Exempt Organization Business Income Tax Return

Transcription

1 Form OMB No For calendar year 2016 or other tax year eginning, and ending. Information aout Form 0-T and its instructions is availale at Department of the Treasury Open to Pulic Inspection for Internal Revenue Service Do not enter SSN numers on this form as it may e made pulic if your organization is a 501(c). 501(c) Organizations Only Employer identification numer A X Check ox if Name of organization ( Check ox if name changed and see instructions.) D (Employees trust, see address changed LEADINGAGE IOWA F/K/A IOWA ASSOCIATION instructions.) B Exempt under section Print OF HOMES & SERVICES FOR THE AGING X 501( c )( 6 ) or E Unrelated usiness activity codes Numer, street, and room or suite no. If a P.O. ox, see instructions. (See instructions.) Type 408(e) 220(e) AURORA AVENUE Book value of all assets C at end of year F Group exemption numer (See instructions.) 1,42,078. G Check organization type X 501(c) corporation 501(c) trust 401(a) trust Other trust H Descrie the organization s primary unrelated usiness activity. ADVERTISING I During the tax year, was the corporation a susidiary in an affiliated group or a parent-susidiary controlled group? ~~~~~~ Yes X No If "Yes," enter the name and identifying numer of the parent corporation. J The ooks are in care of SHANNON STRICKLER Telephone numer Part I Unrelated Trade or Business Income (A) Income (B) Expenses (C) Net 1 a Gross receipts or sales c Less returns and allowances c Balance ~~~ 12 Other (See instructions; attach schedule) ~~~~~~~~~~~~ Total. Comine lines 3 through ,30 1,30 Part II Deductions Not Taken Elsewhere (See instructions for limitations on deductions.) (Except for contriutions, deductions must e directly connected with the unrelated usiness.) T 408A 530(a) City or town, state or province, country, and ZIP or foreign postal code 52(a) URBANDALE, IA Cost of goods sold (Schedule A, line 7) ~~~~~~~~~~~~~~~~~ Gross profit. Sutract line 2 from line 1c ~~~~~~~~~~~~~~~~ 4 a Capital gain net (attach Schedule D) ~~~~~~~~~~~~~~~ Net gain (loss) (Form 477, Part II, line 17) (attach Form 477) ~~~~~~ Capital loss deduction for trusts ~~~~~~~~~~~~~~~~~~~~ Income (loss) from partnerships and S corporations (attach statement) ~~~ Rent (Schedule C) ~~~~~~~~~~~~~~~~~~~~~~ Unrelated det-financed (Schedule E) ~~~~~~~~~~~~~~ Interest, annuities, royalties, and rents from controlled organizations (Sch. F)~ Investment of a section 501(c)(7), (), or (17) organization (Schedule G) Exploited exempt activity (Schedule I) ~~~~~~~~~~~~~~ Advertising (Schedule J) ~~~~~~~~~~~~~~~~~~~~ Compensation of officers, directors, and trustees (Schedule K) ~~~~~~~~~~~~~~~~~~~~~~~~~~~~~ Salaries and wages ~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~ Repairs and maintenance Bad dets ~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~ Interest ~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~ ~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~ Taxes and licenses ~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~ Charitale contriutions (See instructions for limitation rules) ~~~~~~~~~~~~~~~~~~~~~~~~~~~~~ Depreciation (attach Form 4562) Less depreciation claimed on Schedule A and elsewhere on return Depletion Contriutions to deferred compensation plans Exempt Organization Business Income Tax Return (and proxy tax under section 6033(e)) ~~~~~~~~~~~~~~~~~~~~~~~~~~~~ Total deductions. Add lines 14 through 28 ~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~ 1c 2 3 4a 4 4c ~~~~~~~~~~~~~ ~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~ ~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~ Employee enefit programs ~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~ Excess exempt expenses (Schedule I) ~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~ Excess readership costs (Schedule J) ~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~ Other deductions ~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~ SEE STATEMENT 1 Unrelated usiness taxale efore net operating loss deduction. Sutract line 2 from line 13 ~~~~~~~~~~~~ Net operating loss deduction (limited to the amount on line 30) ~~~~~~~~~~~~~~~~~~~~~~~~~~~~~ SEE STATEMENT 2 Unrelated usiness taxale efore specific deduction. Sutract line 31 from line 30 ~~~~~~~~~~~~~~~~~ Specific deduction (Generally $1,000, ut see line 33 instructions for exceptions) ~~~~~~~~~~~~~~~~~~~~~ 21 22a ,30 1,30 1,258. 1, ,00 34 Unrelated usiness taxale. Sutract line 33 from line 32. If line 33 is greater than line 32, enter the smaller of zero or line LHA For Paperwork Reduction Act Notice, see instructions. Form 0-T (2016) LEADINGAGE IOWA F/K/A IOWA 1005_1

