-
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
01-01-2021
and ending
12-31-2021
►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.)
IHC HEALTH SERVICES INC
Number, street, and room or suite no. If a P.O. box, see instructions.
36 S STATE STREET SUITE 2200
City or town, state or province, and ZIP or foreign postal code
SALT LAKE CITY
,
UT
84111
C
Book value of all assets at end of year
.....►
16,642,403,155
D
Employer identification number
94-2854057
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)
...............►
12
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 ►
INTERMOUNTAIN HEALTH
87-0269232
L
The books are in care of ►
COLIN QUINCY
36 SOUTH STATE STREET SUITE 1600
SALT LAKE CITY
,
UT
84111
Telephone number ►
(801) 442-3491
Part I
Total Unrelated Business Taxable Income
1
Total of unrelated business taxable income computed from all unrelated trades or businesses (see instructions)
..............................
1
19,170,656
2
Reserved
..............................
2
3
Add lines 1 and 2
............................
3
19,170,656
4
Charitable contributions (see instructions for limitation rules)
..............
4
0
5
Total unrelated business taxable income before net operating losses. Subtract line 4 from line 3
....
5
19,170,656
6
Deduction for net operating loss. See instructions
.................
6
19,170,656
7
Total of unrelated business taxable income before specific deduction and section 199A deduction.
Subtract line 6 from line 5
.........................
7
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
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
0
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
0
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
0
5
Current net 965 tax liability paid from Form 965-A, Part II, column (k)
...........
5
0
6a
Payments: A 2020 overpayment credited to 2021
........
6a
500,000
b
2021 estimated tax payments. Check if section 643(g) election applies ►
6b
2,500,000
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
7
Total payments.
Add lines 6a through 6g
.....................
7
3,000,000
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
3,000,000
11
Enter the amount of line 10 you want:
Credited to 2022 estimated tax
►
Refunded
►
11
3,000,000
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 ►
AR
BR
Yes
No
Yes
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
.....
► $
21
4
Enter available pre-2018 NOL carryovers here. ► $
19,224,338
. 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.
Part Number
Line Number
Explanation
Amount
990T
PART V
IHC HEALTH SERVICES, INC.94-2854057SECTION 1.263(A)-3(N) ELECTIONDECEMBER 31, 2021SECTION 1.263(A)-3(N) ELECTION STATEMENTIHC HEALTH SERVICES, INC. ("TAXPAYER")36 S. STATE STREET, SUITE 2200SALT LAKE CITY, UT 84111EIN: 94-2854057THE ABOVE REFERENCED TAXPAYER IS MAKING THE ELECTION TO CAPITALIZE REPAIR AND MAINTENANCE COSTS UNDER SECTION 1.263(A)-3(N) FOR ITS TAX YEAR ENDING DECEMBER 31, 2021.
990T
PART V
IHC HEALTH SERVICES, INC.94-2854057SECTION 1.263(A)-1(F) DE MINIMIS SAFE HARBOR ELECTIONDECEMBER 31, 2021SECTION 1.263(A)-1(F) DEMINIS SAFE HARBOR ELECTION STATEMENTIHC HEALTH SERVICES, INC. ("TAXPAYER")36 S. STATE STREET, SUITE 2200SALT LAKE CITY, UT 84111EIN: 94-2854057THE ABOVE REFERENCED TAXPAYER, WHICH HAS AN APPLICABLE FINANCIAL STATEMENT, AS DEFINED UNDER TREAS. REG. SECTION 1.263(A)-1(F)(4), ELECTS TO APPLY THE DE MINIMIS SAFE HARBOR UNDER TREAS. REG. SECTION 1.263(A)-1(F)(1)(I) TO NOT CAPITALIZE UNDER TREAS. REG. SECTION 1.263(A)-2(D)(1) OR 3(D), NOR TREAT AS A MATERIAL OR SUPPLY UNDER TREAS. REG. SECTION 1.162-3(A), AMOUNTS NOT EXCEEDING $5,000, CONSISTENT WITH ITS BOOK METHODS OF EXPENSING AMOUNTS PAID FOR THE ACQUISITION OR PRODUCTION OF CERTAIN TANGIBLE PROPERTY FOR THE TAX YEAR ENDING DECEMBER 31, 2021.
8991
PART I
FORM 8991, PART I, ATTACHMENTNAME OF SEPARATE TAXPAYERS TAKEN INTO ACCOUNT IN THE DETERMINATION OF "1 PERSON" UNDER SECTION 59A(E)(3):INTERMOUNTAIN HEALTH CARE, INC. 87-0269232IHC HEALTH SERVICES, INC. 94-2854057SELECTHEALTH, INC. 87-0409820INTERMOUNTAIN HEALTHCARE FOUNDATION, INC. 80-0225150INTERMOUNTAIN COMMUNITY CARE FOUNDATION, INC. 94-2853320THE HEART & LUNG FOUNDATION, INC. 87-0617606HEALTHCARE CAPTIVE INSURANCE COMPANY 20-1937561INTERMOUNTAIN SUPPLY SERVICES, INC. 47-4576955INTALERE, INC. 43-1415071NAVICAN GENOMICS, INC. 81-4153832EMPIRIC HEALTH, INC. 38-4026200ALLUCEO, INC. 82-4614934INTERMOUNTAIN MEDICAL HOLDINGS NEVADA, INC. 20-0160881HEALTHCARE PARTNERS MEDICAL GROUP (COATS), LTD. 88-0213519SELECTHEALTH BENEFIT ASSURANCE COMPANY 87-0497549SALTZER MEDICAL, INC. 82-0299231CLASSIC MEDICAL, INC. 46-1141912CLASSIC HELICOPTERS, INC. 46-1153642
990T, SCH A
LINE 5
990T, SCHEDULE A, K-1 INVESTMENT FLOW-THROUGH 901101PART I, LINE 5 - INCOME (LOSS) FROM PARTNERSHIPS 5 RCP FUND V, LP 20-8440143 $169,355 6 CANAAN NATURAL GAS PARALLEL FUND X, LP 26-2693114 $(652)8 PERFORMANCE VENTURE CAPITAL II, LP 26-1895337 $(1,234)10 EUROPEAN STRATEGIC PARTNERS 2008 'B', LP 98-0624885 $(182)11 PETERSON PARTNERS V, LP 26-2766801 $(692)13 CROSS CREEK CAPITAL PARTNERS, LLC 26-1917867 $3 14 SOLAMERE FOUNDERS FUND I, LP 26-2562137 $32,943 15 CROSS CREEK CAPITAL PARTNERS II, LP 27-3037833 $(5,637)16 EIG ENERGY FUND XV-A, LP 27-2688983 $298,054 92 CATTERTON PARTNERS VII, LP 45-4869547 $(126)94 CROSS CREEK CAPITAL PARTNERS III, LP 46-3445880 $14,980 95 EIG ENERGY FUND XVI, LP 46-2825629 $549,058 106 BAIN CAPITAL MIDDLE MARKET CREDIT 2014, LP 46-2389040 $12,244 107 SOLAMERE CAPITAL FUND II, LP 46-2502981 $22,615 108 SOLAMERE CAPITAL FUND II-A, LP 46-2509123 $12,030 109 TRIVENTURES III FUND, LP 98-1200976 $(14)121 PARTNERS GROUP REAL ESTATE SECONDARY 2013 (USD) A, LP INC. 98-1158648 $104,462 125 COLUMBIA CAPITAL EQUITY PARTNERS VI (QP), LP 47-0978685 $(120,941)129 AEW PARTNERS VII, LP 46-2156215 $(98,572)132 LEAVITT EQUITY PARTNERS I, LP 37-1762909 $17,358 140 CP7 INTERNATIONAL AIV, LP 98-1168648 $218 162 AEW PARTNERS REAL ESTATE FUND VIII, LP 81-3286462 $2,781,743 165 CROSS CREEK CAPITAL PARTNERS IV LP 81-1341948 $18,238 169 KOHLBERG TE INVESTORS VIII, LP 81-3324873 $13,192 176 L CATTERTON GROWTH PARTNERS III, LP 47-4283473 $206,936 177 STEPSTONE SECONDARIES FUND II, LP (FKA GREENSPRING SECONDARIES FUND II, LP) 81-0781391 $(3,749)187 SOLAMERE PORTFOLIO COMPANY INVESTMENTS II, LLC 46-4628417 $(9,396)188 L CATTERTON VIII, LP 47-4343290 $(25,126)189 ENCAP ENERGY CAPITAL FUND XI, LP 81-4648210 $(1,838,679)193 STEPSTONE VC SECONDARIES FUND III, LP 82-3578905 $(21,082)195 LEAVITT EQUITY PARTNERS II, LP 82-3207762 $(3,651)196 OSP VALUE FUND II, LP 37-1851511 $11,922 204 SOLAMERE CAPITAL FUND III, LP 82-1677137 $(56,998)205 PARTNERS GROUP REAL ESTATE SECONDARY 2017 (USD) A, LP 81-4060468 $311,924 208 GOLD HOLDINGS, LLC 61-1852444 $2 211 ENCAP FLATROCK MIDSTREAM FUND IV, LP 82-2890021 $1,232,533 220 COLUMBIA CAPITAL EQUITY PARTNERS VII (QP), LP 83-0729187 $(216,064)224 AACP CHINA VENTURE INVESTORS F, LP 83-0996261 $1 228 AMP CAPITAL GLOBAL INFRASTRUCTURE FUND II A 98-1398614 $(1,801,195)240 EIG ENERGY FUND XVII, LP 81-5439747 $568,594 243 BRIDGE WORKFORCE AND AFFORDABLE HOUSING FUND, LP 82-2036221 $(204,374)252 L CATTERTON GROWTH IV, LP 83-2097211 $(3,723)255 CREEK CAPITAL DENTAL HOLDINGS 82-1668064 $(5,683)256 HIG MIDDLE MARKET LBO FUND III, LP 83-4172688 $(36,216)261 SOLAMERE PORTFOLIO COMPANY INVESTMENTS III, LLC 83-0533713 $(4,048)267 AACP KOREA BUYOUT INVESTORS II, LP 82-4971663 $(226)277.0 CASTLELAKE AVIATION IV STABLE YIELD, LP 84-2627877 $(19,784)284 STEPSTONE VC SECONDARIES FUND IV, LP 83-4115093 $(11,996)
990T, SCH A
LINE 5
(CONTINUED)990T, SCHEDULE A, K-1 INVESTMENT FLOW-THROUGH 901101PART I, LINE 5 - INCOME (LOSS) FROM PARTNERSHIPS286 CROSS CREEK PARTNERS V, LP 82-4726924 $976 288 CROSS CREEK FOCUS FUND, LP 83-4308364 $(1,583)293 BATTERY VENTURES XIII, LP 84-4405970 $191,473 300 BATTERY VENTURES XIII AIV I CAYMAN, LP 98-1528956 $267 301 LIGHTSPEED VENTURE PARTNERS XIII, LP 98-1534383 $1,205 302 PARTNERS GROUP REAL ESTATE OPPORTUNITIES 2019 (USD) A OPCO, LP 84-3522755 $204,738 304 SHIELDS HEALTH SOLUTION PARENT, LLC 37-1953017 $72,680 307 LC9 INTERNATIONAL AIV, LP 98-1503032 $2,342,128 316 H.I.G. CAPITAL PARTNERS VI, LP 85-0872719 $591,242 325 CATALYST OPPORTUNITY RE FUND IV, LP 85-3444752 $(121,032)352 SOF-XII US TE/NON-US FEEDER, LP 85-1404152 $(1,818)353 SOF-XII US TE/QFPF REIT FEEDER, LP 85-1434132 $182,198 354 STARWOOD OPPORTUNITIES FUND 12 AIV (BLOCKED) 98-1614506 $31,336 358 AEW PARTNERS REAL ESTATE FUND IX, LP 84-2867535 $(270,922)361 OAK HC/FT PARTNERS IV, LP 98-1572916 $(3)364 TA XIV-B, LP 98-1593568 $(4,230)374 HCP STUDIOS PARALLEL FUND A, LP 87-2859469 $(5,639)382 CB OFFSHORE EQUITY OVERAGE FUND X, LP 85-3178133 $(29,273)386 PERFORMANCE DIRECT INVESTMENTS IV, LP 83-1171717 $(5,454)388 CB OFFSHORE EQUITY EQUITY FUND X, LP 85-3126096 $(129,236)389 AACP CHINA GROWTH INVESTORS XII, LP 98-1589934 $308 391 H.I.G. CAPITAL PARTNERS VI-AIV I, LP 87-0923143 $(1,050)393 PARTNERS GROUP DIRECT EQUITY IV (USD) A, LP 83-1270003 $(152,402)395 OAK HC/FT III AHH AIV UB, LP 98-1565005 $(38,662)396 H.I.G. MIDDLE MARKET III AIV IV, LP 87-0866050 $(1,396)397 OAK HC/FT IV AIV A, LP 98-1595308 $(12,436)133 IVINCI PARTNERS, LLC 27-1672060 $(387,105) TOTAL K-1 UNRELATED BUSINESS INCOME (LOSS) $4,344,675
990T, SCH A
LINE C
IHC HEALTH SERVICES, INC.2021 FEDERAL FORM 990T, SCHEDULE A - K-1 INVESTMENT FLOW-THROUGH (ACTIVITY CODE 901101)EIN: 94-XXX-XX-XXXX/31/2021IHC HEALTH SERVICES, INC. PREVIOUSLY USED A REASONABLE INTERPRETATION OF THE STATUTE TO IDENTIFY THE NAICS CODE RELATED TO THIS ACTIVITY, HOWEVER THIS IS THE FIRST YEAR THE FINAL REGULATIONS ARE APPLICABLE AND THE ORGANIZATION HAS MADE CHANGES TO CORRECT REPORTING TO ALIGN WITH THE FINAL REGULATIONS AND IDENTIFY THIS UBI SILO AS "K-1 INVESTMENT FLOW-THROUGH," WITH THE 6-DIGIT CODE 901101. THIS ACTIVITY WAS IDENTIFIED WITH THE 6-DIGIT CODE OF 900000 ON THE PRIOR YEAR RETURN BUT THERE HAVE BEEN NO CHANGES TO THE NATURE OF ACTIVITIES INCLUDED IN THIS UBI SILO.
