Form
990-T
(and proxy tax under section
For calendar year 2004 or other tax year beginning
See separate
Department of the Treasury
InternalRevenueService
0
501(
0
408(e)
0
408A
0
)(
)
0
0
Please
Print or
220(e) Type
530(a)
529(a\
c Book value of all assets F
at end of 8'6'213,841
G033( e»
-- ?-'1- - _,2004, and ending -- !-
G
@O4
-- , 20. -?- -
instructions.
0
0
Check box
if
A
address
changed
6 Exempt under section
OMB No. 1545-0687
Exempt Organization Business Income Tax Return
check box if name changed and see instructions)
Name of organization (
UNIVERSITY
OF NORTHERN
IOWA
D Employer identification number
Number, street, and room or suite no. (Ifa P.O. box, see page 7 of instructions.)
125 GILCHRIST
HALL
42 6004333
E Newunrelatedbus.activity codes
(Seeinstructionsfor BlockE on page7.)
(Empioyees'trust,
seeinstructions
lorBlock0
onpage
7.)
:
City or town, state, and ZIP code
CEDAR
FALLS,
Group exemption
Check
number
organization
722320
IA 50614-0009
(see instructions
type
0
for Block
501 (c) corporation
711300
F on page 7)
0
501 (c) trust
0
0 Other trust
401 (a) trust
H Describe the organization's primary unrelated business activity. ~
I
Duringthe tax year, was the corporation a subsidiary in an affiliated group or a parent-subsidiarycontrolled group?
If "Yes," enter the name and identifying number of the parent corporation. ~
The books are in care of ~ GARY B SHONTZ
Telephone number ~ (
J
Unrelated Trade or Business Income
1a
b
Grossreturns
receipts
sales
Less
andorallowances
1,824,633
[j
(A) Income
c Balance ~
2
Cost of goods sold (Schedule A, line 7) . . .
3
Gross profit (subtract line 2 from line 1c).
. .
4a Capital gain net income (attach Schedule 0) . .
. . .
.
.
.
.
.
.
b Net gain (loss) (Form 4797, Part II, line 17) (attach Form 4797)
c Capitallossdeductionfor trusts. . . . . . . . .
5
Income (loss) from partnerships and S corporations (attach statement)
6
Rent income
7
Unrelated debt-financed income (Schedule E)
8
(Schedule
C)
. . . . . . . . . . .
. . . .
Interest, annuities, royalties, and rents from controlled
organizations
(ScheduleF). . . . . . . . . . .
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26
27
28
29
30
31
32
33
34
Investment
1c
2
3
4a
4b
4c
5
6
7
I
.
~
0 Yes III No
(6) Expenses
1,212,938
611,695
349,157
303,620
45,537
8
income of a section 501(c)(7), (9), or (17)
organization
(ScheduleG). . . . . . . . . ..
Exploitedexemptactivityincome(ScheduleI) . . .,
Advertisingincome(ScheduleJ). . . . . . . ..
9
10
11
Otherincome(seepage9 of the instructions-attachschedule) 12
Total (combine lines 3 throu h 12). . . . . . ..
13
960,852
303,620
657,232
Deductions Not Taken Elsewhere (See page 9 of the instructions for limitations On deductions.)
(Except for contributions, deductions must be directly connected with the unrelated business income,)
14
15
16
17
18
19
Compensation of officers, directors, and trustees (Schedule K)
Salaries and wages.
Repairs and maintenance.
Bad debts.
Interest (attach schedule) .
Taxes and licenses
Charitable contributions (see page 11 of the instructions for limitation rules)..
Depreciation (attach Form 4562) . . . . . . . . . . . ..
I 21
Less depreciationclaimed on ScheduleA and elsewhereon return.
I
I22a I
.52',997 I .
I
Depletion
Contributions to deferred compensation plans.
Employee benefit programs
Excess exempt expenses (Schedule I) .
Excess readership costs (Schedule J) .
Other deductions (attach schedule) .
