Form 990-T

Department of the Treasury 

Internal Revenue Service 

Exempt Organization Business Income Tax Return 

(and proxy tax under section 6033(e))

For calendar year 2016 or other tax year beginning , 2016, and ending , 20 .

▶ Information about Form 990-T and its instructions is available at www.irs.gov/form990t.

▶ Do not enter SSN numbers on this form as it may be made public if your organization is a 501(c)(3). 

OMB No. 1545-0687

2016

Open to Public Inspection for 

501(c)(3) Organizations Only

Print 

or 

Type

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

Number, street, and room or suite no. If a P.O. box, see instructions.

City or town, state or province, country, and ZIP or foreign postal code

A

Check box if 

address changed

B Exempt under section

501( ) ( )

408(e)

408A

529(a)

220(e)

530(a)

C Book value of all assets

at end of year

D Employer identification number 

(Employees’ trust, see instructions.)

E Unrelated business activity codes

(See instructions.)

F Group exemption number (See instructions.) ▶

G Check organization type ▶ 501(c) corporation 501(c) trust 401(a) trust Other trust

H Describe the organization’s primary unrelated business activity. ▶

I During the tax year, was the corporation a subsidiary in an affiliated group or a parent-subsidiary controlled group? . . ▶ Yes No

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

J The books are in care of ▶ Telephone number ▶

Part I Unrelated Trade or Business Income (A) Income (B) Expenses (C) Net

1a Gross receipts or sales

b Less returns and allowances c Balance ▶ 1c

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

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

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 Interest, annuities, royalties, and rents from controlled organizations (Schedule F) 8

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

10 Exploited exempt activity income (Schedule I) . . . . . 10

11 Advertising income (Schedule J) . . . . . . . . . 11

12 Other income (See instructions; attach schedule) . . . . . 12

13 Total. Combine lines 3 through 12 . . . . . . . . 13

Part II Deductions Not Taken Elsewhere (See instructions 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 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 instructions for limitation rules) . . . . . . . . . . . . . 20

21 Depreciation (attach Form 4562) . . . . . . . . . . . . . 21

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

23 Depletion . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 23

24 Contributions to deferred compensation plans . . . . . . . . . . . . . . . . . 24

25 Employee benefit programs . . . . . . . . . . . . . . . . . . . . . . . . 25

26 Excess exempt expenses (Schedule I) . . . . . . . . . . . . . . . . . . . . 26

27 Excess readership costs (Schedule J) . . . . . . . . . . . . . . . . . . . . 27

28 Other deductions (attach schedule) . . . . . . . . . . . . . . . . . . . . . 28

29 Total deductions. Add lines 14 through 28 . . . . . . . . . . . . . . . . . . 29

30 Unrelated business taxable income before net operating loss deduction. Subtract line 29 from line 13 30

31 Net operating loss deduction (limited to the amount on line 30) . . . . . . . . . . . . 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) . . . . . . 33

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 . . . . . . . . . . . . . . . . . . . . . . 34

For Paperwork Reduction Act Notice, see instructions. Cat. No. 11291J Form 990-T (2016)
Form 990-T (2016) Page 2

Part III Tax Computation

35 Organizations Taxable as Corporations. See instructions for tax computation. Controlled group 

members (sections 1561 and 1563) check here ▶ See instructions and:

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

(1) $ (2) $ (3) $

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

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

c Income tax on the amount on line 34 . . . . . . . . . . . . . . . . . . . . ▶ 35c

36 Trusts Taxable at Trust Rates. See instructions for tax computation. Income tax on

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

37 Proxy tax. See instructions . . . . . . . . . . . . . . . . . . . . . . . ▶ 37

38 Alternative minimum tax . . . . . . . . . . . . . . . . . . . . . . . . . 38

39 Tax on Non-Compliant Facility Income. See instructions . . . . . . . . . . . . . 39

40 Total. Add lines 37, 38 and 39 to line 35c or 36, whichever applies . . . . . . . . . . . 40

Part IV Tax and Payments 

41a Foreign tax credit (corporations attach Form 1118; trusts attach Form 1116) . 41a

b Other credits (see instructions) . . . . . . . . . . . . . . . 41b

c General business credit. Attach Form 3800 (see instructions) . . . . . 41c

d Credit for prior year minimum tax (attach Form 8801 or 8827) . . . . . 41d

e Total credits. Add lines 41a through 41d . . . . . . . . . . . . . . . . . . . 41e