990T
PART V
IHC HEALTH SERVICES, INC.94-2854057IRC SECTION 172(B)(3) ELECTION TO FOREGO THE CARRYBACK PERIOD FOR NET OPERATING LOSSDECEMBER 31, 2021IHC HEALTH SERVICES, INC. ("TAXPAYER")36 S. STATE STREET, SUITE 2200SALT LAKE CITY, UT 84111EIN: 94-2854057UNDER IRC REGULATION SECTION 172(B) (3), THE TAXPAYER HEREBY ELECTS TO RELINQUISH THE ENTIRE CARRYBACK PERIOD FOR ANY OF THE CHARITABLE CONTRIBUTIONS CONVERTED TO NET OPERATING LOSS UNDER 170(D)(2)(B)(II).
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:
Line K - Parent Corporation Name Control:
INTE
-
TIN:
SCHEDULE A
(Form 990-T)
Department of the Treasury
Internal Revenue Service
Unrelated Business Taxable Income
From an Unrelated Trade or Business
►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
20
Open to Public Inspection for 501(c)(3) Organizations Only
A
Name of the organization
IHC HEALTH SERVICES INC
B
Employer identification number
94-2854057
C
Unrelated business activity code (see instructions) ►
901101
D
Sequence:
1
of
12
E
Describe the unrelated trade or business ►
K-1 INVESTMENT FLOW-THROUGH
Part I
Unrelated Trade or Business Income
(A) Income
(B) Expenses
(C) Net
1a
Gross receipts or sales
1,022,390
b
Less returns and allowances
c
Balance ►
1c
1,022,390
2
Cost of goods sold (Part III, line 8)
.........
2
996,308
3
Gross profit. Subtract line 2 from line 1c
.......
3
1,022,390
1,022,390
4a
Capital gain net income (attach Sch D (Form 1041 or Form
1120)) (see instructions)
............
4a
b
Net gain (loss) (Form 4797) (attach Form 4797)
(see instructions)
4b
4,173,192
4,173,192
c
Capital loss deduction for trusts
4c
5
Income (loss) from a partnership or an S corporation (attach statement)
................
5
4,344,675
4,344,675
6
Rent income (Part IV)
.............
6
0
0
7
Unrelated debt-financed income (Part V)
.......
7
0
0
131,577
8
Interest, annuities, royalties, and rents from a controlled
organization (Part VI)
.............
8
0
0
9
Investment income of section 501(c)(7), (9), or (17)
organizations (Part VII)
............
9
0
0
10
Exploited exempt activity income (Part VIII)
......
10
11
Advertising income (Part IX)
...........
11
0
0
12
Other income (see instructions; attach statement)
....
12
13
Total.
Combine lines 3 through 12
.........
13
4,344,675
0
4,344,675
Part II
Deductions Not Taken Elsewhere
(See instructions for limitations on deductions) Deductions must be directly connected with the unrelated business income
1
Compensation of officers, directors, and trustees (Part X)
.................
1
0
2
Salaries and wages
............................
2
66,500
3
Repairs and maintenance
..........................
3
2,010
4
Bad debts
...............................
4
5
Interest (attach statement) (see instructions)
...................
5
159
6
Taxes and licenses
.............................
6
30,913
7
Depreciation (attach Form 4562) (see instructions)
.........
7
41,569
8
Less depreciation claimed in Part III and elsewhere on return
.....
8a
8b
41,569
9
Depletion
...............................
9
10
Contributions to deferred compensation plans
.....................
10
321,388
11
Employee benefit programs
..........................
11
19,950
12
Excess exempt expenses (Part VIII)
.......................
12
13
Excess readership costs (Part IX)
........................
13
0
14
Other deductions (attach statement)
......................
14
927,017
15
Total deductions.
Add lines 1 through 14
.....................
15
1,013,467
16
Unrelated business income before net operating loss deduction. Subtract line 15 from Part I, line 13, column (C)
16
3,331,208
17
Deduction for net operating loss (see instructions)
..................
17
0
18
Unrelated business taxable income.
Subtract line 17 from line 16
.............
18
3,331,208
For Paperwork Reduction Act Notice, see instructions.
Cat. No. 74036O
Schedule A (Form 990-T) 2020
Schedule A (Form 990-T) 2020
Page
2
Part III
Cost of Goods Sold
Enter method of inventory valuation ►
1
Inventory at beginning of year
........................
1
0
2
Purchases
...............................
2
0
3
Cost of labor
..............................
3
0
4
Additional section 263A costs (attach statement)
..................
4
0
5
Other costs (attach statement)
........................
5
996,308
6
Total.
Add lines 1 through 5
..........................
6
996,308
7
Inventory at end of year
...........................
7
0
8
Cost of goods sold.
Subtract line 7 from line 6. Enter here and in Part I, line 2
..........
8
996,308
9
Do the rules of section 263A (with respect to property produced or acquired for resale) apply to the organization?
Yes
No
Part IV
Rent Income (From Real Property and Personal Property Leased with Real Property)
1
Description of property (property street address, city, state, ZIP code). Check if a dual-use (see instructions)
A
B
C
D
A
B
C
D
2
Rent received or accrued
a
From personal property (if the percentage of rent for personal property is more than 10% but not more than 50%)
......
b
From real and personal property (if the percentage of rent for personal property exceeds 50% or if the rent is based on profit or income)
..........
c
Total rents received or accrued by property. Add lines 2a and 2b, columns A through D
.
3
Total rents received or accrued. Add line 2c columns A through D. Enter here and on Part I, line 6, column (A)
.►
0
4
Deductions directly connected with the income in lines 2(a) and 2(b) (attach statement)
.
5
Total deductions.
Add line 4 columns A through D. Enter here and on Part I, line 6, column (B)
.....►
0
Part V
Unrelated Debt-Financed Income
(see instructions)
1
Description of debt-financed property (street address, city, state, ZIP code). Check if a dual-use (see instructions)
A
B
C
D
A
B
C
D
2
Gross income from or allocable to debt-financed property
........
256,973
327,586
3
Deductions directly connected with or allocable to debt-financed property
a
Straight line depreciation (attach statement)
104,307
28,582
b
Other deductions (attach statement)
...
65,236
0
c
Total deductions (add lines 3a and 3b, columns A through D)
..........
169,543
28,582
4
Amount of average acquisition debt on or allocable to debt-financed property (attach statement)
...........
1,301,909
1,506,986
5
Average adjusted basis of or allocable to debt-financed property (attach statement)
...
3,914,523
4,396,507
6
Divide line 4 by line 5
.......
33.260 %
34.280 %
7
Gross income reportable. Multiply line 2 by line 6
85,469
112,296
8
Total gross income
(add line 7, columns A through D). Enter here and on Part I, line 7, column (A)
....►
0
9
Allocable deductions. Multiply line 3c by line 6
56,390
9,798
10
Total allocable deductions.
Add line 9, columns A through D. Enter here and on Part I, line 7, column (B)
..►
0
11
Total dividends-received deductions
included in line 10
.................►
0
Schedule A (Form 990-T) 2020
Schedule A (Form 990-T) 2020
Page
3
Part VI
Interest, Annuities, Royalties, and Rents from Controlled Organizations
(see instructions)
1.
Name of controlled organization
2.
Employer identification number
Exempt Controlled Organizations
3.
Net unrelated income (loss)
(see instructions)
4.
Total of specified payments made
5.
Part of column 4 that is included
in the controlling organization's
gross income
6.
Deductions directly connected with income in column 5
(1)
(2)
(3)
(4)
Nonexempt Controlled Organizations
7.
Taxable income
8.
Net unrelated
income (loss)
(see instructions)
9.
Total of specified payments made
10.
Part of column 9
that is included in the
controlling organization's
gross income
11.
Deductions directly connected with
income in column 10
(1)
(2)
(3)
(4)
Add columns 5 and 10.
Enter here and on Part I,
line 8, column (A)
Add columns 6 and 11.
Enter here and on Part I,
line 8, column (B)
Totals
.........................►
0
0
Part VII
Investment Income of a Section 501(c)(7), (9), or (17) Organization
(see instructions)
1.
Description of income
2.
Amount of income
3.
Deductions directly connected
(attach statement)
4.
Set-asides
(attach statement)
5. Total deductions and set-asides
(add columns 3 and 4)
(1)
(2)
(3)
(4)
Totals
.........►
Add amounts in column 2.
Enter here and on Part I,
line 9, column (A)
0
Add amounts in column 5.
Enter here and on Part I,
line 9, column (B)
0
Part VIII
Exploited Exempt Activity Income, Other Than Advertising Income
(see instructions)
1
Description of exploited activity:
2
Gross unrelated business income from trade or business. Enter here and on Part I, line 10, column (A)
...
2
3
Expenses directly connected with production of unrelated business income. Enter here and on Part I, line 10, column (B)
...............................
3
4
Net income (loss) from unrelated trade or business. Subtract line 3 from line 2. If a gain, complete
lines 5 through 7
.............................
4
5
Gross income from activity that is not unrelated business income
..............
5
6
Expenses attributable to income entered on line 5
...................
6
7
Excess exempt expenses. Subtract line 5 from line 6, but do not enter more than the amount on line 4. Enter here and on Part II, line 12
..........................
7
Schedule A (Form 990-T) 2020
Schedule A (Form 990-T) 2020
Page
4
Part IX
Advertising Income
1
Name(s) of periodical(s). Check box if reporting two or more periodicals on a consolidated basis.
A
B
C
D
Enter amounts for each periodical listed above in the corresponding column.
A
B
C
D
2
Gross advertising income
......
a
Add columns A through D. Enter here and on Part I, line 11, column (A)
.............►
0
3
Direct Advertising costs by periodical
..
a
Add columns A through D. Enter here and on Part I, line 11, column (B)
.............►
0
4
Advertising gain (loss). Subtract line 3 from line 2. For any column in line 4 showing a gain, complete lines 5 through 8. For any column in line 4 showing a loss or zero, do not complete lines 5 through 7, and enter zero on line 8
............
5
Readership costs
........
6
Circulation income
........
7
Excess readership costs. If line 6 is less than line 5, subtract line 6 from line 5. If line 5 is less than line 6, enter zero
.....
8
Excess readership costs allowed as a deduction. For each column showing a gain on line 4, enter the lesser of line 4 or line 7
.
a
Add line 8, columns A through D. Enter the greater of the columns total or zero here and on Part II, line 13
..►
0
Part X
Compensation of Officers, Directors, and Trustees
(see instructions)
1.
Name
2.
Title
3.
Percentage
of time devoted
to business
4.
Compensation
attributable to
unrelated business
(1)
(2)
(3)
(4)
Total.