Total deductions (add lines 14 through 28) .
Unrelated business taxable income before net operating loss deduction (subtract line 29 from line 13)
Net operating loss deduction.
Unrelated business taxable income before specific deduction (subtract line 31 from line 30).
Specific deduction (Generally $1,000, but see line 33 instructions for exceptions)
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.
For Privacy Act and Paperwork Reduction Act Notice, see instructions.
Cat. No. 11291J
330,570
19,702
Ii&.
22b
23
24
25
26
27
28
29
30
31
32
33
34
52,997
708.674
1,111,943
(454,711)
(454,711)
(454,711)
Form 990- T (2004)
Form 990- T (2004)
Page
2
Tax Computation
35
Organizations
Taxable as Corporations (see instructions for tax computation on page 12).
Controlled group members (sections 1561 and 1563)-check here 0 . See instructions and:
a Enter your share of the $50,000, $25,000, and $9,925,000 taxable income brackets (in that order):
(1) 1$
1
I
(2) 1$
I
I
(3) 1$
I
1
b
Enter organization's
share of: (1) additional
l!
l!
5% tax (not more than $11,750)
. . . . . . ..
(2) additional 3% tax (not more than $100,000).
c Incometax on the amount on line 34. . . . . . . . . . . . . . . . . .
36 Trusts Taxable at Trust Rates (see instructions for tax computation on page 13). Income
the amount on line 34 from: 0 Tax rate schedule or 0 Schedule 0 (Form 1041). . .
37 Proxy tax (see page 13 of the instructions).
. . . . . . . . . . . . . . .
38 Alternative minimum
tax. . . . . . . . . . . . . .
39 Total (add lines 37 and 38 to line 35c or 36, whicheverapplies) .
Tax and Payments
40a Foreigntax credit (corporationsattach Form1118;trustsattach Form1116)
b Other credits (see page 14 of the instructions).. . . . . . . .
c General business credit-Check
.
.
tax
.
.
~
on
~
~
36
37
38
39
40a
. 40b
here and indicate which forms are attached:
Formfor3800
0 Form(s)
(specify)
~ ---------------------------.
d 0
Credit
prior year
minimum
tax (attach
Form 8801 or 8827) ---------- -- --140C
40d
e Total credits (add lines 40a through 40d).
41
Subtract line 40e from line 39 . . . .
.
Other taxes. Check if from: 0 Form 4255 0 Form 8611 0 Form 8697 0
Totaltax (add lines 41 and 42) . . . . . . .
42
43
Form 8866
0
44a
44b
44c
44d
44e
44a Payments: A 2003 overpayment credited to 2004.
b 2004 estimated tax payments.
c Tax deposited with Form 8868
.
.
d Foreignorganizations-Tax paid or withheld at source(seeinstructions)
e Backup withholding (see instructions). . . .
f
0
0
Other credits and payments:
Form 4136
0
45
46
47
48
49
1
Form 2439
Other
Total ~
Total payments (add lines 44a through 44f). . . .
. . .
. .
0
Estimated tax penalty (see page 4 of the instructions). Check ~
Other (attach schedule)
144f
. .
. . .
. .
..
45
46
47
48
if Form 2220 is attached.
Tax due-If line 45 is less than the total of lines 43 and 46, enter amount owed.
. . . ~
Overpayment-If line 45 is larger than the total of lines 43 and 46, enter amount overpaid. ~
Refunded~
49
Entertheamountof line48youwant: Creditedto 2005estimatedtax ~
Statements Reaardina Certain Activities and Other Information (See instructions on
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)?
If "Yes," the organization may have to file Form TO F 90-22.1. If "Yes," enter the name of the foreign country
here
~
. - . . - - . - - - - - - - - . - - - - - - - - - - - - - - - . - - . --
. -- . . . - . - . . . . --
. . . - . . . -- . -- . . . - . . . --
. --
. . . . - . . . . . . . . . - . . - . --
- . - . --
. - . . - - . - - - - - - - -
2
During the tax year, did the organizationreceivea 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
2
Inventory at beginning of year.
