Fill - Free fillable 990 Preparation Checklist PDF form

990 Preparation Checklist: Page 1

The following checklist is intended to help you prepare for Form 990. If you have any questions

about this checklist or the form, please contact your Rea advisor or Maribeth Wright, a principal

on Rea’s not-for-proﬁt team, at 740.630.9660 or maribeth.wright@reacpa.com. If Rea is

preparing your 990, please send us a copy of this checklist.

• • • • •

Part I, Part VII, Part IX, Part X: Financial Information

Copy of ﬁnancial books or records or a copy Form 990 and/or 990-T if a separate return is ﬁled by the organization. _____

Books or records may include ﬁnancial statements (income statement, balance sheet, ﬁxed asset detail and depreciation

schedules, if applicable) that have been prepared by the organization and the checking and savings account detail along with

copies of bank statements.

Brieﬂy describe the three most signiﬁcant program service activities (in terms of expenses) that the organization carried on

during the year and the total expenses associated with each activity.

ACTIVITY EXPENSE

Did the organization undertake any new signiﬁcant program services during the year? _____ yes _____ no

ducting or make signiﬁcant changes in how it conducts any program services?

Part IV: Checklists of Required Schedules

Did the organization receive directly or indirectly, money, securities or any other type of property aggregating $5,000 or more

for the year? _____ yes _____ no In determining the aggregate amount, separate and independent gifts of less than

$1,000 may be disregarded. If yes, please provide the name and address of each contributor, the aggregate contribution

made by each contributor, and a description of any noncash contribution. (Schedule B)

990 Preparation Checklist

990 Preparation Checklist: Page 2

NAME ADDRESS AGGREGATE

CONTRIBUTION

NON-CASH

CONTRIBUTION

DESCRIPTION

Did the organization engage in direct or indirect political campaign activities on behalf of or in opposition to candidates for

public ofﬁce? _____ yes _____ no If “Yes,” please provide the following (Schedule C, Part I):

• Description of the organization’s direct and indirect political campaign activities. ____________________________________

• Amount of political expenditures. ___________________________________________________________________________

• Number of volunteer hours. ________________________________________________________________________________

• Amount directly expended for exempt function activities of a political action committee (PAC). ________________________

• Amount of internal funds contributed to other organizations for exempt function activities of PACs. ____________________

• Provide the names, addresses and employer identiﬁcation numbers for all political organizations to which payments were

made:

NAME ADDRESS EIN

Did the organization engage in lobbying and political activities? _____ yes _____ no

If “Yes,” please provide the following (Schedule C, Part III):

990 Preparation Checklist: Page 3

• Were substantially all (90 percent or more) dues received nondeductible by members? _____ yes _____ no

• Did the organization make only in-house lobbying expenditures of $2,000 or less? _____ yes _____ no

• Did the organization agree to carryover lobbying and political expenditures from the prior year? _____ yes _____ no

• Section 162(e) nondeductible lobbying and political expenditures for the current year. _______________________________

• Carryover of section 162(e) nondeductible lobbying and political expenditures from the prior year. _____________________

• Aggregate amount lobbying and political expenditures reported as nondeductible on member dues notices. ___________

Did the organization maintain any donor advised funds or any accounts where donors have the right to provide advice on the

distribution or investment of amounts in such funds or accounts? _____ yes _____ no

Did the organization receive or hold a conversation easement, including easements to preserve open space, the environment,

historic land areas or historic structures? _____ yes _____ no

Did the organization maintain collections of works of art, historical treasures or other similar assets? _____ yes _____ no

At any time during the tax year, did the organization have an escrow or custodial account or provide credit counseling ser-

vices and/or debt management plan services such as credit repair or debt negotiations? _____ yes _____ no

Did the organization hold assets in temporary, permanent or quasi-endowments? _____ yes _____ no

Did the organization maintain an ofﬁce, employees or agents outside of the U.S.? _____ yes _____ no

