UNRELATED BUSINESS INCOME QUESTIONNAIRE
FISCAL YEAR 20 -20
RESPONDENT NAME AND TITLE: PHONE #:
DEPARTMENT: INDEX #:
UNRELATED BUSINESS INCOME ACTIVITIES
Does your department generate external revenues from any of the following activities, which are examples of potential sources
of unrelated business income (include sources of revenue even if it results in a net loss after deducting related expenses).
Yes
No If yes, proceed to Parts I-VI below, and answer all questions completely to the best of your knowledge.
If your answer is No, then please sign the last page and return the form to the Treasury Office, Stop 8219.
If you have more than one source of potential unrelated business income, please make a copy of this document and complete for
each different activity (if you are uncertain whether an activity is related or unrelated, please include it).
A. Advertising
B. Affinity card programs where service is provided to a card vendor
C. Athletic facility use for non-University events, and recreational facility use by the public
D. Bookstore and gift shop sales to the public
E. Catering and food service sales to the public
F. Commercially sponsored research
G. Computing resource leasing (i.e. software maintenance and support)
H. Dormitory rentals to the public
I. Entertainment events not involving ISU students/staff (i.e. concerts, movies, etc…)
J. Exclusive provider and sponsor agreements
K. Hotel and restaurant services provided to the public
L. Hospital or health care non-patient sales
M. Leasing and/or rental activities
N. Licensing agreements where services are provided to the licensee
O. Merchandising operations
P. Other sales and services provided to the public
Q. Parking revenue from private companies or contract arrangements
R. Participation or ownership in a partnership or joint venture with a non-University entity
S. Travel tour programs
T. Other activities that are not directly related to the tax-exempt purposes of the University (education, research, and
public service)
I. DESCRIPTION OF ACTIVITY: (Please include the frequency of transactions, the type of customer, and the goods
sold or services provided for FY 20 -20 for any potentially unrelated activities).
II. GENERAL
Is the activity:
YES NO N/A
A. conducted for the purpose of generating income?
B. conducted on a regular basis?
C. related to the University’s exempt purpose?
D. performed by volunteers?
E. conducted via the internet (e-business)?
F. conducted for the convenience of the University
students, faculty, staff, or patients?