Enter here and on Part II, line 1
.........................►
0
Part XI
Supplemental Information
(see instructions)
Schedule A (Form 990-T) 2020
Additional Data
Software ID:
Software Version:
-
TIN:
SCHEDULE A
(Form 990-T)
Department of the Treasury
Internal Revenue Service
Unrelated Business Taxable Income
From an Unrelated Trade or Business
►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
20
Open to Public Inspection for 501(c)(3) Organizations Only
A
Name of the organization
IHC HEALTH SERVICES INC
B
Employer identification number
94-2854057
C
Unrelated business activity code (see instructions) ►
901101
D
Sequence:
1
of
12
E
Describe the unrelated trade or business ►
K-1 INVESTMENT FLOW-THROUGH
Part I
Unrelated Trade or Business Income
(A) Income
(B) Expenses
(C) Net
1a
Gross receipts or sales
1,022,390
b
Less returns and allowances
c
Balance ►
1c
1,022,390
2
Cost of goods sold (Part III, line 8)
.........
2
996,308
3
Gross profit. Subtract line 2 from line 1c
.......
3
1,022,390
1,022,390
4a
Capital gain net income (attach Sch D (Form 1041 or Form
1120)) (see instructions)
............
4a
b
Net gain (loss) (Form 4797) (attach Form 4797)
(see instructions)
4b
4,173,192
4,173,192
c
Capital loss deduction for trusts
4c
5
Income (loss) from a partnership or an S corporation (attach statement)
................
5
4,344,675
4,344,675
6
Rent income (Part IV)
.............
6
0
0
7
Unrelated debt-financed income (Part V)
.......
7
0
0
131,577
8
Interest, annuities, royalties, and rents from a controlled
organization (Part VI)
.............
8
0
0
9
Investment income of section 501(c)(7), (9), or (17)
organizations (Part VII)
............
9
0
0
10
Exploited exempt activity income (Part VIII)
......
10
11
Advertising income (Part IX)
...........
11
0
0
12
Other income (see instructions; attach statement)
....
12
13
Total.
Combine lines 3 through 12
.........
13
4,344,675
0
4,344,675
Part II
Deductions Not Taken Elsewhere
(See instructions for limitations on deductions) Deductions must be directly connected with the unrelated business income
1
Compensation of officers, directors, and trustees (Part X)
.................
1
0
2
Salaries and wages
............................
2
66,500
3
Repairs and maintenance
..........................
3
2,010
4
Bad debts
...............................
4
5
Interest (attach statement) (see instructions)
...................
5
159
6
Taxes and licenses
.............................
6
30,913
7
Depreciation (attach Form 4562) (see instructions)
.........
7
41,569
8
Less depreciation claimed in Part III and elsewhere on return
.....
8a
8b
41,569
9
Depletion
...............................
9
10
Contributions to deferred compensation plans
.....................
10
321,388
11
Employee benefit programs
..........................
11
19,950
12
Excess exempt expenses (Part VIII)
.......................
12
13
Excess readership costs (Part IX)
........................
13
0
14
Other deductions (attach statement)
......................
14
927,017
15
Total deductions.
Add lines 1 through 14
.....................
15
1,013,467
16
Unrelated business income before net operating loss deduction. Subtract line 15 from Part I, line 13, column (C)
16
3,331,208
17
Deduction for net operating loss (see instructions)
..................
17
0
18
Unrelated business taxable income.
Subtract line 17 from line 16
.............
18
3,331,208
For Paperwork Reduction Act Notice, see instructions.
Cat. No. 74036O
Schedule A (Form 990-T) 2020
Schedule A (Form 990-T) 2020
Page
2
Part III
Cost of Goods Sold
Enter method of inventory valuation ►
1
Inventory at beginning of year
........................
1
0
2
Purchases
...............................
2
0
3
Cost of labor
..............................
3
0
4
Additional section 263A costs (attach statement)
..................
4
0
5
Other costs (attach statement)
........................
5
996,308
6
Total.
Add lines 1 through 5
..........................
6
996,308
7
Inventory at end of year
...........................
7
0
8
Cost of goods sold.
Subtract line 7 from line 6. Enter here and in Part I, line 2
..........
8
996,308
9
Do the rules of section 263A (with respect to property produced or acquired for resale) apply to the organization?
Yes
No
Part IV
Rent Income (From Real Property and Personal Property Leased with Real Property)
1
Description of property (property street address, city, state, ZIP code). Check if a dual-use (see instructions)
A
B
C
D
A
B
C
D
2
Rent received or accrued
a
From personal property (if the percentage of rent for personal property is more than 10% but not more than 50%)
......
b
From real and personal property (if the percentage of rent for personal property exceeds 50% or if the rent is based on profit or income)
..........
c
Total rents received or accrued by property. Add lines 2a and 2b, columns A through D
.
3
Total rents received or accrued. Add line 2c columns A through D. Enter here and on Part I, line 6, column (A)
.►
0
4
Deductions directly connected with the income in lines 2(a) and 2(b) (attach statement)
.
5
Total deductions.
Add line 4 columns A through D. Enter here and on Part I, line 6, column (B)
.....►
0
Part V
Unrelated Debt-Financed Income
(see instructions)
1
Description of debt-financed property (street address, city, state, ZIP code). Check if a dual-use (see instructions)
A
B
C
D
A
B
C
D
2
Gross income from or allocable to debt-financed property
........
256,973
327,586
3
Deductions directly connected with or allocable to debt-financed property
a
Straight line depreciation (attach statement)
104,307
28,582
b
Other deductions (attach statement)
...
65,236
0
c
Total deductions (add lines 3a and 3b, columns A through D)
..........
169,543
28,582
4
Amount of average acquisition debt on or allocable to debt-financed property (attach statement)
...........
1,301,909
1,506,986
5
Average adjusted basis of or allocable to debt-financed property (attach statement)
...
3,914,523
4,396,507
6
Divide line 4 by line 5
.......
33.260 %
34.280 %
7
Gross income reportable. Multiply line 2 by line 6
85,469
112,296
8
Total gross income
(add line 7, columns A through D). Enter here and on Part I, line 7, column (A)
....►
0
9
Allocable deductions. Multiply line 3c by line 6
56,390
9,798
10
Total allocable deductions.
Add line 9, columns A through D. Enter here and on Part I, line 7, column (B)
..►
0
11
Total dividends-received deductions
included in line 10
.................►
0
Schedule A (Form 990-T) 2020
Schedule A (Form 990-T) 2020
Page
3
Part VI
Interest, Annuities, Royalties, and Rents from Controlled Organizations
(see instructions)
1.
Name of controlled organization
2.
Employer identification number
Exempt Controlled Organizations
3.
Net unrelated income (loss)
(see instructions)
4.
Total of specified payments made
5.
Part of column 4 that is included
in the controlling organization's
gross income
6.
Deductions directly connected with income in column 5
(1)
(2)
(3)
(4)
Nonexempt Controlled Organizations
7.
Taxable income
8.
Net unrelated
income (loss)
(see instructions)
9.
Total of specified payments made
10.
Part of column 9
that is included in the
controlling organization's
gross income
11.
Deductions directly connected with
income in column 10
(1)
(2)
(3)
(4)
Add columns 5 and 10.
Enter here and on Part I,
line 8, column (A)
Add columns 6 and 11.
Enter here and on Part I,
line 8, column (B)
Totals
.........................►
0
0
Part VII
Investment Income of a Section 501(c)(7), (9), or (17) Organization
(see instructions)
1.
Description of income
2.
Amount of income
3.
Deductions directly connected
(attach statement)
4.
Set-asides
(attach statement)
5. Total deductions and set-asides
(add columns 3 and 4)
(1)
(2)
(3)
(4)
Totals
.........►
Add amounts in column 2.
Enter here and on Part I,
line 9, column (A)
0
Add amounts in column 5.
Enter here and on Part I,
line 9, column (B)
0
Part VIII
Exploited Exempt Activity Income, Other Than Advertising Income
(see instructions)
1
Description of exploited activity:
2
Gross unrelated business income from trade or business. Enter here and on Part I, line 10, column (A)
...
2
3
Expenses directly connected with production of unrelated business income. Enter here and on Part I, line 10, column (B)
...............................
3
4
Net income (loss) from unrelated trade or business. Subtract line 3 from line 2. If a gain, complete
lines 5 through 7
.............................
4
5
Gross income from activity that is not unrelated business income
..............
5
6
Expenses attributable to income entered on line 5
...................
6
7
Excess exempt expenses. Subtract line 5 from line 6, but do not enter more than the amount on line 4. Enter here and on Part II, line 12
..........................
7
Schedule A (Form 990-T) 2020
Schedule A (Form 990-T) 2020
Page
4
Part IX
Advertising Income
1
Name(s) of periodical(s). Check box if reporting two or more periodicals on a consolidated basis.
A
B
C
D
Enter amounts for each periodical listed above in the corresponding column.
A
B
C
D
2
Gross advertising income
......
a
Add columns A through D. Enter here and on Part I, line 11, column (A)
.............►
0
3
Direct Advertising costs by periodical
..
a
Add columns A through D. Enter here and on Part I, line 11, column (B)
.............►
0
4
Advertising gain (loss). Subtract line 3 from line 2. For any column in line 4 showing a gain, complete lines 5 through 8. For any column in line 4 showing a loss or zero, do not complete lines 5 through 7, and enter zero on line 8
............
5
Readership costs
........
6
Circulation income
........
7
Excess readership costs. If line 6 is less than line 5, subtract line 6 from line 5. If line 5 is less than line 6, enter zero
.....
8
Excess readership costs allowed as a deduction. For each column showing a gain on line 4, enter the lesser of line 4 or line 7
.
a
Add line 8, columns A through D. Enter the greater of the columns total or zero here and on Part II, line 13
..►
0
Part X
Compensation of Officers, Directors, and Trustees
(see instructions)
1.
Name
2.
Title
3.
Percentage
of time devoted
to business
4.
Compensation
attributable to
unrelated business
(1)
(2)
(3)
(4)
Total.
Enter here and on Part II, line 1
.........................►
0
Part XI
Supplemental Information
(see instructions)
Schedule A (Form 990-T) 2020
Additional Data
Software ID:
Software Version:
-
TIN:
SCHEDULE A
(Form 990-T)
Department of the Treasury
Internal Revenue Service
Unrelated Business Taxable Income
From an Unrelated Trade or Business
►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
20
Open to Public Inspection for 501(c)(3) Organizations Only
A
Name of the organization
IHC HEALTH SERVICES INC
B
Employer identification number
94-2854057
C
Unrelated business activity code (see instructions) ►
901101
D
Sequence:
1
of
12
E
Describe the unrelated trade or business ►
K-1 INVESTMENT FLOW-THROUGH
Part I
Unrelated Trade or Business Income
(A) Income
(B) Expenses
(C) Net
1a
Gross receipts or sales
1,022,390
b
Less returns and allowances
c
Balance ►
1c
1,022,390
2
Cost of goods sold (Part III, line 8)
.........
2
996,308
3
Gross profit. Subtract line 2 from line 1c
.......
3
1,022,390
1,022,390
4a
Capital gain net income (attach Sch D (Form 1041 or Form
1120)) (see instructions)
............
4a
b
Net gain (loss) (Form 4797) (attach Form 4797)
(see instructions)
4b
4,173,192
4,173,192
c
Capital loss deduction for trusts
4c
5
Income (loss) from a partnership or an S corporation (attach statement)
................
5
4,344,675
4,344,675
6
Rent income (Part IV)
.............
6
0
0
7
Unrelated debt-financed income (Part V)
.......
7
0
0
131,577
8
Interest, annuities, royalties, and rents from a controlled
organization (Part VI)
.............
8
0
0
9
Investment income of section 501(c)(7), (9), or (17)
organizations (Part VII)
............
9
0
0
10
Exploited exempt activity income (Part VIII)
......
10
11
Advertising income (Part IX)
...........
11
0
0
12
Other income (see instructions; attach statement)
....
12
13
Total.
Combine lines 3 through 12
.........
13
4,344,675
0
4,344,675
Part II
Deductions Not Taken Elsewhere
(See instructions for limitations on deductions) Deductions must be directly connected with the unrelated business income
1
Compensation of officers, directors, and trustees (Part X)
.................
1
0
2
Salaries and wages
............................
2
66,500
3
Repairs and maintenance
..........................
3
2,010
4
Bad debts
...............................
4
5
Interest (attach statement) (see instructions)
...................
5
159
6
Taxes and licenses
.............................
6
30,913
7
Depreciation (attach Form 4562) (see instructions)
.........
7
41,569
8
Less depreciation claimed in Part III and elsewhere on return
.....
8a
8b
41,569
9
Depletion
...............................
9
10
Contributions to deferred compensation plans
.....................
10
321,388
11
Employee benefit programs
..........................
11
19,950
12
Excess exempt expenses (Part VIII)
.......................
12
13
Excess readership costs (Part IX)
........................
13
0
14
Other deductions (attach statement)
......................
14
927,017
15
Total deductions.
Add lines 1 through 14
.....................
