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If, when the return is filed, the

payments in the amount entered on this

business taxable income on Part I, line

foundation, entity, managers,

line.

11 of Form 4720.

self-dealers, disqualified persons,

A personal benefit contract is (to the

Part II-A

donors, donor advisors, or related

transferor) any life insurance, annuity,

persons have corrected any acts or

Columns (a) and (b). List the names,

or endowment contract that benefits

transactions resulting in liability for tax

addresses, and taxpayer identification

directly or indirectly the transferor, a

under Chapter 42, answer “Yes,” to

numbers of all persons who owe tax in

member of the transferor’s family, or

question B and give the following

connection with the foundation or

any other person designated by the

information separately for each

organization, whether as managers,

transferor (other than an organization

correction:

self-dealers, disqualified persons,

described in section 170(c)).

•

Schedule and item number of the act

donors, donor advisors, or related

or transaction that has been corrected,

For more information, see Notice

persons, as shown in Schedules A, D,

•

A description of the act or transaction

2000-24, which is on page 952 of

E, F, H, I, J, K, and L.

that resulted in the tax,

Internal Revenue Bulletin 2000-17 at

•

Column (c). For each person listed in

A detailed description of the

column (a), enter the sum of:

correction made,

Line 11

•

The amount of any political

1. Taxes that person owes as a

expenditure recovered,

Enter the charitable remainder trust’s

self-dealer, from Schedule A, Part II,

•

Description of safeguards to prevent

unrelated business taxable income on

column (d), and

future political expenditures, and

2. Tax for acts of self-dealing in

line 11. Charitable remainder trusts

•

The date of correction.

must attach a schedule that shows how

which the individual participated as a

manager, from Schedule A, Part III,

their unrelated business taxable income

For any acts or transactions the

was computed. The excise tax imposed

column (d).

foundation, entity, managers,

on a charitable remainder trust is equal

self-dealers, disqualified persons,

Column (d). Enter for each person

to the trust’s unrelated business taxable

donors, donor advisors, or related

listed in column (a) the tax on jeopardy

income.

persons have not corrected, give the

investments from Schedule D, Part II,

following information separately for

Attached schedule. Charitable

column (d), that the individual took part

each act:

remainder trusts may use Form 990-T

in as a foundation manager.

•

Schedule and item number of the act

as the attached schedule. If the trust

Column (e). Enter for each person

or transaction that has not been

uses Form 990-T as the attached

listed in column (a) the tax on taxable

corrected,

schedule, complete Form 990-T as

•

expenditures from Schedule E, Part II,

A description of the act or

follows:

column (d), that the individual took part

transaction, and

1. Write “ATTACHMENT TO FORM

•

in as a foundation manager.

A detailed explanation of why

4720” at the top of page 1.

correction has not been made and what

2. Enter the trust’s name under

Column (f). Enter for each person

steps are being taken to make the

“Name of organization” and complete

listed in column (a) the tax on political

correction.

item D and E at the top of page 1.

expenditures from Schedule F, Part II,

3. Complete Parts I and II. If a line

column (d), that the individual took part

If you are correcting deficient

does not apply, leave it blank.

in as an organization or foundation

distributions under section 4942 where

4. Complete any of the Schedules

manager.

an election under section 4942(h)(2)

on Form 990-T or other forms or attach

was filed with the IRS, provide a copy

Column (g). Enter for each person

a schedule as required by any line on

of the election. See the instructions for

listed in column (a) the tax on

which an entry is made for Parts I and

Form 990-PF, Part XIII, lines 4b and 4c

disqualifying lobbying expenditures

II. Also, attach any schedule as may be

for more information.

from Schedule H, Part II, column (d),

required on any Schedule on Form

that the individual took part in as an

Part I

990-T or other form that you are

organization manager.

required to complete. However, if

Column (h). For each person listed in

Schedule D (Form 1041) is required, do

Line 8

column (a), enter the sum of:

not complete Part V of Schedule D

(Form 1041).

1. Taxes that person owes as a

If the organization has an entry

5. Enter the amount from line 34 of

disqualified person, from Schedule I,

on this line, it must also file

TIP

Form 990-T on Part I, line 11 of Form

Part II, column (d), and

Form 8870.

4720. Do not complete Parts III-V or the

2. Tax on excess benefit

signature area of Form 990-T.

Enter the total of all premiums paid

transactions in which the organization

by the organization on any personal

manager participated knowing that the

benefit contract if the payment of

If you do not complete a Form 990-T

transaction was improper, from

premiums is in connection with a

as the attached schedule, then attach a

Schedule I, Part III, column (d).

transfer for which a deduction is not

schedule with the same information as

Column (i). Enter for each person

allowed under section 170(f)(10)(A).

Form 990-T and its Schedules (as

Also, if there is an understanding or

discussed above) including all the

listed in column (a) the tax on the entity

expectation that any person will directly

information that must be attached to

manager who approved or otherwise

or indirectly pay any premium on a

Form 990-T and its Schedules, such as

caused the entity to be a party to a

personal benefit contract for the

other forms and attachments. Be sure

prohibited tax shelter transaction from

transferor, include those premium

to enter the amount shown as unrelated

Schedule J, Part II, column (d).

-6-

Form 4720 Instructions

Instructions For Form 4720 - Return Of Certain Excise Taxes - Department Of The Treasury - 2011 Page 6

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