Form 4720 - Return Of Certain Excise Taxes Under Chapters 41 And 42 Of The Internal Revenue Code - 2017 Page 6

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6
Form 4720 (2017)
Page
SCHEDULE I—Initial Taxes on Excess Benefit Transactions (Section 4958) Continued
Part II
Summary of Tax Liability of Disqualified Persons and Proration of Payments
(d) Disqualified person’s total tax
(b) Trans. no. from
(c) Tax from Part I, col. (e),
(a) Names of disqualified persons liable for tax
liability (add amounts in col. (c))
Part I, col. (a)
or prorated amount
(see instructions)
Part III
Summary of Tax Liability of 501(c)(3), (c)(4) & (c)(29) Organization Managers and Proration of Payments
(d) Manager’s total tax liability
(b) Trans. no. from
(c) Tax from Part I, col. (f),
(a) Names of 501(c)(3), (c)(4) & (c)(29) organization managers liable for tax
(add amounts in col. (c))
Part I, col. (a)
or prorated amount
(see instructions)
SCHEDULE J—Taxes on Being a Party to Prohibited Tax Shelter Transactions (Section 4965)
Part I
Prohibited Tax Shelter Transactions (PTST) and Tax Imposed on the Tax-Exempt Entity
(see instructions)
(c) Type of transaction
(a)
1 —Listed
(b) Transaction
Transaction
2 —Subsequently listed
(d) Description of transaction
date
number
3 —Confidential
4 —Contractual protection
1
2
3
4
5
(e) Did the tax-exempt entity know or
have reason to know this transaction
(f) Net income attributable to
(g) 75% of proceeds attributable to
(h) Tax imposed on the tax-exempt
was a PTST when it became a party to
the PTST
the PTST
entity (see instructions)
the transaction? Answer Yes or No
Total—Column (h). Enter here and on Part I, line 9 .
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4720
Form
(2017)

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