15
1,013,467
16
Unrelated business income before net operating loss deduction. Subtract line 15 from Part I, line 13, column (C)
16
3,331,208
17
Deduction for net operating loss (see instructions)
..................
17
0
18
Unrelated business taxable income.
Subtract line 17 from line 16
.............
18
3,331,208
For Paperwork Reduction Act Notice, see instructions.
Cat. No. 74036O
Schedule A (Form 990-T) 2020
Schedule A (Form 990-T) 2020
Page
2
Part III
Cost of Goods Sold
Enter method of inventory valuation ►
1
Inventory at beginning of year
........................
1
0
2
Purchases
...............................
2
0
3
Cost of labor
..............................
3
0
4
Additional section 263A costs (attach statement)
..................
4
0
5
Other costs (attach statement)
........................
5
996,308
6
Total.
Add lines 1 through 5
..........................
6
996,308
7
Inventory at end of year
...........................
7
0
8
Cost of goods sold.
Subtract line 7 from line 6. Enter here and in Part I, line 2
..........
8
996,308
9
Do the rules of section 263A (with respect to property produced or acquired for resale) apply to the organization?
Yes
No
Part IV
Rent Income (From Real Property and Personal Property Leased with Real Property)
1
Description of property (property street address, city, state, ZIP code). Check if a dual-use (see instructions)
A
B
C
D
A
B
C
D
2
Rent received or accrued
a
From personal property (if the percentage of rent for personal property is more than 10% but not more than 50%)
......
b
From real and personal property (if the percentage of rent for personal property exceeds 50% or if the rent is based on profit or income)
..........
c
Total rents received or accrued by property. Add lines 2a and 2b, columns A through D
.
3
Total rents received or accrued. Add line 2c columns A through D. Enter here and on Part I, line 6, column (A)
.►
0
4
Deductions directly connected with the income in lines 2(a) and 2(b) (attach statement)
.
5
Total deductions.
Add line 4 columns A through D. Enter here and on Part I, line 6, column (B)
.....►
0
Part V
Unrelated Debt-Financed Income
(see instructions)
1
Description of debt-financed property (street address, city, state, ZIP code). Check if a dual-use (see instructions)
A
B
C
D
A
B
C
D
2
Gross income from or allocable to debt-financed property
........
256,973
327,586
3
Deductions directly connected with or allocable to debt-financed property
a
Straight line depreciation (attach statement)
104,307
28,582
b
Other deductions (attach statement)
...
65,236
0
c
Total deductions (add lines 3a and 3b, columns A through D)
..........
169,543
28,582
4
Amount of average acquisition debt on or allocable to debt-financed property (attach statement)
...........
1,301,909
1,506,986
5
Average adjusted basis of or allocable to debt-financed property (attach statement)
...
3,914,523
4,396,507
6
Divide line 4 by line 5
.......
33.260 %
34.280 %
7
Gross income reportable. Multiply line 2 by line 6
85,469
112,296
8
Total gross income
(add line 7, columns A through D). Enter here and on Part I, line 7, column (A)
....►
0
9
Allocable deductions. Multiply line 3c by line 6
56,390
9,798
10
Total allocable deductions.
Add line 9, columns A through D. Enter here and on Part I, line 7, column (B)
..►
0
11
Total dividends-received deductions
included in line 10
.................►
0
Schedule A (Form 990-T) 2020
Schedule A (Form 990-T) 2020
Page
3
Part VI
Interest, Annuities, Royalties, and Rents from Controlled Organizations
(see instructions)
1.
Name of controlled organization
2.
Employer identification number
Exempt Controlled Organizations
3.
Net unrelated income (loss)
(see instructions)
4.
Total of specified payments made
5.
Part of column 4 that is included
in the controlling organization's
gross income
6.
Deductions directly connected with income in column 5
(1)
(2)
(3)
(4)
Nonexempt Controlled Organizations
7.
Taxable income
8.
Net unrelated
income (loss)
(see instructions)
9.
Total of specified payments made
10.
Part of column 9
that is included in the
controlling organization's
gross income
11.
Deductions directly connected with
income in column 10
(1)
(2)
(3)
(4)
Add columns 5 and 10.
Enter here and on Part I,
line 8, column (A)
Add columns 6 and 11.
Enter here and on Part I,
line 8, column (B)
Totals
.........................►
0
0
Part VII
Investment Income of a Section 501(c)(7), (9), or (17) Organization
(see instructions)
1.
Description of income
2.
Amount of income
3.
Deductions directly connected
(attach statement)
4.
Set-asides
(attach statement)
5. Total deductions and set-asides
(add columns 3 and 4)
(1)
(2)
(3)
(4)
Totals
.........►
Add amounts in column 2.
Enter here and on Part I,
line 9, column (A)
0
Add amounts in column 5.
Enter here and on Part I,
line 9, column (B)
0
Part VIII
Exploited Exempt Activity Income, Other Than Advertising Income
(see instructions)
1
Description of exploited activity:
2
Gross unrelated business income from trade or business. Enter here and on Part I, line 10, column (A)
...
2
3
Expenses directly connected with production of unrelated business income. Enter here and on Part I, line 10, column (B)
...............................
3
4
Net income (loss) from unrelated trade or business. Subtract line 3 from line 2. If a gain, complete
lines 5 through 7
.............................
4
5
Gross income from activity that is not unrelated business income
..............
5
6
Expenses attributable to income entered on line 5
...................
6
7
Excess exempt expenses. Subtract line 5 from line 6, but do not enter more than the amount on line 4. Enter here and on Part II, line 12
..........................
7
Schedule A (Form 990-T) 2020
Schedule A (Form 990-T) 2020
Page
4
Part IX
Advertising Income
1
Name(s) of periodical(s). Check box if reporting two or more periodicals on a consolidated basis.
A
B
C
D
Enter amounts for each periodical listed above in the corresponding column.
A
B
C
D
2
Gross advertising income
......
a
Add columns A through D. Enter here and on Part I, line 11, column (A)
.............►
0
3
Direct Advertising costs by periodical
..
a
Add columns A through D. Enter here and on Part I, line 11, column (B)
.............►
0
4
Advertising gain (loss). Subtract line 3 from line 2. For any column in line 4 showing a gain, complete lines 5 through 8. For any column in line 4 showing a loss or zero, do not complete lines 5 through 7, and enter zero on line 8
............
5
Readership costs
........
6
Circulation income
........
7
Excess readership costs. If line 6 is less than line 5, subtract line 6 from line 5. If line 5 is less than line 6, enter zero
.....
8
Excess readership costs allowed as a deduction. For each column showing a gain on line 4, enter the lesser of line 4 or line 7
.
a
Add line 8, columns A through D. Enter the greater of the columns total or zero here and on Part II, line 13
..►
0
Part X
Compensation of Officers, Directors, and Trustees
(see instructions)
1.
Name
2.
Title
3.
Percentage
of time devoted
to business
4.
Compensation
attributable to
unrelated business
(1)
(2)
(3)
(4)
Total.
Enter here and on Part II, line 1
.........................►
0
Part XI
Supplemental Information
(see instructions)
Schedule A (Form 990-T) 2020
Additional Data
Software ID:
Software Version:
-
TIN:
SCHEDULE A
(Form 990-T)
Department of the Treasury
Internal Revenue Service
Unrelated Business Taxable Income
From an Unrelated Trade or Business
►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
20
Open to Public Inspection for 501(c)(3) Organizations Only
A
Name of the organization
IHC HEALTH SERVICES INC
B
Employer identification number
94-2854057
C
Unrelated business activity code (see instructions) ►
901101
D
Sequence:
1
of
12
E
Describe the unrelated trade or business ►
K-1 INVESTMENT FLOW-THROUGH
Part I
Unrelated Trade or Business Income
(A) Income
(B) Expenses
(C) Net
1a
Gross receipts or sales
1,022,390
b
Less returns and allowances
c
Balance ►
1c
1,022,390
2
Cost of goods sold (Part III, line 8)
.........
2
996,308
3
Gross profit. Subtract line 2 from line 1c
.......
3
1,022,390
1,022,390
4a
Capital gain net income (attach Sch D (Form 1041 or Form
1120)) (see instructions)
............
4a
b
Net gain (loss) (Form 4797) (attach Form 4797)
(see instructions)
4b
4,173,192
4,173,192
c
Capital loss deduction for trusts
4c
5
Income (loss) from a partnership or an S corporation (attach statement)
................
5
4,344,675
4,344,675
6
Rent income (Part IV)
.............
6
0
0
7
Unrelated debt-financed income (Part V)
.......
7
0
0
131,577
8
Interest, annuities, royalties, and rents from a controlled
organization (Part VI)
.............
8
0
0
9
Investment income of section 501(c)(7), (9), or (17)
organizations (Part VII)
............
9
0
0
10
Exploited exempt activity income (Part VIII)
......
10
11
Advertising income (Part IX)
...........
11
0
0
12
Other income (see instructions; attach statement)
....
12
13
Total.
Combine lines 3 through 12
.........
13
4,344,675
0
4,344,675
Part II
Deductions Not Taken Elsewhere
(See instructions for limitations on deductions) Deductions must be directly connected with the unrelated business income
1
Compensation of officers, directors, and trustees (Part X)
.................
1
0
2
Salaries and wages
............................
2
66,500
3
Repairs and maintenance
..........................
3
2,010
4
Bad debts
...............................
4
5
Interest (attach statement) (see instructions)
...................
5
159
6
Taxes and licenses
.............................
6
30,913
7
Depreciation (attach Form 4562) (see instructions)
.........
7
41,569
8
Less depreciation claimed in Part III and elsewhere on return
.....
8a
8b
41,569
9
Depletion
...............................
9
10
Contributions to deferred compensation plans
.....................
10
321,388
11
Employee benefit programs
..........................
11
19,950
12
Excess exempt expenses (Part VIII)
.......................
12
13
Excess readership costs (Part IX)
........................
13
0
14
Other deductions (attach statement)
......................
14
927,017
15
Total deductions.
Add lines 1 through 14
.....................
15
1,013,467
16
Unrelated business income before net operating loss deduction. Subtract line 15 from Part I, line 13, column (C)
16
3,331,208
17
Deduction for net operating loss (see instructions)
..................
17
0
18
Unrelated business taxable income.
Subtract line 17 from line 16
.............
18
3,331,208
For Paperwork Reduction Act Notice, see instructions.
Cat. No. 74036O
Schedule A (Form 990-T) 2020
Schedule A (Form 990-T) 2020
Page
2
Part III
Cost of Goods Sold
Enter method of inventory valuation ►
1
Inventory at beginning of year
........................
1
0
2
Purchases
...............................
2
0
3
Cost of labor
..............................
3
0
4
Additional section 263A costs (attach statement)
..................
4
0
5
Other costs (attach statement)
........................
5
996,308
6
Total.
Add lines 1 through 5
..........................
6
996,308
7
Inventory at end of year
...........................
7
0
8
Cost of goods sold.
Subtract line 7 from line 6. Enter here and in Part I, line 2
..........
8
996,308
9
Do the rules of section 263A (with respect to property produced or acquired for resale) apply to the organization?
Yes
No
Part IV
Rent Income (From Real Property and Personal Property Leased with Real Property)
1
Description of property (property street address, city, state, ZIP code). Check if a dual-use (see instructions)
A
B
C
D
A
B
C
D
2
Rent received or accrued
a
From personal property (if the percentage of rent for personal property is more than 10% but not more than 50%)
......
b
From real and personal property (if the percentage of rent for personal property exceeds 50% or if the rent is based on profit or income)
..........
c
Total rents received or accrued by property. Add lines 2a and 2b, columns A through D
.
3
Total rents received or accrued. Add line 2c columns A through D. Enter here and on Part I, line 6, column (A)
.►
0
4
Deductions directly connected with the income in lines 2(a) and 2(b) (attach statement)
.
5
Total deductions.
Add line 4 columns A through D. Enter here and on Part I, line 6, column (B)
.....►
0
Part V
Unrelated Debt-Financed Income
(see instructions)
1
Description of debt-financed property (street address, city, state, ZIP code). Check if a dual-use (see instructions)
A
B
C
D
A
B
C
D
2
Gross income from or allocable to debt-financed property
........
256,973
327,586
3
Deductions directly connected with or allocable to debt-financed property
a
Straight line depreciation (attach statement)
104,307
28,582
b
Other deductions (attach statement)
...
65,236
0
c
Total deductions (add lines 3a and 3b, columns A through D)
..........
169,543
28,582
4
Amount of average acquisition debt on or allocable to debt-financed property (attach statement)
...........
1,301,909
1,506,986
5
Average adjusted basis of or allocable to debt-financed property (attach statement)
...
