Form Schedule R (F 990) Schedule R (F 990) Related Organizations and Unrelated Partnerships

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SCHEDULE R
(Form 990)
Department of the Treasury
Internal Revenue Service
Name of the organization

Part I

Related Organizations and Unrelated Partnerships

(2)
(3)
(4)
(5)

2012

Open to Public
Inspection

▶ Complete if the organization answered "Yes" to Form 990, Part IV, line 33, 34, 35, 36, or 37.
▶ Attach to Form 990.

▶ See separate instructions.

Employer identification number

DRAFT AS OF
November 21, 2012
DO NOT FILE

Identification of Disregarded Entities (Complete if the organization answered “Yes” to Form 990, Part IV, line 33.)
(a)
Name, address, and EIN (if applicable) of disregarded entity

(1)

OMB No. 1545-0047

(b)
Primary activity

(c)
Legal domicile (state
or foreign country)

(d)
Total income

(e)
End-of-year assets

(f)
Direct controlling
entity

(6)

Part II

Identification of Related Tax-Exempt Organizations (Complete if the organization answered “Yes” to 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) 2012

Page 2

Schedule R (Form 990) 2012

Part III

Identification of Related Organizations Taxable as a Partnership (Complete if the organization answered “Yes” to 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?

(i)
Code V—UBI
amount in box 20
of Schedule K-1
(Form 1065)

DRAFT AS OF
November 21, 2012
DO NOT FILE
Yes No

(1)
(2)
(3)
(4)
(5)
(6)
(7)

Part IV

(j)
General or
managing
partner?

(k)
Percentage
ownership

Yes No

Identification of Related Organizations Taxable as a Corporation or Trust (Complete if the organization answered “Yes” to 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)
Type of entity
(C corp, S corp, or trust)

(f)
(g)
(h)
Share of total
Share of
Percentage
income
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) 2012

Page 3

Schedule R (Form 990) 2012

Part V

Transactions With Related Organizations (Complete if the organization answered “Yes” to Form 990, Part IV, line 34, 35b, or 36.)

DRAFT AS OF
November 21, 2012
DO NOT FILE

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
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Yes

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1a
1b
1c
1d
1e

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1f
1g
1h
1i
1j

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1k
1l
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1n
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 other 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) 2012

Page 4

Schedule R (Form 990) 2012

Part VI

Unrelated Organizations Taxable as a Partnership (Complete if the organization answered “Yes” to 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)
(e)
(d)
Legal domicile
Are all partners
Predominant
(state or foreign
section
income (related,
country)
501(c)(3)
unrelated, excluded
organizations?
from tax under
section 512-514)

(2)
(3)
(4)
(5)
(6)
(7)

(g)
Share of
end-of-year
assets

(h)
(i)
Disproportionate
Code V—UBI
allocations?
amount in box 20
of Schedule K-1
(Form 1065)

DRAFT AS OF
November 21, 2012
DO NOT FILE
Yes No

(1)

(f)
Share of
total income

Yes No

(j)
General or
managing
partner?

(k)
Percentage
ownership

Yes No

(8)
(9)
(10)
(11)
(12)
(13)
(14)
(15)
(16)
Schedule R (Form 990) 2012

Page 5

Schedule R (Form 990) 2012

Part VII

Supplemental Information
Complete this part to provide additional information for responses to questions on Schedule R (see
instructions).

DRAFT AS OF
November 21, 2012
DO NOT FILE

Schedule R (Form 990) 2012