Form 4720 sch I 4720 sch I Initial Taxes on Excess Benefit Transactions

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Form 4720 (2015)

SCHEDULE G—Tax on Excess Lobbying Expenditures (Section 4911)
1

Excess of grassroots expenditures over grassroots nontaxable amount (from Schedule C (Form
990 or 990-EZ), Part II-A, column (b), line 1h). (See the instructions before making an entry.) . .

1

Excess of lobbying expenditures over lobbying nontaxable amount (from Schedule C (Form 990 or
990-EZ), Part II-A, column (b), line 1i). (See the instructions before making an entry.) . . . . .

2

3

Taxable lobbying expenditures—enter the larger of line 1 or line 2

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3

4

Tax—Enter 25% of line 3 here and on Part I, line 6

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4

2

Part I
(a) Item
number

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SCHEDULE H—Taxes on Disqualifying Lobbying Expenditures (Section 4912)
Expenditures and Computation of Tax
(b) Amount

(c) Date paid or
incurred

(d) Description of lobbying expenditures

(e) Tax imposed on organization
(5% of col. (b))

(f) Tax imposed on organization
managers (if applicable)—
(5% of col. (b))

1
2
3
4
5
Total—Column (e). Enter here and on Part I, line 7 .

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Total—Column (f). Enter total (or prorated amount) here and in Part II, column (c), below .

Part II

(a) Names of organization managers liable for tax

Part I
(a)
Transaction
number

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Summary of Tax Liability of Organization Managers and Proration of Payments
(b) Item no. from
Part I, col. (a)

(c) Tax from Part I, col. (f), or
prorated amount

(d) Manager’s total tax liability
(add amounts in col. (c))
(see instructions)

SCHEDULE I—Initial Taxes on Excess Benefit Transactions (Section 4958)
Excess Benefit Transactions and Tax Computation
(b) Date of transaction

(c) Description of transaction

1
2
3
4
5
(d) Amount of excess benefit

(e) Initial tax on disqualified persons
(25% of col. (d))

(f) Tax on organization managers
(if applicable) (lesser of
$20,000 or 10% of col. (d))

Form 4720 (2015)

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Form 4720 (2015)

Part II

SCHEDULE I—Initial Taxes on Excess Benefit Transactions (Section 4958) Continued
Summary of Tax Liability of Disqualified Persons and Proration of Payments
(b) Trans. no. from
Part I, col. (a)

(a) Names of disqualified persons liable for tax

Part III

Summary of Tax Liability of 501(c)(3), (c)(4) & (c)(29) Organization Managers and Proration of Payments

(a) Names of 501(c)(3), (c)(4) & (c)(29) organization managers liable for tax

Part I

(a)
Transaction
number

(d) Disqualified person’s total tax
liability (add amounts in col. (c))
(see instructions)

(c) Tax from Part I, col. (e),
or prorated amount

(b) Trans. no. from
Part I, col. (a)

(d) Manager’s total tax liability
(add amounts in col. (c))
(see instructions)

(c) Tax from Part I, col. (f),
or prorated amount

SCHEDULE J—Taxes on Being a Party to Prohibited Tax Shelter Transactions (Section 4965)
Prohibited Tax Shelter Transactions (PTST) and Tax Imposed on the Tax-Exempt Entity
(see instructions)
(b) Transaction
date

(c) Type of transaction
1 —Listed
2 —Subsequently listed
3 —Confidential
4 —Contractual protection

(d) Description of transaction

1
2
3
4
5
(e) Did the tax-exempt entity know or
have reason to know this transaction
was a PTST when it became a party to
the transaction? Answer Yes or No

(f) Net income attributable to
the PTST

Total—Column (h). Enter here and on Part I, line 9 .

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(g) 75% of proceeds attributable to
the PTST

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(h) Tax imposed on the tax-exempt
entity (see instructions)

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Form 4720 (2015)