allocable to debt-financed

property

1. Description of debt-financed property (b) Other deductions

(attach schedule)

(a) Straight-line depreciation

(attach schedule)

1

6.

Percentage

which col. 4

is of col. 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)

9. Net income (loss)

includible (column 7 minus

column 8)

7. Gross income reportable

(column 2 3 column 6)

8. Allocable deductions

(column 6 3 total of columns

3(a) and 3(b))

%

%

%

%

2 Total (enter here and on line 7, Part I, page 2) ©

3 Total dividends-received deductions included in column 8 ©

SCHEDULE F—INVESTMENT INCOME OF A SECTION 501(c)(7), (9), (17), OR (20) ORGANIZATION

(see instructions for line 8 on page 8)

4. Net investment

income (column 2

minus column 3)

6. Balance of investment income (column

4 minus column 5)

5. Set-asides

(attach schedule)

3. Deductions

directly connected

(attach schedule)

1. Description of income 2. Amount of income

Total (enter here and on line 8, Part I, page 2) ©

SCHEDULE G—INTEREST, ANNUITIES, ROYALTIES, AND RENTS FROM CONTROLLED ORGANIZATIONS

(see instructions for line 9 on page 9)

4. Exempt controlled organizations 3. Deductions of controlling

organization directly

connected with column 2

income (attach schedule)

2. Gross income

from controlled

organization(s)

(c)

Percentage

which col.

(a) is of

col. (b)

(b) Taxable income computed

as though not exempt under

sec. 501(a), or the amount in

col. (a), whichever is more

(a) Unrelated

business taxable

income

1. Name and address of controlled organization(s)

%

%

%

5. Nonexempt controlled organizations 6. Gross income reportable

(column 2 3 column 4(c) or

column 5(c))

7. Allowable deductions

(column 3 3 column 4(c) or

column 5(c))

8. Net income includible

(column 6 minus column 7) (b) Taxable income, or

amount in column (a),

whichever is more

(c) Percentage

which col. (a)

is of col. (b)

(a) Excess taxable income

%

%

%

Total (enter here and on line 9, Part I, page 2) ©

(b) Deductions directly connected with

personal property (attach schedule)
Part III—A

Form 990-T (1991) Page 4

SCHEDULE H—EXPLOITED EXEMPT ACTIVITY INCOME, OTHER THAN ADVERTISING INCOME

(see instructions for line 10 on page 9)

3. Expenses directly

connected with production of unrelated

business income

7. Excess exempt

expenses (column 6

minus column 5, but

not more than column 4)

4. Net income from

unrelated trade or

business (column 2

minus column 3)

5. Gross income

from activity that

is not unrelated

business income

2. Gross unrelated

business income

from trade or

business

8. Net income

includible

(column 4 minus

column 7)

6. Expenses

attributable to

column 5

1. Description of exploited

activity

Total (enter here and on line 10, Part I, page 2) ©

SCHEDULE I—ADVERTISING INCOME AND ADVERTISING LOSS (see instructions for line 11 on page 9)

Income From Periodicals Reported on a Consolidated Basis 7. If col. 5 equals or exceeds

col. 6, enter in Part III–A col.

(b) the gain from col. 4. If col.

6 exceeds col. 5, enter in Part

III–A col. (b) the gain from

subtracting col. 6 plus col. 3

from col. 5 plus col. 2. For a

loss, see the instructions for

line 11 item 2(c).

4. Advertising gain or

loss (col. 2 minus col.

3). If col. 2 exceeds col.

3, compute cols. 5, 6,

and 7. If col. 3 exceeds

col. 2, enter loss in Part

III–B, col.(b).

6. Readership

costs

5. Circulation

income

3. Direct

advertising costs

2. Gross

advertising income 1. Name of periodical

Total ©

Income From Periodicals Reported on a Separate Basis

Advertising Income Advertising Loss

(b) Enter total amount from column

4, Part I, and amounts listed in

column 4, Part II

(b) Enter total amount from

column 4 or 7, Part I, and amounts

listed in cols. 4 and 7, Part II

(a) Enter “consolidated periodical” or

names of nonconsolidated

periodicals

(a) Enter “consolidated periodical” or

names of nonconsolidated periodicals

Enter total here and on line 28,

Part II, page 2 ©

Enter total here and on line

11, Part I, page 2 ©

SCHEDULE J—COMPENSATION OF OFFICERS, DIRECTORS, AND TRUSTEES (see instructions for line 14)

3. Percent of

time devoted to

business

4. Compensation attributable to

unrelated business 1. Name 2. Title

%

%

%

%

%

%

Total (enter here and on line 14, Part II, page 2) ©

Part I

Part II

Part III—B