-
TIN:
Form
990-T
Department of the Treasury
Internal Revenue Service
Exempt Organization Business Income Tax Return
(and proxy tax under section 6033(e))
For calendar year 2021 or other tax year beginning
07-01-2021
and ending
06-30-2022
►Go to
www.irs.gov/Form990T
for instructions and the latest information.
►Do not enter SSN numbers on this form as it may be made public if your organization is a 501(c)(3).
OMB No. 1545-0047
20
21
Open to Public Inspection for 501(c)(3) Organizations Only
A
Check box if address changed.
B
Exempt under section
501(
c3
)
408(e)
220(e)
408A
530(a)
529(a)
529A
Print or Type
Name of organization (
Check box if name changed and see instructions.)
ZIA THERAPY CENTER INC
Number, street, and room or suite no. If a P.O. box, see instructions.
900 FIRST STREET
City or town, state or province, and ZIP or foreign postal code
ALAMOGORDO
,
NM
88310
C
Book value of all assets at end of year
.....►
2,352,998
D
Employer identification number
85-0199135
E
Group exemption number
(see instructions)
F
Check box if an amended return.
G
Check organization type ►
501(c) corporation
501(c) trust
401(a) trust
Other trust
H
Check if filing only to ►
Claim credit from Form 8941
Claim a refund shown on Form 2439
I
Check if a 501(c)(3) organization filing a consolidated return with a 501(c)(2) titleholding corporation
.........►
J
Enter the number of attached Schedules A (Form 990-T)
...............►
K
During the tax year, was the corporation a subsidiary in an affiliated group or a parent-subsidiary controlled group?
...►
Yes
No
If "Yes," enter the name and identifying number of the parent corporation ►
L
The books are in care of ►
SHARON GILSDORF CFO
900 FIRST STREET
ALAMORGORDO
,
NM
88310
Telephone number ►
(575) 439-4900
Part I
Total Unrelated Business Taxable Income
1
Total of unrelated business taxable income computed from all unrelated trades or businesses (see instructions)
..............................
1
2
Reserved
..............................
2
3
Add lines 1 and 2
............................
3
4
Charitable contributions (see instructions for limitation rules)
..............
4
5
Total unrelated business taxable income before net operating losses. Subtract line 4 from line 3
....
5
6
Deduction for net operating loss. See instructions
.................
6
0
7
Total of unrelated business taxable income before specific deduction and section 199A deduction.
Subtract line 6 from line 5
.........................
7
0
8
Specific deduction (generally $1,000, but see instructions for exceptions)
..........
8
1,000
9
Trusts.
Section 199A deduction. See instructions
.................
9
10
Total deductions.
Add lines 8 and 9
......................
10
1,000
11
Unrelated business taxable income.
Subtract line 10 from line 7. If line 10 is greater than line 7, enter zero
................................
11
0
Part II
Tax Computation
1
Organizations taxable as corporations.
Multiply Part I, line 11 by 21% (0.21)
.......►
1
0
2
Trusts taxable at trust rates.
See instructions for tax computation. Income tax on the amount on
Part I, line 11 from:
Tax rate schedule or
Schedule D (Form 1041)
........►
2
0
3
Proxy tax.
See instructions
.......................►
3
4
Other tax amounts. See instructions
....................
4
5
Alternative minimum tax (trusts only)
.....................
5
6
Tax on noncompliant facility income.
See instructions
................
6
7
Total.
Add lines 3 through 6 to line 1 or 2, whichever applies
...............
7
For Paperwork Reduction Act Notice, see instructions.
Cat. No. 11291J
Form
990-T
(2021)
Form 990-T (2021)
Page
2
Part III
Tax and Payments
1a
Foreign tax credit (corporations attach Form 1118; trusts attach Form 1116)
1a
b
Other credits (see instructions)
..............
1b
c
General business credit. Attach Form 3800 (see instructions)
.....
1c
d
Credit for prior year minimum tax (attach Form 8801 or 8827)
....
1d
e
Total credits.
Add lines 1a through 1d
.....................
1e
2
Subtract line 1e from Part II, line 7
.....................
2
3
Other amounts due. Check if from:
Form 4255
Form 8611
Form 8697
Form 8866
Other (attach statement)
..........
3
4
Total tax.
Add lines 2 and 3 (see instructions).
Check if includes tax previously deferred under
section 1294. Enter the tax amount here
4
5
Current net 965 tax liability paid from Form 965-A, Part II, column (k)
...........
5
6a
Payments: A 2020 overpayment credited to 2021
........