Did the organization have aggregate revenues or expenses of more than $10,000 from grantmaking, fundraising, business

and program service activities outside the U.S.? _____ yes _____ no

Did the organization provide more than $5,000 of aggregate grants to governments, organizations and individuals located

outside the United States? _____ yes _____ no

Did the organization report more than $15,000 in expenses paid for professional fundraising? _____ yes _____ no

Did the organization report more than $15,000 in revenues from gaming activities? _____ yes _____ no

990 Preparation Checklist: Page 4

Did the organization have a tax-exempt bond issue with an outstanding principal amount of more than $100,000 as of the last

day of the year, that was issued after December 31, 2002? _____ yes _____ no

Was a loan to or by a current or former ofﬁcer, trustee, key employee, highly compensated employee or disqualiﬁed person

outstanding as of the end of the organization’s tax year? _____ yes _____ no

Did the organization provide a grant or other assistance to an ofﬁcer, director, trustee, key employee or substantial contributor,

or to a person related to such an individual? _____ yes _____ no

During the tax year, did any person who is a current or former ofﬁcer, director, trustee or key employee:

• Have a direct business relationship with the organization (other than as an ofﬁcer, director, trustee or employee), or an

indirect business relationship through ownership of more than 35 percent in another entity? _____ yes _____ no

• Have a family member who had a direct or indirect business relationship with the organization?_____ yes _____ no

• Serve as an ofﬁcer, director, trustee, key employee, partner or member of an entity (or a shareholder of a professional

corporation) doing business with the organization? _____ yes _____ no

Did the organization receive more than $25,000 in non-cash contributions? _____ yes _____ no

Did the organization receive contributions of art, historical treasures or other similar assets, or qualiﬁed conservation contribu-

tions? _____ yes _____ no

Did the organization have a 100 percent ownership interest in an entity that is disregarded as an entity that is separate from its

owner? _____ yes _____ no

Was the organization related to any tax-exempt or taxable entity? _____ yes _____ no

Is any related organization a controlled entity within the meaning of section 512(b)(13)? _____ yes _____ no For these

purposes, a controlled entity includes any entity in which the organization owns more than 50 percent of the stock, proﬁts or

capital interests, or beneﬁcial interests.

Did the organization conduct more than 5 percent of its exempt activities through an entity that is not a related organization

and that is taxed as a partnership? _____ yes _____ no

990 Preparation Checklist: Page 5

Part V: Statements Regarding Other IRS Filings and Tax Compliance

The organization must use Form 1096 to transmit Forms 1099, 1098, 5498 and W-2G to the IRS. How many Forms W-2G,

1098, 1099 and 5498 did the organization send to report certain amounts paid or received by the organization? (from Box 3

of Form 1096)

FORM NUMBER

W-2G

1098

1099

5498

How many Forms W-2-G did the organization ﬁle with the IRS to report certain gambling winnings paid by the organization? _

Did the organization comply with backup withholding rules for reportable payments to vendors and reportable gaming (gam-

bling) winnings to prize winners? _____ yes _____ no

How many employees reported on Form W-3, transmittal of wage and tax statements ﬁled for the calendar year ending with

or within the year covered by this return? ________________________________________________________________________

Did the organization ﬁle all required federal employment tax returns? _____ yes _____ no

Did the organization have unrelated business gross income of $1,000 or more during the year? Unrelated business gross

income is the gross revenues (before applying expenses) from any trade or business, that is regularly carried on, and is not

substantially related to the organization’s exempt purpose. _____ yes _____ no

At any time during the year, did the organization have an interest in, or a signature or other authority over, a ﬁnancial account

in a foreign country? _____ yes _____ no If “Yes,” please provide the name of the foreign country. ____________________

Was the organization a party to a prohibited tax shelter transaction at any time during the tax year? _____ yes _____ no