3,914,523
4,396,507
6
Divide line 4 by line 5
.......
33.260 %
34.280 %
7
Gross income reportable. Multiply line 2 by line 6
85,469
112,296
8
Total gross income
(add line 7, columns A through D). Enter here and on Part I, line 7, column (A)
....►
0
9
Allocable deductions. Multiply line 3c by line 6
56,390
9,798
10
Total allocable deductions.
Add line 9, columns A through D. Enter here and on Part I, line 7, column (B)
..►
0
11
Total dividends-received deductions
included in line 10
.................►
0
Schedule A (Form 990-T) 2020
Schedule A (Form 990-T) 2020
Page
3
Part VI
Interest, Annuities, Royalties, and Rents from Controlled Organizations
(see instructions)
1.
Name of controlled organization
2.
Employer identification number
Exempt Controlled Organizations
3.
Net unrelated income (loss)
(see instructions)
4.
Total of specified payments made
5.
Part of column 4 that is included
in the controlling organization's
gross income
6.
Deductions directly connected with income in column 5
(1)
(2)
(3)
(4)
Nonexempt Controlled Organizations
7.
Taxable income
8.
Net unrelated
income (loss)
(see instructions)
9.
Total of specified payments made
10.
Part of column 9
that is included in the
controlling organization's
gross income
11.
Deductions directly connected with
income in column 10
(1)
(2)
(3)
(4)
Add columns 5 and 10.
Enter here and on Part I,
line 8, column (A)
Add columns 6 and 11.
Enter here and on Part I,
line 8, column (B)
Totals
.........................►
0
0
Part VII
Investment Income of a Section 501(c)(7), (9), or (17) Organization
(see instructions)
1.
Description of income
2.
Amount of income
3.
Deductions directly connected
(attach statement)
4.
Set-asides
(attach statement)
5. Total deductions and set-asides
(add columns 3 and 4)
(1)
(2)
(3)
(4)
Totals
.........►
Add amounts in column 2.
Enter here and on Part I,
line 9, column (A)
0
Add amounts in column 5.
Enter here and on Part I,
line 9, column (B)
0
Part VIII
Exploited Exempt Activity Income, Other Than Advertising Income
(see instructions)
1
Description of exploited activity:
2
Gross unrelated business income from trade or business. Enter here and on Part I, line 10, column (A)
...
2
3
Expenses directly connected with production of unrelated business income. Enter here and on Part I, line 10, column (B)
...............................
3
4
Net income (loss) from unrelated trade or business. Subtract line 3 from line 2. If a gain, complete
lines 5 through 7
.............................
4
5
Gross income from activity that is not unrelated business income
..............
5
6
Expenses attributable to income entered on line 5
...................
6
7
Excess exempt expenses. Subtract line 5 from line 6, but do not enter more than the amount on line 4. Enter here and on Part II, line 12
..........................
7
Schedule A (Form 990-T) 2020
Schedule A (Form 990-T) 2020
Page
4
Part IX
Advertising Income
1
Name(s) of periodical(s). Check box if reporting two or more periodicals on a consolidated basis.
A
B
C
D
Enter amounts for each periodical listed above in the corresponding column.
A
B
C
D
2
Gross advertising income
......
a
Add columns A through D. Enter here and on Part I, line 11, column (A)
.............►
0
3
Direct Advertising costs by periodical
..
a
Add columns A through D. Enter here and on Part I, line 11, column (B)
.............►
0
4
Advertising gain (loss). Subtract line 3 from line 2. For any column in line 4 showing a gain, complete lines 5 through 8. For any column in line 4 showing a loss or zero, do not complete lines 5 through 7, and enter zero on line 8
............
5
Readership costs
........
6
Circulation income
........
7
Excess readership costs. If line 6 is less than line 5, subtract line 6 from line 5. If line 5 is less than line 6, enter zero
.....
8
Excess readership costs allowed as a deduction. For each column showing a gain on line 4, enter the lesser of line 4 or line 7
.
a
Add line 8, columns A through D. Enter the greater of the columns total or zero here and on Part II, line 13
..►
0
Part X
Compensation of Officers, Directors, and Trustees
(see instructions)
1.
Name
2.
Title
3.
Percentage
of time devoted
to business
4.
Compensation
attributable to
unrelated business
(1)
(2)
(3)
(4)
Total.
Enter here and on Part II, line 1
.........................►
0
Part XI
Supplemental Information
(see instructions)
Schedule A (Form 990-T) 2020
Additional Data
Software ID:
Software Version:
-
TIN:
SCHEDULE A
(Form 990-T)
Department of the Treasury
Internal Revenue Service
Unrelated Business Taxable Income
From an Unrelated Trade or Business
►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
20
Open to Public Inspection for 501(c)(3) Organizations Only
A
Name of the organization
IHC HEALTH SERVICES INC
B
Employer identification number
94-2854057
C
Unrelated business activity code (see instructions) ►
901101
D
Sequence:
1
of
12
E
Describe the unrelated trade or business ►
K-1 INVESTMENT FLOW-THROUGH
Part I
Unrelated Trade or Business Income
(A) Income
(B) Expenses
(C) Net
1a
Gross receipts or sales
1,022,390
b
Less returns and allowances
c
Balance ►
1c
1,022,390
2
Cost of goods sold (Part III, line 8)
.........
2
996,308
3
Gross profit. Subtract line 2 from line 1c
.......
3
1,022,390
1,022,390
4a
Capital gain net income (attach Sch D (Form 1041 or Form
1120)) (see instructions)
............
4a
b
Net gain (loss) (Form 4797) (attach Form 4797)
(see instructions)
4b
4,173,192
4,173,192
c
Capital loss deduction for trusts
4c
5
Income (loss) from a partnership or an S corporation (attach statement)
................
5
4,344,675
4,344,675
6
Rent income (Part IV)
.............
6
0
0
7
Unrelated debt-financed income (Part V)
.......
7
0
0
131,577
8
Interest, annuities, royalties, and rents from a controlled
organization (Part VI)
.............
8
0
0
9
Investment income of section 501(c)(7), (9), or (17)
organizations (Part VII)
............
9
0
0
10
Exploited exempt activity income (Part VIII)
......
10
11
Advertising income (Part IX)
...........
11
0
0
12
Other income (see instructions; attach statement)
....
12
13
Total.
Combine lines 3 through 12
.........
13
4,344,675
0
4,344,675
Part II
Deductions Not Taken Elsewhere
(See instructions for limitations on deductions) Deductions must be directly connected with the unrelated business income
1
Compensation of officers, directors, and trustees (Part X)
.................
1
0
2
Salaries and wages
............................
2
66,500
3
Repairs and maintenance
..........................
3
2,010
4
Bad debts
...............................
4
5
Interest (attach statement) (see instructions)
...................
5
159
6
Taxes and licenses
.............................
6
30,913
7
Depreciation (attach Form 4562) (see instructions)
.........
7
41,569
8
Less depreciation claimed in Part III and elsewhere on return
.....
8a
8b
41,569
9
Depletion
...............................
9
10
Contributions to deferred compensation plans
.....................
10
321,388
11
Employee benefit programs
..........................
11
19,950
12
Excess exempt expenses (Part VIII)
.......................
12
13
Excess readership costs (Part IX)
........................
13
0
14
Other deductions (attach statement)
......................
14
927,017
15
Total deductions.
Add lines 1 through 14
.....................
15
1,013,467
16
Unrelated business income before net operating loss deduction. Subtract line 15 from Part I, line 13, column (C)
16
3,331,208
17
Deduction for net operating loss (see instructions)
..................
17
0
18
Unrelated business taxable income.
Subtract line 17 from line 16
.............
18
3,331,208
For Paperwork Reduction Act Notice, see instructions.
Cat. No. 74036O
Schedule A (Form 990-T) 2020
Schedule A (Form 990-T) 2020
Page
2
Part III
Cost of Goods Sold
Enter method of inventory valuation ►
1
Inventory at beginning of year
........................
1
0
2
Purchases
...............................
2
0
3
Cost of labor
..............................
3
0
4
Additional section 263A costs (attach statement)
..................
4
0
5
Other costs (attach statement)
........................
5
996,308
6
Total.
Add lines 1 through 5
..........................
6
996,308
7
Inventory at end of year
...........................
7
0
8
Cost of goods sold.
Subtract line 7 from line 6. Enter here and in Part I, line 2
..........
8
996,308
9
Do the rules of section 263A (with respect to property produced or acquired for resale) apply to the organization?
Yes
No
Part IV
Rent Income (From Real Property and Personal Property Leased with Real Property)
1
Description of property (property street address, city, state, ZIP code). Check if a dual-use (see instructions)
A
B
C
D
A
B
C
D
2
Rent received or accrued
a
From personal property (if the percentage of rent for personal property is more than 10% but not more than 50%)
......
b
From real and personal property (if the percentage of rent for personal property exceeds 50% or if the rent is based on profit or income)
..........
c
Total rents received or accrued by property. Add lines 2a and 2b, columns A through D
.
3
Total rents received or accrued. Add line 2c columns A through D. Enter here and on Part I, line 6, column (A)
.►
0
4
Deductions directly connected with the income in lines 2(a) and 2(b) (attach statement)
.
5
Total deductions.
Add line 4 columns A through D. Enter here and on Part I, line 6, column (B)
.....►
0
Part V
Unrelated Debt-Financed Income
(see instructions)
1
Description of debt-financed property (street address, city, state, ZIP code). Check if a dual-use (see instructions)
A
B
C
D
A
B
C
D
2
Gross income from or allocable to debt-financed property
........
256,973
327,586
3
Deductions directly connected with or allocable to debt-financed property
a
Straight line depreciation (attach statement)
104,307
28,582
b
Other deductions (attach statement)
...
65,236
0
c
Total deductions (add lines 3a and 3b, columns A through D)
..........
169,543
28,582
4
Amount of average acquisition debt on or allocable to debt-financed property (attach statement)
...........
1,301,909
1,506,986
5
Average adjusted basis of or allocable to debt-financed property (attach statement)
...
3,914,523
4,396,507
6
Divide line 4 by line 5
.......
33.260 %
34.280 %
7
Gross income reportable. Multiply line 2 by line 6
85,469
112,296
8
Total gross income
(add line 7, columns A through D). Enter here and on Part I, line 7, column (A)
....►
0
9
Allocable deductions. Multiply line 3c by line 6
56,390
9,798
10
Total allocable deductions.
Add line 9, columns A through D. Enter here and on Part I, line 7, column (B)
..►
0
11
Total dividends-received deductions
included in line 10
.................►
0
Schedule A (Form 990-T) 2020
Schedule A (Form 990-T) 2020
Page
3
Part VI
Interest, Annuities, Royalties, and Rents from Controlled Organizations
(see instructions)
1.
Name of controlled organization
2.
Employer identification number
Exempt Controlled Organizations
3.
Net unrelated income (loss)
(see instructions)
4.
Total of specified payments made
5.
Part of column 4 that is included
in the controlling organization's
gross income
6.
Deductions directly connected with income in column 5
(1)
(2)
(3)
(4)
Nonexempt Controlled Organizations
7.
Taxable income
8.
Net unrelated
income (loss)
(see instructions)
9.
Total of specified payments made
10.
Part of column 9
that is included in the
controlling organization's
gross income
11.
Deductions directly connected with
income in column 10
(1)
(2)
(3)
(4)
Add columns 5 and 10.
Enter here and on Part I,
line 8, column (A)
Add columns 6 and 11.
Enter here and on Part I,
line 8, column (B)
Totals
.........................►
0
0
Part VII
Investment Income of a Section 501(c)(7), (9), or (17) Organization
(see instructions)
1.
Description of income
2.
Amount of income
3.
Deductions directly connected
(attach statement)
4.
Set-asides
(attach statement)
5. Total deductions and set-asides
(add columns 3 and 4)
(1)
(2)
(3)
(4)
Totals
.........►
Add amounts in column 2.
Enter here and on Part I,
line 9, column (A)
0
Add amounts in column 5.
Enter here and on Part I,
line 9, column (B)
0
Part VIII
Exploited Exempt Activity Income, Other Than Advertising Income
(see instructions)
1
Description of exploited activity:
2
Gross unrelated business income from trade or business. Enter here and on Part I, line 10, column (A)
...
2
3
Expenses directly connected with production of unrelated business income. Enter here and on Part I, line 10, column (B)
...............................
3
4
Net income (loss) from unrelated trade or business. Subtract line 3 from line 2. If a gain, complete
lines 5 through 7
.............................
4
5
Gross income from activity that is not unrelated business income
..............
5
6
Expenses attributable to income entered on line 5
...................
