Form 109 - California Exempt Organization Business Income Tax Return - 2012 Page 4
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5Schedule D Unrelated Debt-Financed Income
1 Description of debt-financed property
2 Gross income from or
3 Deductions directly connected with or allocable to debt-financed property
allocable to debt-financed
(a) Straight-line depreciation
(b) Other deductions (attach
property
(attach schedule)
schedule)
4 Amount of average acquisition
5 Average adjusted basis of or
6 Debt basis
7 Gross income reportable,
8 Allocable deductions,
9 Net income (or loss) includible,
indebtedness on or allocable
allocable to debt-financed
percentage,
column 2 x column 6
total of columns 3(a) and
column 7 less column 8
to debt-financed property
property (attach schedule)
column 4 ÷
3(b) x column 6
(attach schedule)
column 5
%
%
%
Total. Enter here and on Side 2, Part I, line 7 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
Schedule E Investment Income of an R&TC Section 23701g, Section 23701i, or Section 23701n Organization
1 Description
2 Amount
3 Deductions directly connected
4 Net investment income,
5 Set-asides
6 Balance of investment income,
(attach schedule)
column 2 less column 3
(attach schedule)
column 4 less column 5
Total. Enter here and on Side 2, Part I, line 8 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
Enter gross income from members (dues, fees, charges, or similar amounts). . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
Schedule F Interest, Annuities, Royalties and Rents from Controlled Organizations
Exempt Controlled Organizations
1 Name of controlled organizations
2 Employer
3 Net unrelated income
4 Total of specified
5 Part of column (4) that is
6 Deductions directly
Identification
(loss)
payments made
included in the controlling
connected with income in
Number
organization’s gross
column (5)
income
1
2
3
Nonexempt Controlled Organizations
7 Taxable Income
8 Net unrelated income (loss) 9 Total of specified payments
10 Part of column (9) that is
11 Deductions directly
made
included in the controlling
connected with income in
organization’s gross
column (10)
income
1
2
3
4 Add columns 5 and 10 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
5 Add columns 6 and 11 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
6 Subtract line 5 from line 4. Enter here and on Side 2, Part 1, line 9 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
Schedule G Exploited Exempt Activity Income, other than Advertising Income
1 Description of exploited activity (attach schedule if
2 Gross unrelated
3 Expenses directly
4 Net income from
5 Gross income from
6 Expenses
7 Excess exempt
8 Net income
more than one unrelated activity is exploiting the
business income
connected with
unrelated trade or
activity that is not
attributable to
expense, column
includible, column
same exempt activity)
from trade or
production
business, column 2
unrelated business
column 5
6 less column 5
4 less column 7
business
of unrelated
less column 3
income
but not more than
but not less than
business income
column 4
zero
Total. Enter here and on Side 2, Part I, line 10 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
Side 4 Form 109
2012
C1
3644123
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