2 LEADINGAGE IOWA F/K/A IOWA ASSOCIATION Form 0-T (2016) OF HOMES & SERVICES FOR THE AGING Part III Tax Computation 35 Organizations Taxale as Corporations. See instructions for tax computation a c Controlled group memers (sections 1561 and 1563) check here See instructions and: $ $ $ Enter organization s share of: Additional 5 tax (not more than $11,750) $ Additional 3 tax (not more than $100,000) ~~~~~~~~~~~~~ $ Trusts Taxale at Trust Rates. See instructions for tax computation. Income tax on the amount on line 34 from: Proxy tax. See instructions ~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~ Tax on Non-Compliant Facility Income. See instructions ~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~ 40 Total. Add lines 37, 38 and 3 to line 35c or 36, whichever applies Part IV Tax and Payments 41a Foreign tax credit (corporations attach Form 1118; trusts attach Form 1116) ~~~~~~~~ 41a c d e Total credits. Add lines 41a through 41d ~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~ Other taxes. Check if from: Form 4255 Form 8611 Form 867 Form 8866 Other Total tax. Add lines 42 and 43 ~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~ 45 a Payments: A 2015 overpayment credited to 2016 ~~~~~~~~~~~~~~~~~~~ estimated tax payments ~~~~~~~~~~~~~~~~~~~~~~~~~~~~ c Tax deposited with Form 8868 ~~~~~~~~~~~~~~~~~~~~~~~~~~~~ d Foreign organizations: Tax paid or withheld at source (see instructions) ~~~~~~~~~~ f g Other credits and payments: Total payments. Add lines 45a through 45g ~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~ 46 Tax due. If line 46 is less than the total of lines 44 and 47, enter amount owed ~~~~~~~~~~~~~~~~~~~ Overpayment. If line 46 is larger than the total of lines 44 and 47, enter amount overpaid ~~~~~~~~~~~~~~ 50 Enter the amount of line 4 you want: Credited to 2017 estimated tax Refunded Part V Statements Regarding Certain Activities and Other Information (see instructions) 51 At any time during the 2016 calendar year, did the organization have an interest in or a signature or other authority Yes No Sign Here Enter your share of the $50,000, $25,000, and $,25,000 taxale rackets (in that order): Income tax on the amount on line 34 ~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~ Tax rate schedule or Schedule D (Form 1041) ~~~~~~~~~~~~~~~~~~~~~~~~~~~ Alternative minimum tax Other credits (see instructions) ~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~ ~~~~~~~~~~~~~~~~~~~~~~~~~~~ General usiness credit. Attach Form 3800 ~~~~~~~~~~~~~~~~~~~~~~ Credit for prior year minimum tax (attach Form 8801 or 8827) ~~~~~~~~~~~~~~ Sutract line 41e from line 40 ~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~ e Backup withholding (see instructions) ~~~~~~~~~~~~~~~~~~~~~~~~ Credit for small employer health insurance premiums (Attach Form 841) Form 243 ~~~~~~~~ Form 4136 Other Total Estimated tax penalty (see instructions). Check if Form 2220 is attached ~~~~~~~~~~~~~~~~~~~ over a financial account (ank, securities, or other) in a foreign country? If YES, the organization may have to file FinCEN Form 114, Report of Foreign Bank and Financial Accounts. If YES, enter the name of the foreign country here During the tax year, did the organization receive a distriution from, or was it the grantor of, or transferor to, a foreign trust? ~~~~~~~~~ If YES, see instructions for other forms the organization may have to file. Enter the amount of tax-exempt interest received or accrued during the tax year $ Under penalties of perjury, I declare that I have examined this return, including accompanying schedules and statements, and to the est of my knowledge and elief, it is true, correct, and complete. Declaration of preparer (other than taxpayer) is ased on all information of which preparer has any knowledge. = = PRESIDENT/CEO Signature of officer Date Title Print/Type preparer s name Preparer s signature Date Check 41 41c 41d 45a 45 45c 45d 45e 45f 45g 35c e May the IRS discuss this return with the preparer shown elow (see instructions)? self- employed Paid PHILIP J. GOLDSMITH P Preparer Firm s name LWBJ, LLP Firm s EIN Use Only 4200 UNIVERSITY AVE., SUITE 410 Firm s address WEST DES MOINES, IA Phone no Form 0-T (2016) if PTIN X Yes Page 2 X X No LEADINGAGE IOWA F/K/A IOWA 1005_1

3 Form 0-T (2016) LEADINGAGE IOWA F/K/A IOWA ASSOCIATION OF HOMES & SERVICES FOR THE AGING Page 3 Schedule A - Cost of Goods Sold. Enter method of inventory valuation N/A 1 Inventory at eginning of year ~~~ 1 6 Inventory at end of year ~~~~~~~~~~~~ 6 2 Purchases ~~~~~~~~~~~ 2 7 Cost of goods sold. Sutract line 6 3 Cost of laor~~~~~~~~~~~ 3 from line 5. Enter here and in Part I, 4 a Additional section 263A costs line 2 ~~~~~~~~~~~~~~~~~~~~ 7 ~~~~~~~~ 4a 8 Do the rules of section 263A (with respect to Other costs ~~~ 4 property produced or acquired for resale) apply to 5 Total. Add lines 1 through 4 5 the organization? Schedule C - Rent Income (From Real Property and Personal Property Leased With Real Property) (see instructions) 1. Description of property Yes No (a) 2. From personal property (if the percentage of rent for personal property is more than 10 ut not more than 50) Rent received or accrued () From real and personal property (if the percentage of rent for personal property exceeds 50 or if the rent is ased on profit or ) 3(a) Deductions directly connected with the in columns 2(a) and 2() Total Total (c) Total. Add totals of columns 2(a) and 2(). Enter () Total deductions. here and on line 6, column (A) Part I, line 6, column (B) Schedule E - Unrelated Det-Financed Income (see instructions) 3. Deductions directly connected with or allocale 2. Gross from to det-financed property 1. Description of det-financed property or allocale to detfinanced property (a) Straight line depreciation () Other deductions 4. Amount of average acquisition 5. Average adjusted asis 6. Column 4 divided 7. Gross 8. Allocale deductions det on or allocale to det-financed of or allocale to y column 5 reportale (column (column 6 x total of columns property det-financed property 2 x column 6) 3(a) and 3()) Part I, line 7, column (A). Part I, line 7, column (B). Totals ~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~ Total dividends-received deductions included in column 8 Form 0-T (2016) LEADINGAGE IOWA F/K/A IOWA 1005_1