Did the organization solicit any contributions that were not tax deductible? _____ yes _____ no If “Yes,” did the organi-

zation include with every solicitation an express statement that such contributions or gifts were not tax deductible? _____

yes _____ no

990 Preparation Checklist: Page 6

Part VI: Governance, Management and Disclosure

Section A. Governing Body and Management

How many voting members are there in the governing body? _______________________________________________________

How many voting members are independent? ____________________________________________________________________

Did any ofﬁcer, director, trustee or key employee have a family relationship or a business relationship with any other ofﬁcer,

director, trustee or key employee? _____ yes _____ no

Did the organization delegate control over management duties customarily performed by or under the direct supervision of

ofﬁcers, directors or trustees or key employees to a management company or other person? _____ yes _____ no

Did the organization make any signiﬁcant changes to organizational documents since the prior Form 990 was ﬁled? Organiza-

tional documents include articles of incorporation, association or organization; trust instrument; constitution or similar docu-

ment. Organizing documents could also include bylaws, regulations or operating agreements. _____ yes _____ no Ex-

amples of signiﬁcant changes to the organizing or enabling document or bylaws include changes to such documents:

• In the organization’s exempt purposes or mission;

• In the number, composition qualiﬁcations, authority or duties of the governing body’s voting members;

• In the number, composition, qualiﬁcations, authority or duties of the organization’s ofﬁcers or key employees;

• In the role of the stockholders or membership in governance;

• In the distribution of assets upon dissolution;

• In the provisions to amend the organizing or enabling document or bylaws;

• In the quorum, voting rights or voting approval requirements of the governing body members or the organization’s

stockholders or membership;

• In the policies or procedures contained within the organizing document or bylaws regarding compensation of of-

ﬁcers, directors, trustees or key employees, conﬂicts of interest, whistleblowers or document retention and destruc-

tion; and

• In the composition or procedures contained within the organizing document or bylaws of an audit committee.

Did the organization become aware during the year of a material diversion of the organization’s assets? _____ yes _____ no

A diversion of assets includes any unauthorized conversion or use of the organization’s assets other than for the organiza-

tion’s authorized purposes, including but not limited to, an embezzlement or theft. For this purpose, a diversion is considered

material if the gross dollar amount (not taking into account restitution, insurance or similar recoveries) exceeds the lesser of

$250,000 or 5 percent of the lesser of the organization’s gross receipts for its tax year or total assets as of the end of its tax

year.

990 Preparation Checklist: Page 7

Does the organization have members or stockholders? _____ yes _____ no

Does the organization have members, stockholders or other persons who may elect one or more members of the governing

body? _____ yes _____ no

Are any decisions of the governing body subject to approval by members, stockholders, or other persons? _____ yes _____

Did the organization contemporaneously document the meetings held or written actions undertaken during the year by the

governing body? _____ yes _____ no

Did the organization contemporaneously document the meetings held or written actions undertaken during the year by each

committee with authority to act on behalf of the governing body?_____ yes _____ no

Does the organization have local chapters, branches or afﬁliates? _____ yes _____ no If “Yes,” does the organization have

written policies and procedures governing the activities of such chapters, afﬁliates and branches to ensure their operations are

consistent with those of the organization? _____ yes _____ no

Will a copy of the Form 990 be provided to the organization’s governing body before it is ﬁled? _____ yes _____ no

Describe the process, if any, the organization uses to review the Form 990. ___________________________________________

____________________________________________________________________________________________________________

Are there any ofﬁcers, directors, trustees or key employees, who cannot be reached at the organization’s mailing address?

_____ yes _____ no If “Yes,” provide the names and addresses:

NAME ADDRESS

Section B. Policies

Does the organization have a written conﬂict of interest policy? _____ yes _____ no If “Yes”:

990 Preparation Checklist: Page 8

• Are ofﬁcers, directors or trustees and key employees required to annually disclose interests that could give rise to con-

ﬂicts? _____ yes _____ no

• Does the organization regularly and consistently monitor and enforce compliance with the policy? _____ yes _____ no

• Does the organization have a written whistleblower policy? _____ yes _____ no

• Does the organization have a written document retention and destruction policy? _____ yes _____ no

• Did the process for determining compensation of the following persons include a review and approval by independent

persons, comparability data and contemporaneous substantiation of the deliberation and decision?

