Form 109 - California Exempt Organization Business Income Tax Return - 2016
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5California Exempt Organization
TAXABLE YEAR
FORM
2016
109
Business Income Tax Return
Calendar Year 2016 or fiscal year beginning (mm/dd/yyyy)
, and ending (mm/dd/yyyy)
.
Corporation/Organization name
California corporation number
-
Additional information. See instructions.
FEIN
Street address (suite/room no.)
PMB no.
City (If the corporation has a foreign address, see instructions.)
State
ZIP code
Foreign country name
Foreign province/state/county
Foreign postal code
H Is the organization a non-exempt charitable trust as described
A First Return Filed? . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
Yes
No
in IRC Section 4947(a)(1)? . . . . . . . . . . . . . . . . . . . . . . . .
Yes
No
B Is this an education IRA within the meaning of
I Is this organization claiming any former; Enterprise Zone (EZ), Los Angeles
R&TC Section 23712? . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
Yes
No
Revitalization Zone (LARZ), Local Agency Military Base Recovery Area
C Is the organization under audit by the IRS or has the IRS audited
(LAMBRA), Targeted Tax Area (TTA), or Manufacturing Enhancement
in a prior year? . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
Yes
No
Area (MEA) tax benefits? . . . . . . . . . . . . . . . . . . . . . . . . . .
Yes
No
D Final Return?
J Is this organization a qualified pension, profit-sharing, or stock
Dissolved
Surrendered (Withdrawn)
Merged/Reorganized.
bonus plan as described in IRC Section 401(a)? . . . . . . .
Yes
No
/
/
Enter date (mm/dd/yyyy) . . . . . . . . . . . . . . . . . . . . . . . . . . .
K Unrelated Business Activity (UBA) Code . . .
E Amended Return . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
Yes
No
L Is this a Hospital? . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
Yes
No
F Accounting Method Used: (1)
Cash (2)
Accrual (3)
Other
If “Yes,” attach federal Schedule H (Form 990)
G Nature of trade or business _____________________________________
1 Unrelated business taxable income from Side 2, Part II, line 30 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
1
00
2 Multiply line 1 by the average apportionment percentage ________% from the Schedule R,
Taxable
Corpora-
Apportionment Formula Worksheet, Part A, line 2 or Part B, line 5. See instructions . . . . . . . . . . . . . . . . . .
2
00
tion
3 Enter the lesser amount from line 1 or line 2. If the unrelated business activity is wholly in California
and Schedule R was not completed, enter the amount from line 1. .. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
3
00
Taxable
4 Unrelated business taxable income from Side 2, Part II, line 30 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
4
00
Trust
5 Unrelated business taxable income from line 3 or line 4 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
5
00
6 Pierce’s disease, EZ, LARZ, LAMBRA, or TTA NOL carryover deduction . . . . . . . . . . . . . . . . . . . . . . . . . . . .
6
00
7 Net Operating Loss deduction. See General Information N . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
7
00
Tax
Computa-
8 Add line 6 and line 7. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
8
00
tion
9 Net unrelated business taxable income. Subtract line 8 from line 5 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
9
00
10 Tax ________% x line 9. See General Information J . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
10
00
11 Tax credits from Schedule B. See instructions . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
11
00
12 Balance. Subtract line 11 from line 10. If line 11 is greater than line 10, enter -0-. . . . . . . . . . . . . . . . . . . . .
12
00
Total
13 Alternative minimum tax. See General Information O. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
13
00
Tax
14 Total tax. Add line 12 and line 13 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
14
00
15 Overpayment from a prior year allowed as a credit . . . . . . . . . . . . . .
15
00
16 2016 estimated tax payments. See instructions. . . . . . . . . . . . . . . . .
16
00
Payments
17 Withholding (Form 592-B and/or 593.) See instructions . . . . . . . . . .
17
00
18 Amount paid with extension (form FTB 3539) . . . . . . . . . . . . . . . . . .
18
00
19 Total payments and credits. Add line 15 through line 18 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
19
00
20 Use tax. See instructions. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
20
00
21 Payments balance. If line 19 is more than line 20, subtract line 20 from line 19 . . . . . . . . . . . . . . . . . . . . . .
21
00
Use Tax/
22 Use tax balance. If line 20 is more than line 19, subtract line 19 from line 20 . . . . . . . . . . . . . . . . . . . . . . .
22
00
Tax Due/
Overpay-
23 Tax due. Subtract line 21 from line 14. Pay entire amount with return. See instructions . . . . . . . . . . . . . . . .
23
00
ment
24 Overpayment. Subtract line 14 from line 21. See instructions . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
24
00
25 Enter amount of line 24 to be applied to 2017 estimated tax . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
25
00
Form 109
2016 Side 1
3641163
C1
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