Sample Form 990 - Return Of Organization Exempt From Income Tax - 2015 Page 22

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26P0007 10/13/2016 12:54 PM
PHILADELPHIA VETERANS COMFORT HOUSE 23-2694118
2
Schedule D (Form 990) 2015
Page
Part III
Organizations Maintaining Collections of Art, Historical Treasures, or Other Similar Assets (continued)
3
Using the organization’s acquisition, accession, and other records, check any of the following that are a significant use of its
collection items (check all that apply):
a
Public exhibition
d
Loan or exchange programs
b
Scholarly research
e
Other
. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
c
Preservation for future generations
4
Provide a description of the organization’s collections and explain how they further the organization’s exempt purpose in Part
XIII.
5
During the year, did the organization solicit or receive donations of art, historical treasures, or other similar
assets to be sold to raise funds rather than to be maintained as part of the organization’s collection?
Yes
No
. . . . . . . . . . . . . . . . . . . . . . . . . . .
Part IV
Escrow and Custodial Arrangements.
Complete if the organization answered "Yes" on Form 990, Part IV, line 9, or reported an amount on Form
990, Part X, line 21.
1a Is the organization an agent, trustee, custodian or other intermediary for contributions or other assets not
included on Form 990, Part X?
Yes
No
. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
b If “Yes,” explain the arrangement in Part XIII and complete the following table:
Amount
c
Beginning balance
1c
. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
d Additions during the year
1d
. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
1e
e
Distributions during the year
. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
f Ending balance
1f
. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
2a
Did the organization include an amount on Form 990, Part X, line 21, for escrow or custodial account liability?
Yes
No
. . . . . . . . . . . . . . . . .
If “Yes,” explain the arrangement in Part XIII. Check here if the explanation has been provided on Part XIII
b
. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
Part V
Endowment Funds.
Complete if the organization answered “Yes” on Form 990, Part IV, line 10.
(a) Current year
(b) Prior year
(c) Two years back
(d) Three years back
(e) Four years back
1a
Beginning of year balance
. . . . . . . . . . . .
b
Contributions
. . . . . . . . . . . . . . . . . . . . . . . . . .
c Net investment earnings, gains, and
losses
. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
d
Grants or scholarships
. . . . . . . . . . . . . . . .
e Other expenditures for facilities and
programs
. . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
f
Administrative expenses
. . . . . . . . . . . . . .
g End of year balance
. . . . . . . . . . . . . . . . . . .
2
Provide the estimated percentage of the current year end balance (line 1g, column (a)) held as:
a Board designated or quasi-endowment
%
. . . . . . . . . . . . .
b
Permanent endowment
%
. . . . . . . . . . . .
c Temporarily restricted endowment
%
. . . . . . . . . . . . . .
The percentages on lines 2a, 2b, and 2c should equal 100%.
3a
Are there endowment funds not in the possession of the organization that are held and administered for the
Yes No
organization by:
(i)
unrelated organizations
3a(i)
. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
(ii)
related organizations
3a(ii)
. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
b
If “Yes” on line 3a(ii), are the related organizations listed as required on Schedule R?
3b
. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
4
Describe in Part XIII the intended uses of the organization’s endowment funds.
Part VI
Land, Buildings, and Equipment.
Complete if the organization answered “Yes” on Form 990, Part IV, line 11a. See Form 990, Part X, line 10.
Description of property
(a) Cost or other basis
(b) Cost or other basis
(c) Accumulated
(d) Book value
(investment)
(other)
depreciation
8,000
8,000
1a
Land
. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
101,087
66,194
34,893
b
Buildings
. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
c
Leasehold improvements
. . . . . . . . . . . . . . . . .
d
Equipment
. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
e
Other
. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
42,893
Total. Add lines 1a through 1e. (Column (d) must equal Form 990, Part X, column (B), line 10c.)
. . . . . . . . . . . . . . . . . . . . . . . . . . .
Schedule D (Form 990) 2015
DAA

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