1. The organization’s CEO, executive director or top management ofﬁcial? _____ yes _____ no

2. Other ofﬁcers or key employees of the organization? _____ yes _____ no

Please provide a description of the organization’s process for determining compensation for these individuals:

POSITION PROCESS

Did the organization invest in, contribute assets to or participate in a joint venture or similar arrangement with a taxable entity

during the year? _____ yes _____ no

Has the organization adopted a written policy or procedure requiring the organization to evaluate its participation in joint

venture arrangements under applicable Federal tax law, and taken steps to safeguard the organization’s exempt status with

respect to such arrangements? _____ yes _____ no

Section C. Disclosure

IRC Section 6104 requires an organization to make its exemption application (Form 1023 or 1024 if applicable), Form 990 and

Form 990-T (501(c)(3)s only) available for public inspection. Indicate how you make these available. Check all that apply.

_____ own website _____ another’s website _____ upon request

990 Preparation Checklist: Page 9

Does the organization make its governing documents, conﬂicts of interest policy and ﬁnancial statements available to the

public? _____ yes _____ no

State the name, physical address and telephone number of the person who possesses the books and records of the organi-

zation:

NAME ADDRESS PHONE

Part VII: Compensation of Ofﬁcers, Directors, Trustees, Key Employees, High-

est Compensated Employees and Independent Contractors

Section A. Ofﬁcers, Directors, Trustees, Key Employees and Highest Compensated Employees

Complete the table on the next page for all persons required to be listed. Use Schedule J-2 if additional space is needed.

• List all of the organization’s current ofﬁcers, directors, trustees (whether individuals or organizations) and key employees

regardless of amount of compensation. Enter -0- in columns (D), (E) and (F) if no compensation was paid.

• List the organization’s ﬁve current highest compensated employees (other than an ofﬁcer, director, trustee or key employ-

ee) who received reportable compensation (Box 5 of Form W-2 and/or Box 7 of Form 1099-Misc) of more than $100,000

from the organization and any related organizations.

• List all of the organization’s former ofﬁcers, key employees or highest compensated employees who received more than

$100,000 of reportable compensation from the organization and any related organizations.

• List all of the organization’s former directors or trustees that received, in the capacity as a former director or trustee of the

organization, more than $10,000 of reportable compensation from the organization and any related organizations.

• List persons in the following order: individual trustees or directors; institutional trustees; ofﬁcers; key employees; highest

compensated employees and former such persons.

990 Preparation Checklist: Page 10

NAME & TITLE

AVERAGE

HOURS

PER WEEK

POSITION (CHECK ALL THAT APPLY)

REPORTABLE

COMPENSATION

FOR THE

ORGANIZATION

(W-2/1099-MISC)

INDIVIDUAL TRUSTEE OR

DIRECTOR

INSTITUTIONAL TRUSTEE

OFFICER

KEY EMPLOYEE

HIGHEST COMPENSATED

EMPLOYEE

FORMER

990 Preparation Checklist: Page 11

Did the organization provide compensation to any current or former ofﬁcer, director, trustee, key employee, highest compen-

sated employees or independent contractors? _____ yes _____ no

For any current or former ofﬁcer, director, trustee, key employee, highest compensated employees or independent contrac-

tors, is the sum of reportable compensation and other compensation from the organization and related organizations greater

than $150,000? _____ yes _____ no

Did any current or former ofﬁcer, director, trustee, key employee, highest compensated employees or independent con-

tractors receive or accrue compensation from any unrelated organization for services rendered to the organization? _____

yes _____ no

Section B. Independent Contractors

Complete this table for your ﬁve highest compensated independent contractors that received more than $100,000 in com-

pensation from the organization.

NAME BUSINESS ADDRESS DESCRIPTION

OF SERVICES

COMPENSATION

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