P urch ases . . . . . . .
3
Cost of labor.
. . . ..
4a Additional section 263A costs
(attach schedule).
. . ..
b Other costs (attach schedule).
5
Total-Add
lines 1 through 4b
1
2
0
1 058 672
3
154,266
.
7 Cost of goods sold. Subtract line
6 from line 5. (Enter here and on
line 2, Part I.). . . . . . .
8 Do the rules of section 263A (with respect to
property produced or acquired for resale) apply
to the oraanization?
"
4a
4b
5
0
6 Inventory at end of year.
1,212,938
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 ~,.
~
~>l.
(").
~1\0
Signat~re of officer
Paid
Preparer's
Use Only
I
Preparer's
signature
~
..
0 I
I~
Date
~
:1 ~,. CONTROLLERISECRETARY/T
Title
I
Ome
the preparer shown below (see
May the IRS discuss this return with
instructions)?
0
Ves
0
No
Prepare,'s SSN or PTIN
~
Firm's name (or
yours if self-employed).
address, and ZIP code
~
)
Form
990-T
(2004)
Form 990-T (2004)
Page
Schedule C-Rent
3
Income (From Real Property and Personal Property Leased With Real Property)
(See instructionson page 16.)
1 Description of property
(1)PERFORMING ARTS CENTER
(2)UNI DOME
(3)OTHER
(4)
2 Rent received or accrued
(b) From real and personal property (ifthe
percentage of rent for personal property exceeds
50% or if the rent is based on profit or income)
3 Deductions directly connected with the income in
columns 2(a) and 2(b) (attach schedule)
(1)
77,815
142,843
(2)
238,544
143,879
(3)
32,798
16,898
(a) From personal property (ifthe percentage of rent
for personal property is more than 10% but not
more than 50%)
(4)
Total
Total
349,157
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
349,157
(See instructions
303,620
on pa e 17.)
2 Gross income from or
allocable to debt-financed
property
1 Description of debt-financed property
Total deductions. Enter
here and on line 6, column
.
(8), Part I, page 1.
3 Deductions directly connected with or allocable to
debt -financed property
(a) Straight line depreciation
(b) Other deductions
(attach schedule)
(attach schedule)
(1) N/A
(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 x column 6)
(1)
%
(2)
%
(3)
%
(4)
%
8 Allocable deductions
(column 6 x total of columns
3(a) and 3(b»
Enter here and on line 7,
Enter here and on line 7,
column (A), Part I, page 1. column (8), Part I, page 1.
Totals.
Total dividends-received
Schedule F-Interest,
deductions included in column 8
Annuities, Royalties, and Rents From Controlled Organizations (Seeinstructions on page 18.)
Exempt
1 Name of Controlled
Organization
,
2 Employer
Identification Number
Controlled
3 Net unrelated income
(loss) (see instructions)
Organizations
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) N/A
(2)
(3)
(4)
Nonexempt Controlled Organizations
7 Taxable Income
8 Net unrelated income
(ioss) (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)
Add columns 5 and 10. Enter
here and on line 8. Column (A).
Part I, page 1.
Totals
Add columns 6 and 11. Enter
here and on line 8. Column (8),
Part I. page 1.
.
Form 990- T (2004)
Form 990-T (2004)
Page
4
Schedule G-Investment Income of a Section 501(c){7), (9), or (17) Organization
(Seeinstructions on page 18.)
3 Deductions
directly connected
(attach schedule)
2 Amount of income
1 Description of income
4 Set-asides
(attach schedule)
~N/A
@
~
(4)
Enter here and on line 9,
column (A), Part I, page 1.
Enter here and on line 9,
column (B), Part I, page 1.
Totals.
. . . . . . ~
Schedule I-Exploited Exempt Activity Income, Other Than Advertising Income
(See instructions on page 18.)
3 Expenses
directly
connected with
2 Gross
unrelated
businessincome
from trade or
business
1 Description of exploited activity
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).
