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section 664(d) that answered “Yes” to question

Form 8868 is also used to request an

Organizations Organized or

(b) in Part X of Form 990, question 6b in Part

additional extension of time to file; however,

VII-B of Form 990-PF, or question 6b in Part

these extensions are not automatically granted.

Created in a Foreign Country

VI-B of Form 5227.

or U.S. Possession

Name, Address, etc.

Self-dealers, disqualified persons,

Report all amounts in U.S. currency (state

foundation managers, and organization

The name, address, and employer

conversion rate used) and give information in

managers. If you are a self-dealer,

identification number of the private foundation

English. Report items in total, including

disqualified person, foundation manager, or

or public charity should be the same as shown

amounts and transactions from both inside and

organization manager and you have the same

on Form 990-PF, Form 5227, Form 990, Form

outside the United States.

tax year as the foundation or organization, you

990-EZ, and Schedule A (Form 990 or

may report any first tier tax you owe on the

Sections 4941 through 4945 and section

990-EZ). If you are a self-dealer, foundation

Form 4720 filed by the foundation or

4955 do not apply to foreign private

manager, disqualified person, or organization

organization. Managers, self-dealers, and

foundations that receive substantially all of

manager filing a separate Form 4720, enter

disqualified persons who do this are

their support (other than gross investment

your name, address, and taxpayer

responsible for the parts that relate to taxes

income) from sources outside the United

identification number in Part II-A.

they owe and should include their own check

States. These organizations must complete

Include the suite, room, or other unit

or money order, payable to the United States

this form and file it in the same manner as

number after the street address.

Treasury, with the return.

other private foundations. However, these

organizations as well as foundation managers

Self-dealers, disqualified persons,

If the Post Office does not deliver mail to

and self-dealers, do not have to pay any tax

foundation managers, and organization

the street address, show the P.O. box number

that would otherwise be due on this return.

managers who owe tax under Chapter 41 or 42

instead of the street address.

and do not have the same tax year or do not

Tax Payments

If you want a third party (such as an

sign the return of the foundation or

accountant or an attorney) to receive mail for

organization must file a separate return on

Managers, self-dealers, and disqualified

the foundation or charity, enter on the street

Form 4720 showing the tax owed and the

persons paying tax on the organization’s Form

address line “C/O” followed by the third party’s

name of the foundation or organization for

4720 must pay with the return the tax that

name and street address or P.O. box.

which you owe tax. If you file a separate Form

applies to them as shown in Part II-A, page 1.

4720, enter your tax year at the top of the form.

Managers, self-dealers, and disqualified

Signature and Verification

Enter your name, address, and taxpayer

persons who file separate Forms 4720 must

identification number in Part II-A. Complete all

pay the applicable tax with their separate

If you are an organization manager, foundation

the information the form requires, to the extent

returns. When managers do not sign the

manager, disqualified person, or self-dealer,

possible, that applies to your liability.

organization’s Form 4720 to report their own

you should sign only in the spaces that apply,

tax liability, the amount of tax they owe should

whether you use the return of the foundation or

Where To File

not be entered in Part II-B, line 1.

organization as your return, or file separately.

Payment by a private foundation of any

To file Form 4720, mail or deliver it to:

If you are signing on behalf of the

taxes owed by the foundation managers or

Internal Revenue Service Center

foundation or organization and also because of

self-dealers will result in additional taxes under

Ogden, UT 84201-0027

personal tax liability, you must sign twice. You

the self-dealing and taxable expenditure

sign:

provisions. Managers and self-dealers should

When To File

1. On behalf of the foundation or

pay taxes imposed on them with their own

organization, and

Part I taxes. File Form 4720 by the due date

check or money order.

2. For your own personal tax liability.

(not including extensions) for filing the

Disqualified persons and organization

organization’s Form 990-PF, Form 990, Form

managers should pay taxes on excess benefit

990-EZ, or Form 5227.

For a corporation (or an association), the

transactions that are imposed on them with

form may be signed by one of the following:

their own check or money order. Any

If the regular due date falls on a Saturday,

president, vice president, treasurer, assistant

Sunday, or legal holiday, file by the next

reimbursement of a disqualified person’s tax

treasurer, chief accounting officer, or other

liability from excess benefit transactions by the

business day.

corporate officer (such as tax officer).

organization will be treated as an excess

Affiliated group member. For members

benefit transaction subject to the tax unless the

For a manager or self-dealer that is a

of an affiliated group of organizations that have

organization included the reimbursement in the

partnership, Form 4720 is signed by a partner

different tax years, and who are filing Form

disqualified person’s compensation and the

or partners authorized to sign the partnership

4720 to report tax under section 4911, the tax

disqualified person’s total compensation was

return.

year of the affiliated group is the calendar year,

reasonable. See the instructions to Schedule I

unless all members of the group elect under

If the return is filed on behalf of a trust, the

on page 7 for information on excess benefit

Regulations section 56.4911-7(e)(5) to make a

authorized trustee(s) must sign it.

transactions.

member’s year the group’s tax year.

A receiver, trustee, or assignee required to

Rounding Off to Whole

Part II taxes. If you are a manager,

file any return on behalf of an individual, a

self-dealer, or disqualified person owing taxes

trust, estate, partnership, association, company

Dollars

under Chapter 41 or 42 and filing a separate

or corporation must sign the Form 4720 filed

Form 4720, and your tax year ends on the

You may round off cents to whole dollars on

for these taxpayers.

same date as the organization, you must file by

your return and schedules. If you do round to

the due date for filing Form 990-PF, Form

Also, a person with a valid power of

whole dollars, you must round all amounts. To

5227, Form 990, or Form 990-EZ of the

attorney may sign for the organization,

round, drop amounts under 50 cents and

organization for which you owe tax. If your tax

foundation, manager, or self-dealer. Include a

increase amounts from 50 to 99 cents to the

year ends on a date different from that of the

copy of the power of attorney with the return.

next dollar. For example, $1.39 becomes $1

organization, you must file a Form 4720 by the

and $2.50 becomes $3.

Any person, firm, or corporation that

15th day of the 5th month after your tax year

If you have to add two or more amounts to

prepared the return for a fee must also sign it

ends.

figure the amount to enter on a line, include

and fill in the address of the preparer. If a firm

If the regular due date falls on a Saturday,

cents when adding the amounts and round off

or corporation prepares the return, it should be

Sunday, or legal holiday, file by the next

only the total.

signed in the name of the firm or corporation.

business day.

Penalties and Interest

Attachments

Extension

There are penalties for failure to file or to pay

If you need more space, attach separate

If you cannot file Form 4720 by the due date,

tax. There are also penalties for willful failure to

sheets showing the same information in the

you may request an automatic 3-month

file, supply information or pay tax, and for filing

same order as on the printed form. Show the

extension of time to file by using Form 8868,

fraudulent returns and statements, that apply to

totals on the printed form.

Application for Extension of Time To File an

public charities, private foundations, managers,

Exempt Organization Return. The automatic

Enter the organization’s name and EIN on

and self-dealers who are required to file this

3-month extension will be granted if you

each sheet. Use sheets that are the same size

return. See sections 6651, 7203, 7206, and

properly complete this form, file it, and pay any

as the form and indicate clearly the line of the

7207. Also, see section 6684 for penalties that

balance due by the due date for Form 4720.

printed form to which the information relates.

relate to tax liability under Chapter 42.

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Form 4720 Instructions

Instructions For Form 4720 - Return Of Certain Excise Taxes On Charities And Other Persons - Department Of The Treasury - 2004 Page 2

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