42 Subtract line 41e from line 40 . . . . . . . . . . . . . . . . . . . . . . . 42

43 Other taxes. Check if from: Form 4255 Form 8611 Form 8697 Form 8866 Other (attach schedule) . 43

44 Total tax. Add lines 42 and 43 . . . . . . . . . . . . . . . . . . . . . . . 44

45a Payments: A 2015 overpayment credited to 2016 . . . . . . . . 45a

b 2016 estimated tax payments . . . . . . . . . . . . . . . . 45b

c Tax deposited with Form 8868 . . . . . . . . . . . . . . . 45c

d Foreign organizations: Tax paid or withheld at source (see instructions) . 45d

e Backup withholding (see instructions) . . . . . . . . . . . . 45e

f Credit for small employer health insurance premiums (Attach Form 8941) . 45f

g Other credits and payments: Form 2439

Form 4136 Other Total ▶ 45g

46 Total payments. Add lines 45a through 45g . . . . . . . . . . . . . . . . . . 46

47 Estimated tax penalty (see instructions). Check if Form 2220 is attached . . . . . . . . ▶ 47

48 Tax due. If line 46 is less than the total of lines 44 and 47, enter amount owed . . . . . . ▶ 48

49 Overpayment. If line 46 is larger than the total of lines 44 and 47, enter amount overpaid . . ▶ 49

50 Enter the amount of line 49 you want: Credited to 2017 estimated tax ▶ Refunded ▶ 50

Part V Statements Regarding Certain Activities and Other Information (see instructions)

51 At any time during the 2016 calendar year, did the organization have an interest in or a signature or other authority 

over a financial account (bank, securities, or other) in a foreign country? If YES, the organization may have to file 

FinCEN Form 114, Report of Foreign Bank and Financial Accounts. If YES, enter the name of the foreign country 

here ▶

Yes No

52 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 instructions for other forms the organization may have to file.

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

Sign 

Here

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.

Signature of officer Date

▲

Title

May the IRS discuss this return 

with the preparer shown below 

(see instructions)? Yes No 

Paid 

Preparer 

Use Only

Print/Type preparer’s name Preparer’s signature Date Check if 

self-employed 

PTIN

Firm’s name ▶

Firm’s address ▶

Firm’s EIN ▶

Phone no. 

Form 990-T (2016)
Form 990-T (2016) Page 3

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

1 Inventory at beginning of year 1

2 Purchases . . . . . . 2

3 Cost of labor . . . . . . 3

4 a Additional section 263A costs 

(attach schedule) . . . . 4a

b Other costs (attach schedule) 4b

5 Total. Add lines 1 through 4b 5

6 Inventory at end of year . . . 6

7 Cost of goods sold. Subtract 

line 6 from line 5. Enter here and 

in Part I, line 2 . . . . . . 7

8 Do the rules of section 263A (with respect to 

property produced or acquired for resale) apply 

to the organization? . . . . . . . . .

Yes No

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

(see instructions)

1. Description of property

(1)

(2)

(3)

(4)

2. Rent received or accrued

(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)

(1)

(2)

(3)

(4)

Total Total

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

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

3(a) Deductions directly connected with the income

in columns 2(a) and 2(b) (attach schedule)

(b) Total deductions. 

Enter here and on page 1,

Part I, line 6, column (B) ▶

Schedule E—Unrelated Debt-Financed Income (see instructions)

1. Description of debt-financed property

2. Gross income from or

allocable to debt-financed

property

3. Deductions directly connected with or allocable to

debt-financed property

(a) Straight line depreciation

(attach schedule)

(b) Other deductions

 (attach schedule)

(1)

(2)

(3)

(4)

4. Amount of average

acquisition debt on or

allocable to debt-financed

property (attach schedule)

5. Average adjusted basis

of or allocable to

debt-financed property

(attach schedule)

6. Column

4 divided

by column 5

7. Gross income reportable

(column 2 × column 6)

8. Allocable deductions

(column 6 × total of columns

3(a) and 3(b))

(1) %

(2) %

(3) %

(4) %

Totals . . . . . . . . . . . . . . . . . . . . . . . . . ▶

Enter here and on page 1, 

Part I, line 7, column (A).