~N/A
@
~
(4)
Enter here and on
line 10. col. (A),
Part I, page 1.
I
Enter here and on
line 10, col. (8),
Part I. page 1.
Totals. . . . . . . . . ~
Schedule J-Advertising
Income (See instructions on page 19.
Income From Periodicals Reported on a Consolidated
2 Gross
advertising
income
1 Name of periodical
~N/A
@
~
~
Totals
line(5))
(carry
to
3 Direct
advertising costs
Enter here and
on line 26, Part II.
page 1.
Basis
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).
II,
Part
.~
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.)
~N/A
@
~
(4)
(5) Totals from Part I
Enter here and on
line 11, col. (A).
Part I, page 1.
Totals, Part II (lines 1-5) .
Schedule
K-Compensatlon
I
Enter here and on
line 11, col. (8),
Part I, page 1.
Enter here and
on line 27, Part II,
page 1.
.~
of Officers,
1 Name
Directors,
and 'Iruslees
2 Title
(::;ee instructions
on page l.)
3 Percent of
4 Compensationattributable to
time devoted to
unrelated business
business
%
%
%
%
Total-Enter
here and on line 14, Part II, page 1.
Form 990- T (2004)
FOnTI
4562
Depreciation and Amortization
(IncludingInformationon Listed Property)
(Rev. January 2006)
Department of the Treasury
Internal
RevenueService
Name(s)shownon retum
OMB No. 1545-0172
~@O5
Attachment
Sequence No.
~ See separate instructions.
~ Attach to your tax return.
Businessor activityto whichthis fOnTIrelates
UNIVERSITYOF NORTHERN IOWA
Election To Expense
FORM 990-T
Certain
Property
Under Section
67
Identifying number
42-6004333
179
Note: If you have any listed property, complete Part V before you complete Part I.
1
2
3
4
5
Maximumamount.Seethe instructionsfor a higherlimit for certainbusinesses. . .
Total cost of section 179 property placed in service(see instructions)
Thresholdcost of section 179 property before reduction in limitation
Reduction in limitation. Subtract line 3 from line 2. If zero or less, enter -0- . .
Dollar limitation for tax year. Subtract line 4 from line 1. If zero or less, enter -0-. If marriedfiling
separately,see instructions
(a) Description of property
(b) Cost (business use only)
$105.000
1
2
3
4
. . . . .
$420,000
5
(c) Elected cost
6
7 Listedproperty.Entertheamountfromline29. . . . . . . . . L1.
8 Totalelectedcostof section179property.Addamountsin column(c),lines6 and7. . . .
9 Tentativededuction.Enterthesmallerof line5 or line8. . . . . . . . . . . . . .
9
10 Carryover of disallowed deduction from line 13 of your 2004 Form 4562 . . . . . . . . 10
11 Businessincomelimitation.Enterthe smallerof businessincome(notlessthanzero)or line 5 (seeinstructions) 11
12 Section 179 expense deduction. Add lines 9 and 10, but do not enter more than line 11. . . 12
13 Carryover of disallowed deduction to 2006. Add lines 9 and 10, less line 12 ~
Note: Do not use Part /I or Part 11/below for listed property. Instead, use Part V.
Special Depreciation
Allowance and Other Depreciation (Do not include listed
~
~
14
Special allowance for certain aircraft, certain property with a long production period, and qualified NYL
or GO Zone property (other than listed property) placed in service during the tax year (see instructions)
15 Property
subjectto section168(f)(1)
election.
4
~
. . . . . . . . . . . . . . . . 15
16
Other depreciation(includingACRS) . . . . . . . . . . . . . . . . . .
MACRS Depreciation (Do not include listed property.) (See instructions.
Section A
17
18
MACRS deductions for assets placed in service in tax years beginning before 2005 .