6
7
Excess exempt expenses. Subtract line 5 from line 6, but do not enter more than the amount on line 4. Enter here and on Part II, line 12
..........................
7
Schedule A (Form 990-T) 2020
Schedule A (Form 990-T) 2020
Page
4
Part IX
Advertising Income
1
Name(s) of periodical(s). Check box if reporting two or more periodicals on a consolidated basis.
A
B
C
D
Enter amounts for each periodical listed above in the corresponding column.
A
B
C
D
2
Gross advertising income
......
a
Add columns A through D. Enter here and on Part I, line 11, column (A)
.............►
0
3
Direct Advertising costs by periodical
..
a
Add columns A through D. Enter here and on Part I, line 11, column (B)
.............►
0
4
Advertising gain (loss). Subtract line 3 from line 2. For any column in line 4 showing a gain, complete lines 5 through 8. For any column in line 4 showing a loss or zero, do not complete lines 5 through 7, and enter zero on line 8
............
5
Readership costs
........
6
Circulation income
........
7
Excess readership costs. If line 6 is less than line 5, subtract line 6 from line 5. If line 5 is less than line 6, enter zero
.....
8
Excess readership costs allowed as a deduction. For each column showing a gain on line 4, enter the lesser of line 4 or line 7
.
a
Add line 8, columns A through D. Enter the greater of the columns total or zero here and on Part II, line 13
..►
0
Part X
Compensation of Officers, Directors, and Trustees
(see instructions)
1.
Name
2.
Title
3.
Percentage
of time devoted
to business
4.
Compensation
attributable to
unrelated business
(1)
(2)
(3)
(4)
Total.
Enter here and on Part II, line 1
.........................►
0
Part XI
Supplemental Information
(see instructions)
Schedule A (Form 990-T) 2020
Additional Data
Software ID:
Software Version:
-
TIN:
SCHEDULE A
(Form 990-T)
Department of the Treasury
Internal Revenue Service
Unrelated Business Taxable Income
From an Unrelated Trade or Business
►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
20
Open to Public Inspection for 501(c)(3) Organizations Only
A
Name of the organization
IHC HEALTH SERVICES INC
B
Employer identification number
94-2854057
C
Unrelated business activity code (see instructions) ►
901101
D
Sequence:
1
of
12
E
Describe the unrelated trade or business ►
K-1 INVESTMENT FLOW-THROUGH
Part I
Unrelated Trade or Business Income
(A) Income
(B) Expenses
(C) Net
1a
Gross receipts or sales
1,022,390
b
Less returns and allowances
c
Balance ►
1c
1,022,390
2
Cost of goods sold (Part III, line 8)
.........
2
996,308
3
Gross profit. Subtract line 2 from line 1c
.......
3
1,022,390
1,022,390
4a
Capital gain net income (attach Sch D (Form 1041 or Form
1120)) (see instructions)
............
4a
b
Net gain (loss) (Form 4797) (attach Form 4797)
(see instructions)
4b
4,173,192
4,173,192
c
Capital loss deduction for trusts
4c
5
Income (loss) from a partnership or an S corporation (attach statement)
................
5
4,344,675
4,344,675
6
Rent income (Part IV)
.............
6
0
0
7
Unrelated debt-financed income (Part V)
.......
7
0
0
131,577
8
Interest, annuities, royalties, and rents from a controlled
organization (Part VI)
.............
8
0
0
9
Investment income of section 501(c)(7), (9), or (17)
organizations (Part VII)
............
9
0
0
10
Exploited exempt activity income (Part VIII)
......
10
11
Advertising income (Part IX)
...........
11
0
0
12
Other income (see instructions; attach statement)
....
12
13
Total.
Combine lines 3 through 12
.........
13
4,344,675
0
4,344,675
Part II
Deductions Not Taken Elsewhere
(See instructions for limitations on deductions) Deductions must be directly connected with the unrelated business income
1
Compensation of officers, directors, and trustees (Part X)
.................
1
0
2
Salaries and wages
............................
2
66,500
3
Repairs and maintenance
..........................
3
2,010
4
Bad debts
...............................
4
5
Interest (attach statement) (see instructions)
...................
5
159
6
Taxes and licenses
.............................
6
30,913
7
Depreciation (attach Form 4562) (see instructions)
.........
7
41,569
8
Less depreciation claimed in Part III and elsewhere on return
.....
8a
8b
41,569
9
Depletion
...............................
9
10
Contributions to deferred compensation plans
.....................
10
321,388
11
Employee benefit programs
..........................
11
19,950
12
Excess exempt expenses (Part VIII)
.......................
12
13
Excess readership costs (Part IX)
........................
13
0
14
Other deductions (attach statement)
......................
14
927,017
15
Total deductions.
Add lines 1 through 14
.....................
15
1,013,467
16
Unrelated business income before net operating loss deduction. Subtract line 15 from Part I, line 13, column (C)
16
3,331,208
17
Deduction for net operating loss (see instructions)
..................
17
0
18
Unrelated business taxable income.
Subtract line 17 from line 16
.............
18
3,331,208
For Paperwork Reduction Act Notice, see instructions.
Cat. No. 74036O
Schedule A (Form 990-T) 2020
Schedule A (Form 990-T) 2020
Page
2
Part III
Cost of Goods Sold
Enter method of inventory valuation ►
1
Inventory at beginning of year
........................
1
0
2
Purchases
...............................
2
0
3
Cost of labor
..............................
3
0
4
Additional section 263A costs (attach statement)
..................
4
0
5
Other costs (attach statement)
........................
5
996,308
6
Total.
Add lines 1 through 5
..........................
6
996,308
7
Inventory at end of year
...........................
7
0
8
Cost of goods sold.
Subtract line 7 from line 6. Enter here and in Part I, line 2
..........
8
996,308
9
Do the rules of section 263A (with respect to property produced or acquired for resale) apply to the organization?
Yes
No
Part IV
Rent Income (From Real Property and Personal Property Leased with Real Property)
1
Description of property (property street address, city, state, ZIP code). Check if a dual-use (see instructions)
A
B
C
D
A
B
C
D
2
Rent received or accrued
a
From personal property (if the percentage of rent for personal property is more than 10% but not more than 50%)
......
b
From real and personal property (if the percentage of rent for personal property exceeds 50% or if the rent is based on profit or income)
..........
c
Total rents received or accrued by property. Add lines 2a and 2b, columns A through D
.
3
Total rents received or accrued. Add line 2c columns A through D. Enter here and on Part I, line 6, column (A)
.►
0
4
Deductions directly connected with the income in lines 2(a) and 2(b) (attach statement)
.
5
Total deductions.
Add line 4 columns A through D. Enter here and on Part I, line 6, column (B)
.....►
0
Part V
Unrelated Debt-Financed Income
(see instructions)
1
Description of debt-financed property (street address, city, state, ZIP code). Check if a dual-use (see instructions)
A
B
C
D
A
B
C
D
2
Gross income from or allocable to debt-financed property
........
256,973
327,586
3
Deductions directly connected with or allocable to debt-financed property
a
Straight line depreciation (attach statement)
104,307
28,582
b
Other deductions (attach statement)
...
65,236
0
c
Total deductions (add lines 3a and 3b, columns A through D)
..........
169,543
28,582
4
Amount of average acquisition debt on or allocable to debt-financed property (attach statement)
...........
1,301,909
1,506,986
5
Average adjusted basis of or allocable to debt-financed property (attach statement)
...
3,914,523
4,396,507
6
Divide line 4 by line 5
.......
33.260 %
34.280 %
7
Gross income reportable. Multiply line 2 by line 6
85,469
112,296
8
Total gross income
(add line 7, columns A through D). Enter here and on Part I, line 7, column (A)
....►
0
9
Allocable deductions. Multiply line 3c by line 6
56,390
9,798
10
Total allocable deductions.
Add line 9, columns A through D. Enter here and on Part I, line 7, column (B)
..►
0
11
Total dividends-received deductions
included in line 10
.................►
0
Schedule A (Form 990-T) 2020
Schedule A (Form 990-T) 2020
Page
3
Part VI
Interest, Annuities, Royalties, and Rents from Controlled Organizations
(see instructions)
1.
Name of controlled organization
2.
Employer identification number
Exempt Controlled Organizations
3.
Net unrelated income (loss)
(see instructions)
4.
Total of specified payments made
5.
Part of column 4 that is included
in the controlling organization's
gross income
6.
Deductions directly connected with income in column 5
(1)
(2)
(3)
(4)
Nonexempt Controlled Organizations
7.
Taxable income
8.
Net unrelated
income (loss)
(see instructions)
9.
Total of specified payments made
10.
Part of column 9
that is included in the
controlling organization's
gross income
11.
Deductions directly connected with
income in column 10
(1)
(2)
(3)
(4)
Add columns 5 and 10.
Enter here and on Part I,
line 8, column (A)
Add columns 6 and 11.
Enter here and on Part I,
line 8, column (B)
Totals
.........................►
0
0
Part VII
Investment Income of a Section 501(c)(7), (9), or (17) Organization
(see instructions)
1.
Description of income
2.
Amount of income
3.
Deductions directly connected
(attach statement)
4.
Set-asides
(attach statement)
5. Total deductions and set-asides
(add columns 3 and 4)
(1)
(2)
(3)
(4)
Totals
.........►
Add amounts in column 2.
Enter here and on Part I,
line 9, column (A)
0
Add amounts in column 5.
Enter here and on Part I,
line 9, column (B)
0
Part VIII
Exploited Exempt Activity Income, Other Than Advertising Income
(see instructions)
1
Description of exploited activity:
2
Gross unrelated business income from trade or business. Enter here and on Part I, line 10, column (A)
...
2
3
Expenses directly connected with production of unrelated business income. Enter here and on Part I, line 10, column (B)
...............................
3
4
Net income (loss) from unrelated trade or business. Subtract line 3 from line 2. If a gain, complete
lines 5 through 7
.............................
4
5
Gross income from activity that is not unrelated business income
..............
5
6
Expenses attributable to income entered on line 5
...................
6
7
Excess exempt expenses. Subtract line 5 from line 6, but do not enter more than the amount on line 4. Enter here and on Part II, line 12
..........................
7
Schedule A (Form 990-T) 2020
Schedule A (Form 990-T) 2020
Page
4
Part IX
Advertising Income
1
Name(s) of periodical(s). Check box if reporting two or more periodicals on a consolidated basis.
A
B
C
D
Enter amounts for each periodical listed above in the corresponding column.
A
B
C
D
2
Gross advertising income
......
a
Add columns A through D. Enter here and on Part I, line 11, column (A)
.............►
0
3
Direct Advertising costs by periodical
..
a
Add columns A through D. Enter here and on Part I, line 11, column (B)
.............►
0
4
Advertising gain (loss). Subtract line 3 from line 2. For any column in line 4 showing a gain, complete lines 5 through 8. For any column in line 4 showing a loss or zero, do not complete lines 5 through 7, and enter zero on line 8
............
5
Readership costs
........
6
Circulation income
........
7
Excess readership costs. If line 6 is less than line 5, subtract line 6 from line 5. If line 5 is less than line 6, enter zero
.....
8
Excess readership costs allowed as a deduction. For each column showing a gain on line 4, enter the lesser of line 4 or line 7
.
a
Add line 8, columns A through D. Enter the greater of the columns total or zero here and on Part II, line 13
..►
0
Part X
Compensation of Officers, Directors, and Trustees
(see instructions)
1.
Name
2.
Title
3.
Percentage
of time devoted
to business
4.
Compensation
attributable to
unrelated business
(1)
(2)
(3)
(4)
Total.
Enter here and on Part II, line 1
.........................►
0
Part XI
Supplemental Information
(see instructions)
Schedule A (Form 990-T) 2020
Additional Data
Software ID:
Software Version:
-
TIN:
SCHEDULE A
(Form 990-T)
Department of the Treasury
Internal Revenue Service
Unrelated Business Taxable Income
From an Unrelated Trade or Business
►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
20
Open to Public Inspection for 501(c)(3) Organizations Only
A
Name of the organization
IHC HEALTH SERVICES INC
B
Employer identification number
94-2854057
C
Unrelated business activity code (see instructions) ►
901101
D
Sequence:
1
of
12
E
Describe the unrelated trade or business ►
K-1 INVESTMENT FLOW-THROUGH
Part I
Unrelated Trade or Business Income
(A) Income
(B) Expenses
(C) Net
1a
Gross receipts or sales
1,022,390
b
Less returns and allowances
c
Balance ►
1c
1,022,390
2
Cost of goods sold (Part III, line 8)
.........
2
996,308
3
Gross profit. Subtract line 2 from line 1c
.......
3
1,022,390
1,022,390
4a
Capital gain net income (attach Sch D (Form 1041 or Form
1120)) (see instructions)
............