Enter here and on page 1, 

Part I, line 7, column (B).

Total dividends-received deductions included in column 8 . . . . . . . . . . . . . . . . . ▶

Form 990-T (2016)
Form 990-T (2016) Page 4

Schedule F—Interest, Annuities, Royalties, and Rents From Controlled Organizations (see instructions)

1. Name of controlled

organization

2. Employer

identification number

Exempt Controlled Organizations

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

6. Deductions directly

connected with income

in column 5 

(1)

(2)

(3)

(4)

Nonexempt Controlled Organizations

7. Taxable Income 8. Net unrelated income

(loss) (see instructions)

9. Total of specified

payments made

10. Part of column 9 that is

included in the controlling

organization’s gross income

11. Deductions directly

connected with income in

column 10

(1)

(2)

(3)

(4)

Totals . . . . . . . . . . . . . . . . . . . . . . . . . . ▶

Add columns 5 and 10. 

Enter here and on page 1, 

Part I, line 8, column (A).

Add columns 6 and 11. 

Enter here and on page 1, 

Part I, line 8, column (B).

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

1. Description of income 2. Amount of income

3. Deductions

directly connected

(attach schedule)

4. Set-asides

(attach schedule)

5. Total deductions

and set-asides (col. 3

plus col. 4)

(1)

(2)

(3)

(4)

Totals . . . . . . . . ▶

Enter here and on page 1, 

Part I, line 9, column (A).

Enter here and on page 1, 

Part I, line 9, column (B).

Schedule I—Exploited Exempt Activity Income, Other Than Advertising Income (see instructions)

1. Description of exploited activity

2. Gross

unrelated

business income

from trade or

business

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

6. Expenses

attributable to

column 5

7. Excess exempt

expenses

(column 6 minus

column 5, but not

more than

column 4).

(1)

(2)

(3)

(4)

Totals . . . . . . . . . ▶

Enter here and on 

page 1, Part I, 

line 10, col. (A).

Enter here and on 

page 1, Part I, 

line 10, col. (B).

Enter here and 

on page 1, 

Part II, line 26.

Schedule J—Advertising Income (see instructions)

Part I Income From Periodicals Reported on a Consolidated Basis

1. Name of periodical

2. Gross

advertising

income

3. Direct

advertising costs

4. Advertising

gain or (loss) (col.

2 minus col. 3). If

a gain, compute

cols. 5 through 7.

5. Circulation

income

6. Readership

costs

7. Excess readership

costs (column 6

minus column 5, but

not more than

column 4).

(1)

(2)

(3)

(4)

Totals (carry to Part II, line (5)) . . ▶

Form 990-T (2016)
Form 990-T (2016) Page 5

Part II Income From Periodicals Reported on a Separate Basis (For each periodical listed in Part II, fill in columns 

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

1. Name of periodical

2. Gross

advertising

income

3. Direct

advertising costs

4. Advertising

gain or (loss) (col.

2 minus col. 3). If

a gain, compute

cols. 5 through 7.

5. Circulation

income

6. Readership

costs

7. Excess readership

costs (column 6

minus column 5, but

not more than

column 4).

(1)

(2)

(3)

(4)

Totals from Part I . . . . . . ▶

Totals, Part II (lines 1-5) . . . . ▶

Enter here and on 

page 1, Part I, 

line 11, col. (A).

Enter here and on 

page 1, Part I, 

line 11, col. (B).

Enter here and 

on page 1, 

Part II, line 27.

Schedule K—Compensation of Officers, Directors, and Trustees (see instructions)

1. Name 2. Title

3. Percent of

time devoted to

business

4. Compensation attributable to

unrelated business

(1) %

(2) %

(3) %

(4) %

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

Form 990-T (2016)