If you are electing to group any assets placed in service during the tax year into one or more
general
assetaccounts,
checkhere. . . . . . . . . . . . . . . . . ~ D
Section B-Assets
Placed in Service During 2005 Tax Year Using the General Depreciation
(a)
Classification
of property
I
(b) Month and
year placed in
service
3-year property
5-year property
7-year property
10-year property
15-year property
20-year property
25-year property
Residential rental
property
i Nonresidential real
property
Section C-Assets
20a Class life
(c) Basis for depreciation
(business/investment use
onlv-see
instructions'
19a
b
c
d
e
f
g
h
(e) Convention
in Service
12 yrs.
40 yrs.
MM
45,849
16
System
(g) Depreciation deduction
S/L
S/L
S/L
S/L
S/L
Depreciation
S/L
System
S/L
S/L
(see instructions
Enter amount
from line 28
21
.
21
Listed
22
Total. Add amounts from line 12, lines 14 through 17, lines 19 and 20 in column (g), and line 21.
Enter here and on the appropriate lines of your return. Partnerships and S corporations-see instr.
For assets shown above and placed in service during the current year,
23
enter the portion of the basis attributable to section 263A costs
23
property.
I
. .
(f) Method
MM
MM
MM
MM
During 2005 Tax Year Using the Alternative
b 12-year
c 40-year
Summary
d Reco
()
.;;ery
pen
25 rs.
27.5 yrs.
27.5 yrs.
39 yrs.
Placed
.. .See instructions.
For Paperwork Reduction Act Notice, see separate instructions.
Cat. No. 12906N
22
Form 4562
52,997
(2005)(Rev.1-2006)
Form 4562 (2005)(Rev, 1-2006)
rm!I
Page
Listed Property (Include automobiles, certain other vehicles, cellular telephones,
property used for entertainment, recreation, or amusement.)
certain computers,
2
and
Note: For any vehicle for which you are using the standard mileage rate or deducting lease expense, complete only
24a, 24b, columns (a)through (c) of Section A, all of Section 8, and Section C if applicable.
Section A-Depreciation and Other Information (Caution: See the instructionsfor limits for passen er automobiles.)
24a Doyouhaveevidence
to supportthebusiness/investment
useclaimed?DYes
(a)
Type of ' property
(list
'
I f Irst)
ve h ICes
(b)
Date placed in
,
service
Ie)
Businessl
(d)
Investment
use
percent age
D No 24b If "Yes,"is the evidencewritten? DYes D No
(e)
asls
, for depreC ,atIOn
,
,
(f)
B uSlness/ lOvest men t Recovery
'
(b
d
peno
use onIy)
Cost or ' other
b aSls
(g)
Methodl'
C onven t Ion
25
Specialallowancefor certain aircraft,certain property with a long production period,and qualified NYL or GOZone
property placed in serviceduring the tax year and used more than 50% in a qualifiedbusinessuse (seeinstructions)I 25
26
Property used more than 50% in a qualified
business
§
%
%
r aq"al~i
Ii)
EI ct d
~ e
sec t Ion 1 79
cost
use:
%
27 Pmp"" "'""150%°' ,,,'
(h)
Depreciation
'
d ed uc t Ion
b""o." ",e
1
~
1
28
Add amounts in column (h), lines 25 through 27. Enter here and on line 21, page 1.
Add amounts in column (i), line 26. Enter here and on line 7, page 1. . .
Section B-Information
on Use of Vehicles
Complete this section for vehicles used by a sole proprietor, partner, or other "more than 5% owner," or related person.
Ifyoup-c:Md:d
vetlidesto your ~
first alSW8I"" the q.JeStiCflS
in SoctionC to seeif you!TEeta1exceptionto cc:x;petingttis sectionfa' tIn;e vetlides.
28
29
30
31
32
33
34
35
36
Total businesslinvestmentmiles driven
duringthe year(do not includecommuting
miles) .
Totalcommutingmilesdrivenduringtheyear
(a)
Vehicle1
(b)
Vehicle2
(c)
Vehicle3
(d)
Vehicle4
(e)
(f)
Vehicle 5
Vehicle6
Total other personal (noncommuting)
miles driven.