6a
b
2021 estimated tax payments. Check if section 643(g) election applies ►
6b
c
Tax deposited with Form 8868
..............
6c
d
Foreign organizations: Tax paid or withheld at source (see instructions)
.
6d
e
Backup withholding (see instructions)
............
6e
f
Credit for small employer health insurance premiums (attach Form 8941)
.
6f
g
Other credits, adjustments, and payments:
Form 2439
Form 4136
Other
Total ►
6g
10,003
7
Total payments.
Add lines 6a through 6g
.....................
7
10,003
8
Estimated tax penalty (see instructions). Check if Form 2220 is attached
........
►
8
9
Tax due.
If line 7 is smaller than the total of lines 4, 5, and 8, enter amount owed
.......►
9
10
Overpayment.
If line 7 is larger than the total of lines 4, 5, and 8, enter amount overpaid
....►
10
10,003
11
Enter the amount of line 10 you want:
Credited to 2022 estimated tax
►
Refunded
►
11
10,003
Part IV
Statements Regarding Certain Activities and Other Information
(see instructions)
1
At any time during the 2021 calendar year, did the organization have an interest in or a signature or other authority over a financial account (bank, 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 ►
Yes
No
No
2
During the tax year, did the organization receive a distribution from, or was it the grantor of, or transferor to, a foreign trust?
No
If "Yes," see instructions for other forms the organization may have to file.
3
Enter the amount of tax-exempt interest received or accrued during the tax year
.....
► $
4
Enter available pre-2018 NOL carryovers here. ► $
. Do not include any post-2017 NOL carryover shown on Schedule A (Form 990-T). Don't reduce the NOL carryover shown here by any deduction reported on Part I, line 4.
5
Post-2017 NOL carryovers. Enter available Business Activity Code and post-2017 NOL carryovers. Don't reduce the amounts shown below by any NOL claimed on any Schedule A, Part II, line 17 for the tax year. See instructions.
Business activity code
Available post-2017 NOL carryover
$
$
$
$
6a
Did the organization change its method of accounting? (see instructions)
.................
No
b
If 6a is "Yes," has the organization described the change on Form 990, 990-EZ, 990-PF, or Form 1128? If "No," explain in Part V
Part V
Supplemental Information
Provide the explanation required by Part IV, line 6b. Also, provide any other addtional information. See instructions.
Sign Here
Under penalties of perjury, I declare that I have examined this return, including accompanying schedules and statements, and to the best of my knowledge and belief, it is true, correct, and complete. Declaration of preparer (other than taxpayer) is based on all information of which preparer has any knowledge.
Signature of officer
Date
Title
May the IRS discuss this return with the preparer shown below (see instructions)?
Yes
No
Paid Preparer Use Only
Print/Type preparer's name
Preparer's signature
Date
Check
if
self-employed
PTIN
Firm's name
Firm's EIN
Firm's address
Phone no.
Form
990-T
(2021)
Additional Data
Software ID:
Software Version:
Part III, Line 6g - Total Fuel Tax Credit Amount:
10,003
-
TIN:
Form
4136
Department of the Treasury
Internal Revenue Service (99)
Credit for Federal Tax Paid on Fuels
Go to
www.irs.gov/Form4136
for instructions and the latest information.
OMB No. 1545-0162
20
21
Attachment
Sequence No.
23
Name (as shown on your income tax return)
ZIA THERAPY CENTER INC
Taxpayer identification number
85-0199135
Caution:
Claimant has the name and address of the person who sold the fuel to the claimant and the dates of purchase. For claims on lines 1c and 2b (type of use 13 or 14), 3d, 4c, and 5, claimant has not waived the right to make the claim. For claims on lines 1c and 2b (type of use 13 or 14), claimant certifies that a certificate has not been provided to the credit card issuer.
1
Nontaxable Use of Gasoline
Note.
CRN is credit reference number.
(a) Type of use
(b) Rate
(c) Gallons
(d) Amount of credit
(e) CRN
a
Off-highway business use
$ .183
$
9,752
362
b
Use on a farm for farming purposes
.183
c
Other nontaxable use (see
Caution
above line 1)
.183
d
Exported
.184
411
2
Nontaxable Use of Aviation Gasoline
(a) Type of use
(b) Rate
(c) Gallons
(d) Amount of credit
(e) CRN
a
Use in commercial aviation (other than foreign trade)
$ .15
$
354
b
Other nontaxable use (see
Caution
above line 1)
.193
324
c
Exported
.194
412
d
LUST tax on aviation fuels used in foreign trade
.001
433
3
Nontaxable Use of Undyed Diesel Fuel
Claimant certifies that the diesel fuel did not contain visible evidence of dye.