4a
b
Net gain (loss) (Form 4797) (attach Form 4797)
(see instructions)
4b
4,173,192
4,173,192
c
Capital loss deduction for trusts
4c
5
Income (loss) from a partnership or an S corporation (attach statement)
................
5
4,344,675
4,344,675
6
Rent income (Part IV)
.............
6
0
0
7
Unrelated debt-financed income (Part V)
.......
7
0
0
131,577
8
Interest, annuities, royalties, and rents from a controlled
organization (Part VI)
.............
8
0
0
9
Investment income of section 501(c)(7), (9), or (17)
organizations (Part VII)
............
9
0
0
10
Exploited exempt activity income (Part VIII)
......
10
11
Advertising income (Part IX)
...........
11
0
0
12
Other income (see instructions; attach statement)
....
12
13
Total.
Combine lines 3 through 12
.........
13
4,344,675
0
4,344,675
Part II
Deductions Not Taken Elsewhere
(See instructions for limitations on deductions) Deductions must be directly connected with the unrelated business income
1
Compensation of officers, directors, and trustees (Part X)
.................
1
0
2
Salaries and wages
............................
2
66,500
3
Repairs and maintenance
..........................
3
2,010
4
Bad debts
...............................
4
5
Interest (attach statement) (see instructions)
...................
5
159
6
Taxes and licenses
.............................
6
30,913
7
Depreciation (attach Form 4562) (see instructions)
.........
7
41,569
8
Less depreciation claimed in Part III and elsewhere on return
.....
8a
8b
41,569
9
Depletion
...............................
9
10
Contributions to deferred compensation plans
.....................
10
321,388
11
Employee benefit programs
..........................
11
19,950
12
Excess exempt expenses (Part VIII)
.......................
12
13
Excess readership costs (Part IX)
........................
13
0
14
Other deductions (attach statement)
......................
14
927,017
15
Total deductions.
Add lines 1 through 14
.....................
15
1,013,467
16
Unrelated business income before net operating loss deduction. Subtract line 15 from Part I, line 13, column (C)
16
3,331,208
17
Deduction for net operating loss (see instructions)
..................
17
0
18
Unrelated business taxable income.
Subtract line 17 from line 16
.............
18
3,331,208
For Paperwork Reduction Act Notice, see instructions.
Cat. No. 74036O
Schedule A (Form 990-T) 2020
Schedule A (Form 990-T) 2020
Page
2
Part III
Cost of Goods Sold
Enter method of inventory valuation ►
1
Inventory at beginning of year
........................
1
0
2
Purchases
...............................
2
0
3
Cost of labor
..............................
3
0
4
Additional section 263A costs (attach statement)
..................
4
0
5
Other costs (attach statement)
........................
5
996,308
6
Total.
Add lines 1 through 5
..........................
6
996,308
7
Inventory at end of year
...........................
7
0
8
Cost of goods sold.
Subtract line 7 from line 6. Enter here and in Part I, line 2
..........
8
996,308
9
Do the rules of section 263A (with respect to property produced or acquired for resale) apply to the organization?
Yes
No
Part IV
Rent Income (From Real Property and Personal Property Leased with Real Property)
1
Description of property (property street address, city, state, ZIP code). Check if a dual-use (see instructions)
A
B
C
D
A
B
C
D
2
Rent received or accrued
a
From personal property (if the percentage of rent for personal property is more than 10% but not more than 50%)
......
b
From real and personal property (if the percentage of rent for personal property exceeds 50% or if the rent is based on profit or income)
..........
c
Total rents received or accrued by property. Add lines 2a and 2b, columns A through D
.
3
Total rents received or accrued. Add line 2c columns A through D. Enter here and on Part I, line 6, column (A)
.►
0
4
Deductions directly connected with the income in lines 2(a) and 2(b) (attach statement)
.
5
Total deductions.
Add line 4 columns A through D. Enter here and on Part I, line 6, column (B)
.....►
0
Part V
Unrelated Debt-Financed Income
(see instructions)
1
Description of debt-financed property (street address, city, state, ZIP code). Check if a dual-use (see instructions)
A
B
C
D
A
B
C
D
2
Gross income from or allocable to debt-financed property
........
256,973
327,586
3
Deductions directly connected with or allocable to debt-financed property
a
Straight line depreciation (attach statement)
104,307
28,582
b
Other deductions (attach statement)
...
65,236
0
c
Total deductions (add lines 3a and 3b, columns A through D)
..........
169,543
28,582
4
Amount of average acquisition debt on or allocable to debt-financed property (attach statement)
...........
1,301,909
1,506,986
5
Average adjusted basis of or allocable to debt-financed property (attach statement)
...
3,914,523
4,396,507
6
Divide line 4 by line 5
.......
33.260 %
34.280 %
7
Gross income reportable. Multiply line 2 by line 6
85,469
112,296
8
Total gross income
(add line 7, columns A through D). Enter here and on Part I, line 7, column (A)
....►
0
9
Allocable deductions. Multiply line 3c by line 6
56,390
9,798
10
Total allocable deductions.
Add line 9, columns A through D. Enter here and on Part I, line 7, column (B)
..►
0
11
Total dividends-received deductions
included in line 10
.................►
0
Schedule A (Form 990-T) 2020
Schedule A (Form 990-T) 2020
Page
3
Part VI
Interest, Annuities, Royalties, and Rents from Controlled Organizations
(see instructions)
1.
Name of controlled organization
2.
Employer identification number
Exempt Controlled Organizations
3.
Net unrelated income (loss)
(see instructions)
4.
Total of specified payments made
5.
Part of column 4 that is included
in the controlling organization's
gross income
6.
Deductions directly connected with income in column 5
(1)
(2)
(3)
(4)
Nonexempt Controlled Organizations
7.
Taxable income
8.
Net unrelated
income (loss)
(see instructions)
9.
Total of specified payments made
10.
Part of column 9
that is included in the
controlling organization's
gross income
11.
Deductions directly connected with
income in column 10
(1)
(2)
(3)
(4)
Add columns 5 and 10.
Enter here and on Part I,
line 8, column (A)
Add columns 6 and 11.
Enter here and on Part I,
line 8, column (B)
Totals
.........................►
0
0
Part VII
Investment Income of a Section 501(c)(7), (9), or (17) Organization
(see instructions)
1.
Description of income
2.
Amount of income
3.
Deductions directly connected
(attach statement)
4.
Set-asides
(attach statement)
5. Total deductions and set-asides
(add columns 3 and 4)
(1)
(2)
(3)
(4)
Totals
.........►
Add amounts in column 2.
Enter here and on Part I,
line 9, column (A)
0
Add amounts in column 5.
Enter here and on Part I,
line 9, column (B)
0
Part VIII
Exploited Exempt Activity Income, Other Than Advertising Income
(see instructions)
1
Description of exploited activity:
2
Gross unrelated business income from trade or business. Enter here and on Part I, line 10, column (A)
...
2
3
Expenses directly connected with production of unrelated business income. Enter here and on Part I, line 10, column (B)
...............................
3
4
Net income (loss) from unrelated trade or business. Subtract line 3 from line 2. If a gain, complete
lines 5 through 7
.............................
4
5
Gross income from activity that is not unrelated business income
..............
5
6
Expenses attributable to income entered on line 5
...................
6
7
Excess exempt expenses. Subtract line 5 from line 6, but do not enter more than the amount on line 4. Enter here and on Part II, line 12
..........................
7
Schedule A (Form 990-T) 2020
Schedule A (Form 990-T) 2020
Page
4
Part IX
Advertising Income
1
Name(s) of periodical(s). Check box if reporting two or more periodicals on a consolidated basis.
A
B
C
D
Enter amounts for each periodical listed above in the corresponding column.
A
B
C
D
2
Gross advertising income
......
a
Add columns A through D. Enter here and on Part I, line 11, column (A)
.............►
0
3
Direct Advertising costs by periodical
..
a
Add columns A through D. Enter here and on Part I, line 11, column (B)
.............►
0
4
Advertising gain (loss). Subtract line 3 from line 2. For any column in line 4 showing a gain, complete lines 5 through 8. For any column in line 4 showing a loss or zero, do not complete lines 5 through 7, and enter zero on line 8
............
5
Readership costs
........
6
Circulation income
........
7
Excess readership costs. If line 6 is less than line 5, subtract line 6 from line 5. If line 5 is less than line 6, enter zero
.....
8
Excess readership costs allowed as a deduction. For each column showing a gain on line 4, enter the lesser of line 4 or line 7
.
a
Add line 8, columns A through D. Enter the greater of the columns total or zero here and on Part II, line 13
..►
0
Part X
Compensation of Officers, Directors, and Trustees
(see instructions)
1.
Name
2.
Title
3.
Percentage
of time devoted
to business
4.
Compensation
attributable to
unrelated business
(1)
(2)
(3)
(4)
Total.
Enter here and on Part II, line 1
.........................►
0
Part XI
Supplemental Information
(see instructions)
Schedule A (Form 990-T) 2020
Additional Data
Software ID:
Software Version:
-
TIN:
SCHEDULE A
(Form 990-T)
Department of the Treasury
Internal Revenue Service
Unrelated Business Taxable Income
From an Unrelated Trade or Business
►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
20
Open to Public Inspection for 501(c)(3) Organizations Only
A
Name of the organization
IHC HEALTH SERVICES INC
B
Employer identification number
94-2854057
C
Unrelated business activity code (see instructions) ►
901101
D
Sequence:
1
of
12
E
Describe the unrelated trade or business ►
K-1 INVESTMENT FLOW-THROUGH
Part I
Unrelated Trade or Business Income
(A) Income
(B) Expenses
(C) Net
1a
Gross receipts or sales
1,022,390
b
Less returns and allowances
c
Balance ►
1c
1,022,390
2
Cost of goods sold (Part III, line 8)
.........
2
996,308
3
Gross profit. Subtract line 2 from line 1c
.......
3
1,022,390
1,022,390
4a
Capital gain net income (attach Sch D (Form 1041 or Form
1120)) (see instructions)
............
4a
b
Net gain (loss) (Form 4797) (attach Form 4797)
(see instructions)
4b
4,173,192
4,173,192
c
Capital loss deduction for trusts
4c
5
Income (loss) from a partnership or an S corporation (attach statement)
................
5
4,344,675
4,344,675
6
Rent income (Part IV)
.............
6
0
0
7
Unrelated debt-financed income (Part V)
.......
7
0
0
131,577
8
Interest, annuities, royalties, and rents from a controlled
organization (Part VI)
.............
8
0
0
9
Investment income of section 501(c)(7), (9), or (17)
organizations (Part VII)
............
9
0
0
10
Exploited exempt activity income (Part VIII)
......
10
11
Advertising income (Part IX)
...........
11
0
0
12
Other income (see instructions; attach statement)
....
12
13
Total.
Combine lines 3 through 12
.........
13
4,344,675
0
4,344,675
Part II
Deductions Not Taken Elsewhere
(See instructions for limitations on deductions) Deductions must be directly connected with the unrelated business income
1
Compensation of officers, directors, and trustees (Part X)
.................
1
0
2
Salaries and wages
............................
2
66,500
3
Repairs and maintenance
..........................
3
2,010
4
Bad debts
...............................
4
5
Interest (attach statement) (see instructions)
...................
5
159
6
Taxes and licenses
.............................
6
30,913
7
Depreciation (attach Form 4562) (see instructions)
.........
7
41,569
8
Less depreciation claimed in Part III and elsewhere on return
.....
8a
8b
41,569
9
Depletion
...............................
9
10
Contributions to deferred compensation plans
.....................
10
321,388
11
Employee benefit programs
..........................
11
19,950
12
Excess exempt expenses (Part VIII)
.......................
12
13
Excess readership costs (Part IX)
........................
13
0
14
Other deductions (attach statement)
......................
14
927,017
15
Total deductions.
Add lines 1 through 14
.....................
15
1,013,467
16
Unrelated business income before net operating loss deduction. Subtract line 15 from Part I, line 13, column (C)
16
3,331,208
17
Deduction for net operating loss (see instructions)
..................
17
0
18
Unrelated business taxable income.
Subtract line 17 from line 16
.............
18
3,331,208
For Paperwork Reduction Act Notice, see instructions.
Cat. No. 74036O
Schedule A (Form 990-T) 2020
Schedule A (Form 990-T) 2020
Page
2
Part III
Cost of Goods Sold
Enter method of inventory valuation ►
1
Inventory at beginning of year
........................
1
0
2
Purchases
...............................
2
0
3
Cost of labor
..............................
3
0
4
Additional section 263A costs (attach statement)
..................
4
0
5
Other costs (attach statement)
........................