Total miles driven during the year. Add
lines 30 through 32
Was the vehicle available for personal
use during off-duty hours?
Was the vehicle used primarily by a
more than 5% owner or related person?
Is another vehicle availablefor personal
use? .
Yes
No
Yes
No
Yes
No
Yes
No
Yes
No
Yes
No
Section C-Questions
for Employers Who Provide Vehicles for Use by Their Employees
Answer these questions to determine if you meet an exception to completing Section B for vehicles used by employees who are
not more than 5% owners or related persons (see instructions).
Yes
No
37
Do you maintain a written policy statement that prohibits all personal use of vehicles, including commuting,
by your employees?
. .
. . . ..
..
38 Do you maintaina written policy statementthat prohibits personaluseof vehicles,except commuting,by your employees?
See the instructions for vehicles used by corporate officers, directors,or 1% or more owners
39
40
41
Do you treat all use of vehicles by employees as personal use?
..
..
Do you provide more than five vehicles to your employees, obtain information from your employees about
the use of the vehicles, and retain the information received?.
..
. .
Do you meet the requirementsconcerningqualified automobiledemonstrationuse? (See instructions.)
Note: If your answer to 37, 38, 39, 40, or 41 is "Ves," do not comolete Section 8 for the covered vehicles.
Amortization
(b)
Date amortization
begins
(a)
Descriptionof costs
Id)
Code
section
(e)
Amortizable
amount
42
Amortization of costs that begins during your 2005 tax year (see instructions):
43
44
Amortizationof coststhat beganbeforeyour2005tax year. . . . . . .
Total.Addamountsin column(t).Seetheinstructionsfor whereto report. .
I
I
t
(e)
Amortization
period or
percentage
+
~
Form
(f)
Amortization for
this year
4562
(2005) (Rev. 1-2006)
University of Northern Iowa
Unrelated Business Income Tax
Form 990-T
Other Deductions line 28
Travel
General Supplies
Postage and Shipping
Business Meals and Entertainment
Dues and Subscriptions
Insurance
Rents/Leases
Telephone
Printing/Duplicating/AV/Photography Services
Computer Supplies
Purchased Services
Administrative Overhead
Advertising
Utilities
Miscellaneous
Other:
990 Schs sales svcs.xlsUBIT
3,400
25,745
1,646
368
498
4,719
919
3.517
925
2,285
3,406
605.809
109
33,282
22,046
708,674
1 of 1
2/15/20063:36 PM
Form
8868
~
Application for Extension of Time To File an
Exempt Organization Return
(Rev. December 2004)
Department of the Treasury
Internal Revenue Service
OMB No. 1545-1709
~ File a separate application for each return.
.
If you are filing for an Automatic 3-Month Extension, complete only Part I and check this box.
. ~ []
If you are filing for an Additional (not automatic) 3-Month Extension, complete only Part II (on page 2 of this form).
Do not complete Part II unless you have already been granted an automatic 3-month extension on a previously filed Form BB6B.
Automatic 3-Month Extension of Time-Only
submit original (no copies needed)
.
Form 990-T corporations
requesting
an automatic
6-month
extension-check
this box and complete
Part I only.
. ~ 0
All other corporations (including Form 990-C filers) must use Form 7004 to request an extension of time to file income tax returns.
Partnerships, REMICs, and trusts must use Form 8736 to request an extension of time to file Form 1065, 1066, or 1041.
Electronic Filing (e-file). Form 8868 can be filed electronically if you want a 3-month automatic extension of time to file one of the
returns noted below (6 months for corporate Form 990-T filers). However, you cannot file it electronically if you want the additional
(not automatic) 3-month extension, instead you must submit the fully completed signed page 2 (Part II) of Form 8868. For more
details on the electronic filing of this form, visit www.irs.gov/efile.
Employer identification number
Type or
Name of Exempt Organization'
42:6004333
print
Universityof Northern Iowa
I
Fileby the
due date for
Number, street. and room or suite no. If a P.O. box, see instructions.