Exception.
If any of the diesel fuel included in this claim
did
contain visible evidence of dye, attach an explanation and check here
(a) Type of use
(b) Rate
(c) Gallons
(d) Amount of credit
(e) CRN
a
Nontaxable use
$ .243
b
Use on a farm for farming purposes
.243
$
360
c
Use in trains
.243
353
d
Use in certain intercity and local buses (see
Caution
above line 1)
.17
1475
251
350
e
Exported
.244
413
4
Nontaxable Use of Undyed Kerosene (Other Than Kerosene Used in Aviation)
Claimant certifies that the kerosene did not contain visible evidence of dye.
Exception.
If any of the kerosene included in this claim
did
contain visible evidence of dye, attach an explanation and check here
(a) Type of use
(b) Rate
(c) Gallons
(d) Amount of credit
(e) CRN
a
Nontaxable use taxed at $.244
$ .243
b
Use on a farm for farming purposes
.243
$
346
c
Use in certain intercity and local buses (see
Caution
above line 1)
.17
347
d
Exported
.244
414
e
Nontaxable use taxed at $.044
.043
377
f
Nontaxable use taxed at $.219
.218
369
For Paperwork Reduction Act Notice, see the separate instructions.
Cat. No. 12625R
Form
4136
(2021)
Form 4136 (2021)
Page
2
5
Kerosene Used in Aviation
(a) Type of use
(b) Rate
(c) Gallons
(d) Amount of credit
(e) CRN
a
Kerosene used in commercial aviation (other than foreign trade) taxed at $.244
$ .200
$
417
b
Kerosene used in commercial aviation (other than foreign trade) taxed at $.219
.175
355
c
Nontaxable use (other than use by state or local government) taxed at $.244
.243
346
d
Nontaxable use (other than use by state or local government) taxed at $.219
.218
369
e
LUST tax on aviation fuels used in foreign trade
.001
433
6
Sales by Registered Ultimate Vendors of Undyed Diesel Fuel
Registration No.
Claimant certifies that it sold the diesel fuel at a tax-excluded price, repaid the amount of tax to the buyer, or has obtained the written consent of the buyer to make the claim. Claimant certifies that the diesel fuel did not contain visible evidence of dye.
Exception.
If any of the diesel fuel included in this claim
did
contain visible evidence of dye, attach an explanation and check here
(b) Rate
(c) Gallons
(d) Amount of credit
(e) CRN
a
Use by a state or local government
$ .243
$
360
b
Use in certain intercity and local buses
.17
350
7
Sales by Registered Ultimate Vendors of Undyed Kerosene (Other
Than Kerosene For Use in Aviation)
Registration No.
Claimant certifies that it sold the kerosene at a tax-excluded price, repaid the amount of tax to the buyer, or has obtained the written consent of the buyer to make the claim. Claimant certifies that the kerosene did not contain visible evidence of dye.
Exception.
If any of the kerosene included in this claim
did
contain visible evidence of dye, attach an explanation and check here
(b) Rate
(c) Gallons
(d) Amount of credit
(e) CRN
a
Use by a state or local government
$ .243
$
346
b
Sales from a blocked pump
.243
c
Use in certain intercity and local buses
.17
347
8
Sales by Registered Ultimate Vendors of Kerosene For Use in Aviation
Registration No.
Claimant sold the kerosene for use in aviation at a tax-excluded price and has not collected the amount of tax from the buyer, repaid the amount of tax to the buyer, or has obtained the written consent of the buyer to make the claim. See the instructions for additional information to be submitted.
(a) Type of use
(b) Rate
(c) Gallons
(d) Amount of credit
(e) CRN
a
Use in commercial aviation (other than foreign trade) taxed at $.219
$ .175
$
355
b
Use in commercial aviation (other than foreign trade) taxed at $.244
.200
417
c
Nonexempt use in noncommercial aviation
.025
418
d
Other nontaxable uses taxed at $.244
.243
346
e
Other nontaxable uses taxed at $.219
.218
369
f
LUST tax on aviation fuels used in foreign trade
.001
433
Form
4136
(2021)
Form 4136 (2021)
Page
3
9
Reserved for future use
Registration No.
(b) Rate
(c) Gallons of alcohol
(d) Amount of credit
(e) CRN
a
Reserved for future use
b
Reserved for future use
10
Biodiesel or Renewable Diesel Mixture Credit
Registration No.
