Form 990-EZ (2019)
Page 3
Part V Other Information (Note the Schedule A and personal benefit contract statement requirements in the
instructions for Part V.) Check if the organization used Schedule O to respond to any question in this Part V .
Yes No
33
Did the organization engage in any significant activity not previously reported to the IRS? If “Yes,” provide a
detailed description of each activity in Schedule O . . . . . . . . . . . . . . . . . . .
33
34
Were any significant changes made to the organizing or governing documents? If “Yes,” attach a conformed
copy of the amended documents if they reflect a change to the organization’s name. Otherwise, explain the
change on Schedule O. See instructions . . . . . . . . . . . . . . . . . . . . . .
34
35 a
Did the organization have unrelated business gross income of $1,000 or more during the year from business
activities (such as those reported on lines 2, 6a, and 7a, among others)? . . . . . . . . . . . .
35a
b
If “Yes” to line 35a, has the organization filed a Form 990-T for the year? If “No,” provide an explanation in Schedule O
35b
c
Was the organization a section 501(c)(4), 501(c)(5), or 501(c)(6) organization subject to section 6033(e) notice,
reporting, and proxy tax requirements during the year? If “Yes,” complete Schedule C, Part III . . . . .
35c
36
Did the organization undergo a liquidation, dissolution, termination, or significant disposition of net assets
during the year? If “Yes,” complete applicable parts of Schedule N . . . . . . . . . . . . .
36
37 a
Enter amount of political expenditures, direct or indirect, as described in the instructions
▶
37a
b Did the organization file Form 1120-POL for this year? . . . . . . . . . . . . . . . . . . 37b
38a
Did the organization borrow from, or make any loans to, any officer, director, trustee, or key employee; or were
any such loans made in a prior year and still outstanding at the end of the tax year covered by this return? .
38a
b If “Yes,” complete Schedule L, Part II, and enter the total amount involved . . . . 38b
39 Section 501(c)(7) organizations. Enter:
a Initiation fees and capital contributions included on line 9 . . . . . . . . . . 39a
b Gross receipts, included on line 9, for public use of club facilities . . . . . . . 39b
40 a Section 501(c)(3) organizations. Enter amount of tax imposed on the organization during the year under:
section 4911
▶
; section 4912
▶
; section 4955
▶
b
Section 501(c)(3), 501(c)(4), and 501(c)(29) organizations. Did the organization engage in any section 4958
excess benefit transaction during the year, or did it engage in an excess benefit transaction in a prior year
that has not been reported on any of its prior Forms 990 or 990-EZ? If “Yes,” complete Schedule L, Part I
40b
c
Section 501(c)(3), 501(c)(4), and 501(c)(29) organizations. Enter amount of tax imposed
on organization managers or disqualified persons during the year under sections 4912,
4955, and 4958 . . . . . . . . . . . . . . . . . . . . . . .
▶
d
Section 501(c)(3), 501(c)(4), and 501(c)(29) organizations. Enter amount of tax on line
40c reimbursed by the organization . . . . . . . . . . . . . . . .
▶
e
All organizations. At any time during the tax year, was the organization a party to a prohibited tax shelter
transaction? If “Yes,” complete Form 8886-T . . . . . . . . . . . . . . . . . . . . .
40e
41
List the states with which a copy of this return is filed
▶
42a
The organization’s books are in care of
▶
Telephone no.
▶
Located at
▶
ZIP + 4
▶
b
At any time during the 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)?
Yes No
42b
If “Yes,” enter the name of the foreign country
▶
See the instructions for exceptions and filing requirements for FinCEN Form 114, Report of Foreign Bank and
Financial Accounts (FBAR).
c At any time during the calendar year, did the organization maintain an office outside the United States? .
42c
If “Yes,” enter the name of the foreign country
▶
43 Section 4947(a)(1) nonexempt charitable trusts filing Form 990-EZ in lieu of Form 1041—Check here . . . . . .
▶
and enter the amount of tax-exempt interest received or accrued during the tax year . . . . .
▶
43
Yes No
44 a
Did the organization maintain any donor advised funds during the year? If “Yes,” Form 990 must be
completed instead of Form 990-EZ . . . . . . . . . . . . . . . . . . . . . . . .
44a
b
Did the organization operate one or more hospital facilities during the year? If “Yes,” Form 990 must be
completed instead of Form 990-EZ . . . . . . . . . . . . . . . . . . . . . . . .
44b
c Did the organization receive any payments for indoor tanning services during the year? . . . . . . . 44c
d
If “Yes” to line 44c, has the organization filed a Form 720 to report these payments? If “No,” provide an
explanation in Schedule O . . . . . . . . . . . . . . . . . . . . . . . . . . .
44d
45 Did the organization have a controlled entity within the meaning of section 512(b)(13)? . . . . . . . 45a a
b
Did the organization receive any payment from or engage in any transaction with a controlled entity within the
meaning of section 512(b)(13)? If “Yes,” Form 990 and Schedule R may need to be completed instead of
Form 990-EZ. See instructions . . . . . . . . . . . . . . . . . . . . . . . . . .
45b
Form 990-EZ (2019)