..
instructions.
ljlty.
filingyour
return.See
125
GJ.lchrJ.st
Ha 11
town or post office, state. and ZIP code. For a foreign address, see instructions.
Cedar
Falls,
50614-0009
Iowa
Check type of return to be filed (filea separate application for each return);
0 Form990
rn Form 990-T (corporation)
0
0
0
Form 990-BL
Form 990-EZ
Form 990-PF
0
0
0
. The books are in the care of ~
Telephone No. ~
Gary
0
0
0
0
Form 990-T (sec. 401(a)or 408(a)trust)
Form 990-T (trust other than above)
Form 1041-A
B.
Shontz
""''''''''''''''''''''''''''''''''''''''''''''''''''''''''''''''''''''''''''''''''''''''
(JJ.~...J..f.n:-:}~?~
.
FAXNo. ~ J.}}.9...L.~.?~::~.~.q..~..............
. If the organizationdoes not have an office or place of business in the United States, check this box.
. If this is for a Group Return, enter the organization's four digit Group Exemption Number (GEN)
is for the whole group, check this box ~ 0 . If it is for part of the group, check this box ~
names and EINs of all members the extension will cover.
1
0
.
..
. ~
0
. If this
and attach a list with the
I request an automatic 3-month (6-months for a Form 990-T corporation) extension of time until .E~bxJ.!a1=".Y..J5... ,20 .9.t?
to file the exempt organization return for the organization named above. The extension is for the organization's return for:
~ 0 calendar year 20 ... or
~
2
Form 4720
Form 5227
Form 6069
Form 8870
IKJ
tax year beginning
:!~f:Y...L
If this tax year is for less than 12 months, check reason;
, 209.~,andending
0
Initial return
0
~?~.~.}9
Final return
0
, 20~?
Change in accounting period
3a If this application is for Form 990-BL, 990-PF, 990-T, 4720, or 6069, enter the tentative tax, less any
nonrefundable
credits.Seeinstructions. . . . . . . . . . . . . . . . . . . . . . ~
b If this application is for Form 990-PF or 990- T, enter any refundable credits and estimated tax payments
made.Includeanyprioryearoverpaymentallowedasa credit.
. . . . . . . . . . ..
~
0
0
c Balance Due. Subtract line 3b from line 3a. Include your payment with this form, or, if required, deposit
with FTD coupon . or,
0
instructions.
. if. required,
. . . .by . using
. . EFTPS
. . . (Electronic
. . . . Federal
. . . Tax
. .Payment
. . . System).
. . . See
. . $
Caution. If you are going to make an electronic fund withdrawal with this Form 8868, see Form 8453-EO and Form 8879-EO
for payment instructions.
For Privacy Act and Paperwork Reduction Act Notice, see Instructions.
Cat. No. 27916D
Form
8868
(Rev. 12-2004)
Form 8868 (Rev. 12-2004)
Page
. If you are filing for an Additional (not automatic) 3-Month Extension, complete only Part II and check this box.
2
0
~
Note. Only complete Part II if you have already been granted an automatic 3-month extension on a previously filed Form 8868.
3-Month Extension, complete only Part I (on page 1).
Additional
(not automatic)
3-Month
Extension
of Time-Must
File Ori inal and One Co
. If you are filing for an Automatic
Type or
print
Name of Exempt Organization
File by the
extended
due date for
filing the
return. See
instructions.
Number, street, and room or suite no. If a P.O. box, see instructions.
Employer
identification
number
City, town or post office, state, and ZIP code. For a foreign address, see instructions.
Check type of return to be filed (File a separate application for each return):
0
0
0
0
Form
Form
Form
Form
0
0
0
0
990
990-BL
990-EZ
990-PF
Form
Form
Form
Form
990- T (sec. 401 (a) or 408(a) trust)
990-T (trust other than above)
1041-A
4720
0
Form 5227
0
0
Form 6069
Form 8870
STOP: Do not complete Part 1/if you were not already granted an automatic 3-month extension on a previously filed Form 8868.
