PwC`s Annotated 2015 Form 990

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2015 Form 990,
Return of
Organization
Exempt From
Income Tax
Core Form & Schedules
with Annotations
Provided by PwC's
Exempt Organizations
Tax Services Practice
March 2016
Disclaimer: This document is for general information purposes only and should not be used as a substitute for consultation with professional
advisors. This document was not intended or written to be used, and it cannot be used, for the purpose of avoiding U.S. federal, state or local
tax penalties.
Contributors
Travis Patton
Paul Tanis
Lauren Bennett
Kimberly Bier
Herve Le Brusq
Nathan Doane
Amyn Gillani
Abby Lewis
Alexander Noren
Kelley O’Brien
Alison O’Connor
Anne Pancheri
Eugenia Richardson
Table of Contents*
Core Form
Heading
Part I: Summary
Part II: Signature Block
Part III: Statement of Program Service Accomplishments
Part IV: Checklist of Required Schedules
Part V: Statements Regarding Other IRS Filings and Tax Compliance
Part VI: Governance, Management, and Disclosure
Part VII: Compensation of Officers, Directors, Trustees, Key Employees, Highest
Compensated Employees, and Independent Contractors
Part VIII: Statement of Revenue
Part IX: Statement of Functional Expenses
Part X: Balance Sheet
Part XI: Reconciliation of Net Assets
Part XII: Financial Statements and Reporting
Schedules
Schedule A: Public Charity Status and Public Support
Schedule B: Schedule of Contributors
Schedule C: Political Campaign and Lobbying Activities
Schedule D: Supplemental Financial Statements
Schedule E: Schools
Schedule F: Statement of Activities Outside the United States
Schedule G: Supplemental Information Regarding Fundraising or Gaming Activities
Schedule H: Hospitals
Schedule I: Grants and Other Assistance to Organizations, Governments, and
Individuals in the United States
Schedule J: Compensation Information
Schedule K: Supplemental Information on Tax-Exempt Bonds
Schedule L: Transactions With Interested Persons
Schedule M: Noncash Contributions
Schedule N: Liquidation, Termination, Dissolution, or Significant Disposition of Assets
Schedule O: Supplemental Information to Form 990 or 990-EZ
Schedule R: Related Organizations and Unrelated Partnerships
*Please note this PwC Annotated Form 990 incorporates forms and instructions that
were current on the IRS website as of March 15, 2016.
No substantive changes were made to Core Form 990 for 2015.
Instructions
for Schedule
L clarify
reporting
requirements
for lines 28ac.
The instructions to Line 10a now refers to leasehold
improvements (consistent with Schedule D, Part VI)
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The instructions contain the following new requirement for a potential Part VI disclosure:
"Rev. Proc. 2015-21, 2015-13 I.R.B. 817, provides guidance regarding correction and
disclosure procedures for hospital organizations to follow so that certain failures to meet
the requirements of section 501(r) will be excused for purposes of sections 501(r)(1) and
501(r) (2)(B). Section 7 of the revenue procedure provides that certain information must
be disclosed on the organization’s Form 990. Provide this information in Part VI."
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No substantive changes were made to Schedule I for 2015.
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No substantive changes were made to Schedule M for 2015.
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No substantive changes were made to Schedule N for 2015.
SCHEDULE N
(Form 990 or 990-EZ)
Department of the Treasury
Internal Revenue Service
Liquidation, Termination, Dissolution, or Significant Disposition of Assets
1
2015
Complete if the organization answered "Yes" on Form 990, Part IV, lines 31 or 32; or Form 990-EZ, line 36.
Attach certified copies of any articles of dissolution, resolutions, or plans.
Attach to Form 990 or 990-EZ.
Information about Schedule N (Form 990 or 990-EZ) and its instructions is at www.irs.gov/form990.
Name of the organization
Part I
OMB No. 1545-0047
Open to Public
Inspection
Employer identification number
Liquidation, Termination, or Dissolution. Complete this part if the organization answered “Yes” on Form 990, Part IV, line 31, or Form 990-EZ, line 36.
Part I can be duplicated if additional space is needed.
(a) Description of asset(s)
distributed or transaction
expenses paid
(b) Date of
distribution
(c) Fair market value of
asset(s) distributed or
amount of transaction
expenses
(d) Method of
determining FMV for
asset(s) distributed or
transaction expenses
(e) EIN of recipient
(f) Name and address of recipient
(g) IRC section of
recipient(s) (if
tax-exempt) or type
of entity
Yes No
2
a
b
c
d
e
Did or will any officer, director, trustee, or key employee of the organization:
Become a director or trustee of a successor or transferee organization? . . . . . . . . . . . . . . . . . . . . . . . . .
Become an employee of, or independent contractor for, a successor or transferee organization? . . . . . . . . . . . . . . . . .
Become a direct or indirect owner of a successor or transferee organization? . . . . . . . . . . . . . . . . . . . . . . .
Receive, or become entitled to, compensation or other similar payments as a result of the organization’s liquidation, termination, or dissolution? .
If the organization answered “Yes” to any of the questions on lines 2a through 2d, provide the name of the person involved and explain in Part III.
For Paperwork Reduction Act Notice, see the Instructions for Form 990 or Form 990-EZ.
ISA
.
.
.
.
.
.
.
.
2a
2b
2c
2d
Schedule N (Form 990 or 990-EZ) (2015)
Schedule N (Form 990 or 990-EZ) (2015)
Part I
Page
Note. If the organization distributed all of its assets during the tax year, then Form 990, Part X, column (B), line 16 (Total assets), and line 26
(Total liabilities), should equal -0-.
3
4a
b
5
6a
b
c
Did the organization distribute its assets in accordance with its governing instrument(s)? If “No,” describe in Part III . . . . . . . . . . . . .
Is the organization required to notify the attorney general or other appropriate state official of its intent to dissolve, liquidate, or terminate? . . . . .
If “Yes,” did the organization provide such notice? . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
Did the organization discharge or pay all of its liabilities in accordance with state laws? . . . . . . . . . . . . . . . . . . . . . .
Did the organization have any tax-exempt bonds outstanding during the year? . . . . . . . . . . . . . . . . . . . . . . . . .
If “Yes” to line 6a, did the organization discharge or defease all of its tax-exempt bond liabilities during the tax year in accordance with the Internal Revenue Code and state laws?
If “Yes” on line 6b, describe in Part III how the organization defeased or otherwise settled these liabilities. If “No” on line 6b, explain in Part III.
Part II
1
2
Liquidation, Termination, or Dissolution (continued)
Yes No
3
4a
4b
5
6a
6b
Sale, Exchange, Disposition, or Other Transfer of More Than 25% of the Organization’s Assets. Complete this part if the organization answered
“Yes” on Form 990, Part IV, line 32, or Form 990-EZ, line 36. Part II can be duplicated if additional space is needed.
(a) Description of asset(s)
distributed or transaction
expenses paid
(b) Date of
distribution
(c) Fair market value of
asset(s) distributed or
amount of transaction
expenses
(d) Method of
determining FMV for
asset(s) distributed or
transaction expenses
(e) EIN of recipient
(f) Name and address of recipient
(g) IRC section of
recipient(s) (if
tax-exempt) or type
of entity
Yes No
2
a
b
c
d
e
Did or will any officer, director, trustee, or key employee of the organization:
Become a director or trustee of a successor or transferee organization? . . . . . . . . . . . . . . . . . . . . . . . .
Become an employee of, or independent contractor for, a successor or transferee organization? . . . . . . . . . . . . . . . .
Become a direct or indirect owner of a successor or transferee organization? . . . . . . . . . . . . . . . . . . . . . .
Receive, or become entitled to, compensation or other similar payments as a result of the organization’s significant disposition of assets? . .
If the organization answered “Yes” to any of the questions on lines 2a through 2d, provide the name of the person involved and explain in Part III
.
.
.
.
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.
.
.
.
.
2a
2b
2c
2d
Schedule N (Form 990 or 990-EZ) (2015)
Schedule N (Form 990 or 990-EZ) (2015)
Part III
Page 3
Supplemental Information. Provide the information required by Part I, lines 2e and 6c, and Part II, line 2e.
Also complete this part to provide any additional information.
Schedule N (Form 990 or 990-EZ) (2015)
No substantive changes were made to Schedule O for 2015.
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No substantive changes were made to Schedule R for 2015.
SCHEDULE R
(Form 990)
OMB No. 1545-0047
Related Organizations and Unrelated Partnerships
2015
a Complete if the organization answered "Yes" on Form 990, Part IV, line 33, 34, 35b, 36, or 37.
Department of the Treasury
Internal Revenue Service
Open to Public
Inspection
a Attach to Form 990.
a Information about Schedule R (Form 990) and its instructions is at www.irs.gov/form990.
Name of the organization
Part I
Employer identification number
Identification of Disregarded Entities Complete if the organization answered “Yes” on Form 990, Part IV, line 33.
(a)
Name, address, and EIN (if applicable) of disregarded entity
(b)
Primary activity
(c)
Legal domicile (state
or foreign country)
(d)
Total income
(e)
End-of-year assets
(f)
Direct controlling
entity
(1)
(2)
(3)
(4)
(5)
(6)
Part II
Identification of Related Tax-Exempt Organizations Complete if the organization answered “Yes” on Form 990, Part IV, line 34 because it had
one or more related tax-exempt organizations during the tax year.
(a)
Name, address, and EIN of related organization
(b)
Primary activity
(c)
Legal domicile (state
or foreign country)
(d)
Exempt Code section
(e)
Public charity status
(if section 501(c)(3))
(f)
Direct controlling
entity
(g)
Section 512(b)(13)
controlled
entity?
Yes
No
(1)
(2)
(3)
(4)
(5)
(6)
(7)
For Paperwork Reduction Act Notice, see the Instructions for Form 990.
Cat. No. 50135Y
Schedule R (Form 990) 2015
Page 2
Schedule R (Form 990) 2015
Part III
Identification of Related Organizations Taxable as a Partnership Complete if the organization answered “Yes” on Form 990, Part IV, line 34
because it had one or more related organizations treated as a partnership during the tax year.
(a)
Name, address, and EIN of
related organization
(b)
Primary activity
(c)
Legal
domicile
(state or
foreign
country)
(d)
Direct controlling
entity
(e)
Predominant
income (related,
unrelated,
excluded from
tax under
sections 512-514)
(f)
Share of total
income
(g)
(h)
Share of end-of- Disproportionate
year assets
allocations?
Yes No
(i)
Code V—UBI
amount in box 20
of Schedule K-1
(Form 1065)
(j)
General or
managing
partner?
(k)
Percentage
ownership
Yes No
(1)
(2)
(3)
(4)
(5)
(6)
(7)
Part IV
Identification of Related Organizations Taxable as a Corporation or Trust Complete if the organization answered “Yes” on Form 990, Part IV,
line 34 because it had one or more related organizations treated as a corporation or trust during the tax year.
(a)
Name, address, and EIN of related organization
(b)
Primary activity
(c)
Legal domicile
(state or foreign country)
(d)
Direct controlling
entity
(e)
(f)
Type of entity
Share of total
(C corp, S corp, or trust)
income
(g)
(h)
Share of
Percentage
end-of-year assets ownership
(i)
Section 512(b)(13)
controlled
entity?
Yes
No
(1)
(2)
(3)
(4)
(5)
(6)
(7)
Schedule R (Form 990) 2015
Page 3
Schedule R (Form 990) 2015
Part V
Transactions With Related Organizations Complete if the organization answered “Yes” on Form 990, Part IV, line 34, 35b, or 36.
Note. Complete line 1 if any entity is listed in Parts II, III, or IV of this schedule.
1
During the tax year, did the organization engage in any of the following transactions with one or more related organizations listed in Parts II–IV?
a Receipt of (i) interest, (ii) annuities, (iii) royalties, or (iv) rent from a controlled entity . . . . . . . . . . . . . . . . . . . .
b Gift, grant, or capital contribution to related organization(s) . . . . . . . . . . . . . . . . . . . . . . . . . . . .
c Gift, grant, or capital contribution from related organization(s)
. . . . . . . . . . . . . . . . . . . . . . . . . . .
d Loans or loan guarantees to or for related organization(s) . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
e Loans or loan guarantees by related organization(s) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
f
g
h
i
j
Dividends from related organization(s) . . . . . . . . . . .
Sale of assets to related organization(s) . . . . . . . . . . .
Purchase of assets from related organization(s) . . . . . . . .
Exchange of assets with related organization(s) . . . . . . . .
Lease of facilities, equipment, or other assets to related organization(s)
k
l
m
n
o
Lease of facilities, equipment, or other assets from related organization(s) . . . . . .
Performance of services or membership or fundraising solicitations for related organization(s)
Performance of services or membership or fundraising solicitations by related organization(s)
Sharing of facilities, equipment, mailing lists, or other assets with related organization(s) . .
Sharing of paid employees with related organization(s) . . . . . . . . . . . . .
p Reimbursement paid to related organization(s) for expenses .
q Reimbursement paid by related organization(s) for expenses .
r
s
2
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1o
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1p
1q
No
Other transfer of cash or property to related organization(s) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
1r
Other transfer of cash or property from related organization(s) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
1s
If the answer to any of the above is “Yes,” see the instructions for information on who must complete this line, including covered relationships and transaction thresholds.
(a)
Name of related organization
(b)
Transaction
type (a–s)
(c)
Amount involved
(d)
Method of determining amount involved
(1)
(2)
(3)
(4)
(5)
(6)
Schedule R (Form 990) 2015
Page 4
Schedule R (Form 990) 2015
Part VI
Unrelated Organizations Taxable as a Partnership Complete if the organization answered “Yes” on Form 990, Part IV, line 37.
Provide the following information for each entity taxed as a partnership through which the organization conducted more than five percent of its activities (measured by total assets
or gross revenue) that was not a related organization. See instructions regarding exclusion for certain investment partnerships.
(a)
Name, address, and EIN of entity
(b)
Primary activity
(c)
(d)
(e)
Legal domicile
Predominant
Are all partners
(state or foreign
income (related,
section
country)
unrelated, excluded
501(c)(3)
from tax under
organizations?
sections 512-514)
Yes No
(f)
Share of
total income
(g)
Share of
end-of-year
assets
(h)
(i)
Disproportionate
Code V—UBI
amount in box 20
allocations?
of Schedule K-1
(Form 1065)
Yes No
(j)
General or
managing
partner?
(k)
Percentage
ownership
Yes No
(1)
(2)
(3)
(4)
(5)
(6)
(7)
(8)
(9)
(10)
(11)
(12)
(13)
(14)
(15)
(16)
Schedule R (Form 990) 2015
Page 5
Schedule R (Form 990) 2015
Part VII
Supplemental Information
Provide additional information for responses to questions on Schedule R (see instructions).
Schedule R (Form 990) 2015
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