4 LEADINGAGE IOWA F/K/A IOWA ASSOCIATION Form 0-T (2016) OF HOMES & SERVICES FOR THE AGING Schedule F - Interest, Annuities, Royalties, and Rents From Controlled Organizations (see instructions) Exempt Controlled Organizations 1. Name of controlled organization 2. Employer 3. Net unrelated 4. Total of specified 5. Part of column 4 that is 6. Deductions directly identification (loss) (see instructions) payments made included in the controlling connected with numer organization s gross in column 5 Page 4 Nonexempt Controlled Organizations 7. Taxale Income 8. Net unrelated (loss). Total of specified payments 1 Part of column that is included 11. Deductions directly connected (see instructions) made in the controlling organization s with in column 10 gross Totals J Schedule G - Investment Income of a Section 501(c)(7), (), or (17) Organization (see instructions) 1. Description of exploited activity 1. Description of 2. Amount of 2. Gross unrelated usiness from trade or usiness line 10, col. (A). 3. Expenses directly connected with production of unrelated usiness line 10, col. (B). Part I, line, column (A). 4. Net (loss) from unrelated trade or usiness (column 2 minus column 3). If a gain, compute cols. 5 through 7. Add columns 5 and 1 Part I, line 8, column (A). Add columns 6 and 11. Part I, line 8, column (B). 3. Deductions Total deductions directly connected 4. Set-asides 5. and set-asides (col. 3 plus col. 4) 5. Gross 6. Expenses from activity that attriutale to is not unrelated column 5 usiness Part I, line, column (B). Totals Schedule I - Exploited Exempt Activity Income, Other Than Advertising Income (see instructions) 7. Excess exempt expenses (column 6 minus column 5, ut not more than column 4). Enter here and on page 1, Part II, line 26. Totals Schedule J - Advertising Income (see instructions) Part I Income From Periodicals Reported on a Consolidated Basis Name of periodical Totals (carry to Part II, line (5)) 2. Gross 3. Direct advertising advertising costs 4. Advertising gain or (loss) (col. 2 minus col. 3). If a gain, compute cols. 5 through Circulation 6. Readership costs 1,30 7. Excess readership costs (column 6 minus column 5, ut not more than column 4). 1,30 1,30 Form 0-T (2016) LEADINGAGE IOWA F/K/A IOWA 1005_1

5 LEADINGAGE IOWA F/K/A IOWA ASSOCIATION Form 0-T (2016) OF HOMES & SERVICES FOR THE AGING Part II Income From Periodicals Reported on a Separate Basis (For each periodical listed in Part II, fill in columns 2 through 7 on a line-y-line asis.) Totals from Part I 1. Name of periodical 2. Gross 3. Direct advertising advertising costs line 11, col. (A). line 11, col. (B). 4. Advertising gain or (loss) (col. 2 minus col. 3). If a gain, compute cols. 5 through Circulation 6. Readership costs 7. Excess readership costs (column 6 minus column 5, ut not more than column 4). Enter here and on page 1, Part II, line 27. Totals, Part II (lines 1-5) 1,30 Schedule K - Compensation of Officers, Directors, and Trustees (see instructions) 3. Percent of 4. Compensation attriutale Title time devoted to 1. Name 2. to unrelated usiness usiness 1,30 Total. Part II, line 14 Page 5 Form 0-T (2016) LEADINGAGE IOWA F/K/A IOWA 1005_1

6 LEADINGAGE IOWA F/K/A IOWA ASSOCIATION O }}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}} }}}}}}}}}} ~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~ FORM 0-T OTHER DEDUCTIONS STATEMENT 1 }}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}} DESCRIPTION AMOUNT }}}}}}}}}}} }}}}}}}}}}}}}} EXPENSE ALLOCATION 1,258. }}}}}}}}}}}}}} TOTAL TO FORM 0-T, PAGE 1, LINE 28 1,258. ~~~~~~~~~~~~~~ ~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~ FORM 0-T NET OPERATING LOSS DEDUCTION STATEMENT 2 }}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}} LOSS PREVIOUSLY LOSS AVAILABLE TAX YEAR LOSS SUSTAINED APPLIED REMAINING THIS YEAR }}}}}}}} }}}}}}}}}}}}}} }}}}}}}}}}}}}} }}}}}}}}}}}}}} }}}}}}}}}}}}}} 12/31/11 7,046. 1,051. 5,5. 5,5. 12/31/ /31/ }}}}}}}}}}}}}} 464. }}}}}}}}}}}}}} NOL CARRYOVER AVAILABLE THIS YEAR 7,258. 7,258. ~~~~~~~~~~~~~~ ~~~~~~~~~~~~~~ 31 STATEMENT(S) 1, LEADINGAGE IOWA F/K/A IOWA 1005_1