. The booksarein thecareof ~
-- -
-..
Telephone No. ~ L.. ---_..),.. ---..
-- -..
-..
_.. -
--.
FAXNo. ~
-.. ... -.. -..
- -..............
-""""""
does not have an office or place of business in the United States, check this box
. ~
If this is for a Group Return, enter the organization's four digit Group Exemption Number (GEN)
If this is
for the whole group, check this box ~
O. If it is for part of the group, check this box ~ 0 and attach a list with the
. If the
.
--.) -
C
organization
0
names and EINs of all members the extension is for.
4
I request an additional 3-month extension of time until
5
For calendaryear.. -
6
J.fthis tax year is for less than 12 months, check reason:
7
State
in detail
. - . . . - . . . . . - . ..
. . . . . . . . .
-
, or other tax year beginning
-- , 20
0
why you need the extension
. . - . . . . . . . ..
. - . . . . . . . . . . ..
. . ..
. - . . . . . - . . . . . . . ..
. . . . . . . . . - . . . . . . . . . - . - ..
. . . . ..
. . . . . . . . . . . . . . . . . ..
. . . . . - . . . - . . . - - .
. ..
.
20
, 20......
0
Change in accounting period
Final return
- - --"""
. . . . . . . ..
. ..
0
Initial return
..
-Jand ending
-.. -..
- . . . - . - . . .
- . . . - - . . . - . . - . .
- . .
.
- . ..
- . . . . - . . . . .
- . . . - . . . . . - .
- . . . . ..
- - . .
. .
. . . . - - . - . . . - - . .
. . ..
.........
- - - . ..
- . . . . . .
. - - . . . . - - - . - . . . .
8a If this application is for Form 990-BL, 990-PF, 990-T. 4720, or 6069, enter the tentative tax, less any
nonrefundable
credits. See instructions
- .
. . .
. - . . - -
. . . - - - . --
i
b If this application is for Form 990-PF, 990-T, 4720, or 6069, enter any refundable credits and estimated
tax payments made. Include any prior year overpayment allowed as a credit and any amount paid
previouslywith Form 8868
i
c Balance Due. Subtract line 8b from line 8a. Include your paymentwith this form, or, if required, deposit
with FTDcoupon or, if required,by using EFTPS(ElectronicFederalTaxPaymentSystem).See instructions.
$
Signature and Verification
Under penalties of perjury, I declare that I have examined this form, Including accompanying
it is true, correct, and complete, and that I am authorized to prepare this form.
Signature ~
0
0
0
0
0
.h
"
~~
We have approved
-
Title ~
Notice to Applicant-To
this application.
Please
schedules
and statements,
and to the best of my knowledge and belief.
~
\ \ -10- ZODS
Date ~
Be Completed by the IRS
attach this form to the organization's
return.
We have not approved this application. However, we have granted a 10-day grace period from the later of the date shown below or the due
date of the organization's
return (including any prior extensions). This grace period is considered to be a valid extension of time for elections
otherwise required to be made on a timely return. Please attach this form to the organization's
return.
Wefile.
have
thisaapplication.
After
considering the reasons stated in item 7, we cannot grant your request for an extension of time
to
Wenot
are approved
not granting
10-day grace
period.
We cannot consider
Other
-..
this application because it was filed after the extended due date of the return for which an extension was requested.
-"""""'.""
'"''''''''''
-""""
'-
-.. ..
. - -.. --.. .. - - . ..
-.. . -
-"'..
.
'" .. -.....
By:
Director
Date
Alternate Mailing Address
-
Enter the address if you want the copy of this application for an additional 3-month extension
returned to an address different than the one entered above.
I Name
Type or
print
Number and street (include suite, room, or apt. no.) or a P.O. box number
City or town,
province
or state,
and country
(including
postal
or ZIP code)
Form
8868
(Rev- 12-2004)