Biodiesel mixtures.
Claimant produced a mixture by mixing biodiesel with diesel fuel. The biodiesel used to produce the mixture met ASTM D6751 and met EPA's registration requirements for fuels and fuel additives. The mixture was sold by the claimant to any person for use as a fuel or was used as a fuel by the claimant. Claimant has attached the Certificate for Biodiesel and, if applicable, the Statement of Biodiesel Reseller.
Renewable diesel mixtures.
Claimant produced a mixture by mixing renewable diesel with liquid fuel (other than renewable diesel). The renewable diesel used to produce the renewable diesel mixture was derived from biomass, met EPA's registration requirements for fuels and fuel additives, and met ASTM D975, D396, or other equivalent standard approved by the IRS. The mixture was sold by the claimant to any person for use as a fuel or was used as a fuel by the claimant. Claimant has attached the Certificate for Biodiesel and, if applicable, Statement of Biodiesel Reseller, both of which have been edited as discussed in the instructions for line 10. See the instructions for line 10 for information about renewable diesel used in aviation.
(b) Rate
(c) Gallons of biodiesel or renewable diesel
(d) Amount of credit
(e) CRN
a
Biodiesel (other than agri-biodiesel) mixtures
$ 1.00
$
388
b
Agri-biodiesel mixtures
$ 1.00
390
c
Renewable diesel mixtures
$ 1.00
307
11
Nontaxable Use of Alternative Fuel
Caution.
There is a reduced credit rate for use in certain intercity and local buses (type of use 5) (see instructions).
(a) Type of use
(b) Rate
(c) Gallons, or gasoline or diesel gallon equivalents
(d) Amount of credit
(e) CRN
a
Liquefied petroleum gas (LPG) (see instructions)
.183
419
b
"P Series" fuels
.183
420
c
Compressed natural gas (CNG) (see instructions)
.183
421
d
Liquefied hydrogen
.183
422
e
Fischer–Tropsch process liquid fuel from coal (including peat)
.243
423
f
Liquid fuel derived from biomass
.243
424
g
Liquefied natural gas (LNG) (see instructions)
.243
425
h
Liquefied gas derived from biomass
.183
435
12
Alternative Fuel Credit
Registration No.
(b) Rate
(c) Gallons, or gasoline or diesel gallon equivalents
(d) Amount of credit
(e) CRN
a
Liquefied petroleum gas (LPG)
$ .50
$
426
b
"P Series" fuels
.50
427
c
Compressed natural gas (CNG) (see instructions)
.50
428
d
Liquefied hydrogen
.50
429
e
Fischer–Tropsch process liquid fuel from coal (including peat)
.50
430
f
Liquid fuel derived from biomass
.50
431
g
Liquefied natural gas (LNG)
.50
432
h
Liquefied gas derived from biomass
.50
436
i
Compressed gas derived from biomass
.50
437
Form
4136
(2021)
Form 4136 (2021)
Page
4
13
Registered Credit Card Issuers
Registration No.
(b) Rate
(c) Gallons
(d) Amount of credit
(e) CRN
a
Diesel fuel sold for the exclusive use of a state or local government
$ .243
$
360
b
Kerosene sold for the exclusive use of a state or local government
.243
346
c
Kerosene for use in aviation sold for the exclusive use of a state or local government taxed at $.219
.218
369
14
Nontaxable Use of a Diesel-Water Fuel Emulsion
Caution.
There is a reduced credit rate for use in certain intercity and local buses (type of use 5) (see instructions).
(a) Type of use
(b) Rate
(c) Gallons
(d) Amount of credit
(e) CRN
a
Nontaxable use
.197
309
b
Exported
.198
306
15
Diesel-Water Fuel Emulsion Blending
Registration No.
(b) Rate
(c) Gallons
(d) Amount of credit
(e) CRN
Blender credit
$ .046
$
310
16
Exported Dyed Fuels and Exported Gasoline Blendstocks
(b) Rate
(c) Gallons
(d) Amount of credit
(e) CRN
a
Exported dyed diesel fuel and exported gasoline blendstocks taxed at $.001
$ .001
$
415
b
Exported dyed kerosene
.001
416
17
Total income tax credit claimed.
Add lines 1 through 16, column (d). Enter here and on Schedule 3 (Form 1040), line 12; Form 1120, Schedule J, line 20b; Form 1120S, line 23c; Form 1041, line 25h; or the proper line of other returns.
.................
17
$
10,003
Form
4136
(2021)
Additional Data
Software ID:
Software Version: