Fillable Supplemental Information on Tax-Exempt Bonds Form 990-SK

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Supplemental Information on Tax-Exempt Bonds Form 990-SK

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SCHEDULE K
(Form 990)
Department of the Treasury
Internal Revenue Service
Supplemental Information on Tax-Exempt Bonds
▶
Complete if the organization answered “Yes” on Form 990, Part IV, line 24a. Provide descriptions,
explanations, and any additional information in Part VI.
▶
Attach to Form 990.
▶
Go to www.irs.gov/Form990 for instructions and the latest information.
OMB No. 1545-0047
2018
Open to Public
Inspection
Name of the organization Employer identification number
Part I Bond Issues
(a) Issuer name (b) Issuer EIN (c) CUSIP # (d) Date issued (e) Issue price (f) Description of purpose
(g) Defeased
(h) On
behalf of
issuer
(i) Pooled
financing
Yes No Yes No Yes No
A
B
C
D
Part II Proceeds
A B C D
1 Amount of bonds retired . . . . . . . . . . . . . . . . . .
2 Amount of bonds legally defeased . . . . . . . . . . . . . .
3 Total proceeds of issue . . . . . . . . . . . . . . . . . .
4 Gross proceeds in reserve funds . . . . . . . . . . . . . . .
5 Capitalized interest from proceeds . . . . . . . . . . . . . .
6 Proceeds in refunding escrows . . . . . . . . . . . . . . . .
7 Issuance costs from proceeds . . . . . . . . . . . . . . . .
8 Credit enhancement from proceeds . . . . . . . . . . . . . .
9 Working capital expenditures from proceeds . . . . . . . . . . .
10 Capital expenditures from proceeds . . . . . . . . . . . . . .
11 Other spent proceeds . . . . . . . . . . . . . . . . . . .
12 Other unspent proceeds . . . . . . . . . . . . . . . . . .
13 Year of substantial completion . . . . . . . . . . . . . . . .
Yes No Yes No Yes No Yes No
14
Were the bonds issued as part of a refunding issue of tax-exempt bonds (or,
if issued prior to 2018, a current refunding issue)? . . . . . . . . .
15
Were the bonds issued as part of a refunding issue of taxable bonds (or, if
issued prior to 2018, an advance refunding issue)? . . . . . . . . .
16 Has the final allocation of proceeds been made? . . . . . . . . . .
17 Does the organization maintain adequate books and records to support the
final allocation of proceeds? . . . . . . . . . . . . . . . .
For Paperwork Reduction Act Notice, see the Instructions for Form 990.
Cat. No. 50193E Schedule K (Form 990) 2018
Schedule K (Form 990) 2018
Page 2
Part III Private Business Use
A B C D
1 Was the organization a partner in a partnership, or a member of an LLC,
which owned property financed by tax-exempt bonds? . . . . . . . .
Yes No Yes No Yes No Yes No
2 Are there any lease arrangements that may result in private business use of
bond-financed property? . . . . . . . . . . . . . . . . . .
3a Are there any management or service contracts that may result in private
business use of bond-financed property? . . . . . . . . . . . .
b
If “Yes” to line 3a, does the organization routinely engage bond counsel or other outside
counsel to review any management or service contracts relating to the financed property?
c Are there any research agreements that may result in private business use of
bond-financed property? . . . . . . . . . . . . . . . . . .
d
If “Yes” to line 3c, does the organization routinely engage bond counsel or other
outside counsel to review any research agreements relating to the financed property?
4
Enter the percentage of financed property used in a private business use by entities
other than a section 501(c)(3) organization or a state or local government
. . .
▶
% % % %
5
Enter the percentage of financed property used in a private business use as a
result of unrelated trade or business activity carried on by your organization,
another section 501(c)(3) organization, or a state or local government . . .
▶
% %
% %
6 Total of lines 4 and 5 . . . . . . . . . . . . . . . . . . .
% %
% %
7 Does the bond issue meet the private security or payment test? . . . . .
8a
Has there been a sale or disposition of any of the bond-financed property to a
nongovernmental person other than a 501(c)(3) organization since the bonds were issued?
b
If “Yes” to line 8a, enter the percentage of bond-financed property sold or
disposed of . . . . . . . . . . . . . . . . . . . . . .
% % % %
c
If “Yes” to line 8a, was any remedial action taken pursuant to Regulations
sections 1.141-12 and 1.145-2? . . . . . . . . . . . . . . .
9
Has the organization established written procedures to ensure that all
nonqualified bonds of the issue are remediated in accordance with the
requirements under Regulations sections 1.141-12 and 1.145-2? . . . .
Part IV Arbitrage
A B C D
1
Has the issuer filed Form 8038-T, Arbitrage Rebate, Yield Reduction and
Penalty in Lieu of Arbitrage Rebate? . . . . . . . . . . . . . .
Yes No Yes No Yes No Yes No
2 If “No” to line 1, did the following apply?
a Rebate not due yet? . . . . . . . . . . . . . . . . . . .
b Exception to rebate? . . . . . . . . . . . . . . . . . . .
c No rebate due? . . . . . . . . . . . . . . . . . . . . .
If “Yes” to line 2c, provide in Part VI the date the rebate computation was
performed . . . . . . . . . . . . . . . . . . . . . .
3 Is the bond issue a variable rate issue? . . . . . . . . . . . . .
Schedule K (Form 990) 2018
Schedule K (Form 990) 2018
Page 3
Part IV Arbitrage (Continued)
A B C D
4a
Has the organization or the governmental issuer entered into a qualified
hedge with respect to the bond issue? . . . . . . . . . . . . .
Yes No Yes No Yes No Yes No
b Name of provider . . . . . . . . . . . . . . . . . . . .
c Term of hedge . . . . . . . . . . . . . . . . . . . . .
d Was the hedge superintegrated? . . . . . . . . . . . . . . .
e Was the hedge terminated? . . . . . . . . . . . . . . . . .
5a Were gross proceeds invested in a guaranteed investment contract (GIC)? .
b Name of provider . . . . . . . . . . . . . . . . . . . .
c Term of GIC . . . . . . . . . . . . . . . . . . . . . .
d
Was the regulatory safe harbor for establishing the fair market value of the GIC satisfied?
6
Were any gross proceeds invested beyond an available temporary period? .
7
Has the organization established written procedures to monitor the
requirements of section 148? . . . . . . . . . . . . . . . .
Part V Procedures To Undertake Corrective Action
A B C D
Has the organization established written procedures to ensure that violations
of federal tax requirements are timely identified and corrected through the
voluntary closing agreement program if self-remediation isn’t available under
applicable regulations? . . . . . . . . . . . . . . . . . .
Yes No Yes No Yes No Yes No
Part VI Supplemental Information. Provide additional information for responses to questions on Schedule K. See instructions
Schedule K (Form 990) 2018
Schedule K (Form 990) 2018
Page 4
Part VI
Supplemental Information. Provide additional information for responses to questions on Schedule K. See instructions (Continued)
Schedule K (Form 990) 2018
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Supplemental Information on Tax-Exempt Bonds Form 990-SK

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Completed 27 March 2019

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