5
996,308
6
Total.
Add lines 1 through 5
..........................
6
996,308
7
Inventory at end of year
...........................
7
0
8
Cost of goods sold.
Subtract line 7 from line 6. Enter here and in Part I, line 2
..........
8
996,308
9
Do the rules of section 263A (with respect to property produced or acquired for resale) apply to the organization?
Yes
No
Part IV
Rent Income (From Real Property and Personal Property Leased with Real Property)
1
Description of property (property street address, city, state, ZIP code). Check if a dual-use (see instructions)
A
B
C
D
A
B
C
D
2
Rent received or accrued
a
From personal property (if the percentage of rent for personal property is more than 10% but not more than 50%)
......
b
From real and personal property (if the percentage of rent for personal property exceeds 50% or if the rent is based on profit or income)
..........
c
Total rents received or accrued by property. Add lines 2a and 2b, columns A through D
.
3
Total rents received or accrued. Add line 2c columns A through D. Enter here and on Part I, line 6, column (A)
.►
0
4
Deductions directly connected with the income in lines 2(a) and 2(b) (attach statement)
.
5
Total deductions.
Add line 4 columns A through D. Enter here and on Part I, line 6, column (B)
.....►
0
Part V
Unrelated Debt-Financed Income
(see instructions)
1
Description of debt-financed property (street address, city, state, ZIP code). Check if a dual-use (see instructions)
A
B
C
D
A
B
C
D
2
Gross income from or allocable to debt-financed property
........
256,973
327,586
3
Deductions directly connected with or allocable to debt-financed property
a
Straight line depreciation (attach statement)
104,307
28,582
b
Other deductions (attach statement)
...
65,236
0
c
Total deductions (add lines 3a and 3b, columns A through D)
..........
169,543
28,582
4
Amount of average acquisition debt on or allocable to debt-financed property (attach statement)
...........
1,301,909
1,506,986
5
Average adjusted basis of or allocable to debt-financed property (attach statement)
...
3,914,523
4,396,507
6
Divide line 4 by line 5
.......
33.260 %
34.280 %
7
Gross income reportable. Multiply line 2 by line 6
85,469
112,296
8
Total gross income
(add line 7, columns A through D). Enter here and on Part I, line 7, column (A)
....►
0
9
Allocable deductions. Multiply line 3c by line 6
56,390
9,798
10
Total allocable deductions.
Add line 9, columns A through D. Enter here and on Part I, line 7, column (B)
..►
0
11
Total dividends-received deductions
included in line 10
.................►
0
Schedule A (Form 990-T) 2020
Schedule A (Form 990-T) 2020
Page
3
Part VI
Interest, Annuities, Royalties, and Rents from Controlled Organizations
(see instructions)
1.
Name of controlled organization
2.
Employer identification number
Exempt Controlled Organizations
3.
Net unrelated income (loss)
(see instructions)
4.
Total of specified payments made
5.
Part of column 4 that is included
in the controlling organization's
gross income
6.
Deductions directly connected with income in column 5
(1)
(2)
(3)
(4)
Nonexempt Controlled Organizations
7.
Taxable income
8.
Net unrelated
income (loss)
(see instructions)
9.
Total of specified payments made
10.
Part of column 9
that is included in the
controlling organization's
gross income
11.
Deductions directly connected with
income in column 10
(1)
(2)
(3)
(4)
Add columns 5 and 10.
Enter here and on Part I,
line 8, column (A)
Add columns 6 and 11.
Enter here and on Part I,
line 8, column (B)
Totals
.........................►
0
0
Part VII
Investment Income of a Section 501(c)(7), (9), or (17) Organization
(see instructions)
1.
Description of income
2.
Amount of income
3.
Deductions directly connected
(attach statement)
4.
Set-asides
(attach statement)
5. Total deductions and set-asides
(add columns 3 and 4)
(1)
(2)
(3)
(4)
Totals
.........►
Add amounts in column 2.
Enter here and on Part I,
line 9, column (A)
0
Add amounts in column 5.
Enter here and on Part I,
line 9, column (B)
0
Part VIII
Exploited Exempt Activity Income, Other Than Advertising Income
(see instructions)
1
Description of exploited activity:
2
Gross unrelated business income from trade or business. Enter here and on Part I, line 10, column (A)
...
2
3
Expenses directly connected with production of unrelated business income. Enter here and on Part I, line 10, column (B)
...............................
3
4
Net income (loss) from unrelated trade or business. Subtract line 3 from line 2. If a gain, complete
lines 5 through 7
.............................
4
5
Gross income from activity that is not unrelated business income
..............
5
6
Expenses attributable to income entered on line 5
...................
6
7
Excess exempt expenses. Subtract line 5 from line 6, but do not enter more than the amount on line 4. Enter here and on Part II, line 12
..........................
7
Schedule A (Form 990-T) 2020
Schedule A (Form 990-T) 2020
Page
4
Part IX
Advertising Income
1
Name(s) of periodical(s). Check box if reporting two or more periodicals on a consolidated basis.
A
B
C
D
Enter amounts for each periodical listed above in the corresponding column.
A
B
C
D
2
Gross advertising income
......
a
Add columns A through D. Enter here and on Part I, line 11, column (A)
.............►
0
3
Direct Advertising costs by periodical
..
a
Add columns A through D. Enter here and on Part I, line 11, column (B)
.............►
0
4
Advertising gain (loss). Subtract line 3 from line 2. For any column in line 4 showing a gain, complete lines 5 through 8. For any column in line 4 showing a loss or zero, do not complete lines 5 through 7, and enter zero on line 8
............
5
Readership costs
........
6
Circulation income
........
7
Excess readership costs. If line 6 is less than line 5, subtract line 6 from line 5. If line 5 is less than line 6, enter zero
.....
8
Excess readership costs allowed as a deduction. For each column showing a gain on line 4, enter the lesser of line 4 or line 7
.
a
Add line 8, columns A through D. Enter the greater of the columns total or zero here and on Part II, line 13
..►
0
Part X
Compensation of Officers, Directors, and Trustees
(see instructions)
1.
Name
2.
Title
3.
Percentage
of time devoted
to business
4.
Compensation
attributable to
unrelated business
(1)
(2)
(3)
(4)
Total.
Enter here and on Part II, line 1
.........................►
0
Part XI
Supplemental Information
(see instructions)
Schedule A (Form 990-T) 2020
Additional Data
Software ID:
Software Version:
-
TIN:
SCHEDULE A
(Form 990-T)
Department of the Treasury
Internal Revenue Service
Unrelated Business Taxable Income
From an Unrelated Trade or Business
►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
20
Open to Public Inspection for 501(c)(3) Organizations Only
A
Name of the organization
IHC HEALTH SERVICES INC
B
Employer identification number
94-2854057
C
Unrelated business activity code (see instructions) ►
901101
D
Sequence:
1
of
12
E
Describe the unrelated trade or business ►
K-1 INVESTMENT FLOW-THROUGH
Part I
Unrelated Trade or Business Income
(A) Income
(B) Expenses
(C) Net
1a
Gross receipts or sales
1,022,390
b
Less returns and allowances
c
Balance ►
1c
1,022,390
2
Cost of goods sold (Part III, line 8)
.........
2
996,308
3
Gross profit. Subtract line 2 from line 1c
.......
3
1,022,390
1,022,390
4a
Capital gain net income (attach Sch D (Form 1041 or Form
1120)) (see instructions)
............
4a
b
Net gain (loss) (Form 4797) (attach Form 4797)
(see instructions)
4b
4,173,192
4,173,192
c
Capital loss deduction for trusts
4c
5
Income (loss) from a partnership or an S corporation (attach statement)
................
5
4,344,675
4,344,675
6
Rent income (Part IV)
.............
6
0
0
7
Unrelated debt-financed income (Part V)
.......
7
0
0
131,577
8
Interest, annuities, royalties, and rents from a controlled
organization (Part VI)
.............
8
0
0
9
Investment income of section 501(c)(7), (9), or (17)
organizations (Part VII)
............
9
0
0
10
Exploited exempt activity income (Part VIII)
......
10
11
Advertising income (Part IX)
...........
11
0
0
12
Other income (see instructions; attach statement)
....
12
13
Total.
Combine lines 3 through 12
.........
13
4,344,675
0
4,344,675
Part II
Deductions Not Taken Elsewhere
(See instructions for limitations on deductions) Deductions must be directly connected with the unrelated business income
1
Compensation of officers, directors, and trustees (Part X)
.................
1
0
2
Salaries and wages
............................
2
66,500
3
Repairs and maintenance
..........................
3
2,010
4
Bad debts
...............................
4
5
Interest (attach statement) (see instructions)
...................
5
159
6
Taxes and licenses
.............................
6
30,913
7
Depreciation (attach Form 4562) (see instructions)
.........
7
41,569
8
Less depreciation claimed in Part III and elsewhere on return
.....
8a
8b
41,569
9
Depletion
...............................
9
10
Contributions to deferred compensation plans
.....................
10
321,388
11
Employee benefit programs
..........................
11
19,950
12
Excess exempt expenses (Part VIII)
.......................
12
13
Excess readership costs (Part IX)
........................
13
0
14
Other deductions (attach statement)
......................
14
927,017
15
Total deductions.
Add lines 1 through 14
.....................
15
1,013,467
16
Unrelated business income before net operating loss deduction. Subtract line 15 from Part I, line 13, column (C)
16
3,331,208
17
Deduction for net operating loss (see instructions)
..................
17
0
18
Unrelated business taxable income.
Subtract line 17 from line 16
.............
18
3,331,208
For Paperwork Reduction Act Notice, see instructions.
Cat. No. 74036O
Schedule A (Form 990-T) 2020
Schedule A (Form 990-T) 2020
Page
2
Part III
Cost of Goods Sold
Enter method of inventory valuation ►
1
Inventory at beginning of year
........................
1
0
2
Purchases
...............................
2
0
3
Cost of labor
..............................
3
0
4
Additional section 263A costs (attach statement)
..................
4
0
5
Other costs (attach statement)
........................
5
996,308
6
Total.
Add lines 1 through 5
..........................
6
996,308
7
Inventory at end of year
...........................
7
0
8
Cost of goods sold.
Subtract line 7 from line 6. Enter here and in Part I, line 2
..........
8
996,308
9
Do the rules of section 263A (with respect to property produced or acquired for resale) apply to the organization?
Yes
No
Part IV
Rent Income (From Real Property and Personal Property Leased with Real Property)
1
Description of property (property street address, city, state, ZIP code). Check if a dual-use (see instructions)
A
B
C
D
A
B
C
D
2
Rent received or accrued
a
From personal property (if the percentage of rent for personal property is more than 10% but not more than 50%)
......
b
From real and personal property (if the percentage of rent for personal property exceeds 50% or if the rent is based on profit or income)
..........
c
Total rents received or accrued by property. Add lines 2a and 2b, columns A through D
.
3
Total rents received or accrued. Add line 2c columns A through D. Enter here and on Part I, line 6, column (A)
.►
0
4
Deductions directly connected with the income in lines 2(a) and 2(b) (attach statement)
.
5
Total deductions.
Add line 4 columns A through D. Enter here and on Part I, line 6, column (B)
.....►
0
Part V
Unrelated Debt-Financed Income
(see instructions)
1
Description of debt-financed property (street address, city, state, ZIP code). Check if a dual-use (see instructions)
A
B
C
D
A
B
C
D
2
Gross income from or allocable to debt-financed property
........
256,973
327,586
3
Deductions directly connected with or allocable to debt-financed property
a
Straight line depreciation (attach statement)
104,307
28,582
b
Other deductions (attach statement)
...
65,236
0
c
Total deductions (add lines 3a and 3b, columns A through D)
..........
169,543
28,582
4
Amount of average acquisition debt on or allocable to debt-financed property (attach statement)
...........
1,301,909
1,506,986
5
Average adjusted basis of or allocable to debt-financed property (attach statement)
...
3,914,523
4,396,507
6
Divide line 4 by line 5
.......
33.260 %
34.280 %
7
Gross income reportable. Multiply line 2 by line 6
85,469
112,296
8
Total gross income
(add line 7, columns A through D). Enter here and on Part I, line 7, column (A)
....►
0
9
Allocable deductions. Multiply line 3c by line 6
56,390
9,798
10
Total allocable deductions.
Add line 9, columns A through D. Enter here and on Part I, line 7, column (B)
..►
0
11
Total dividends-received deductions
included in line 10
.................►
0
Schedule A (Form 990-T) 2020
Schedule A (Form 990-T) 2020
Page
3
Part VI
Interest, Annuities, Royalties, and Rents from Controlled Organizations
(see instructions)
1.
Name of controlled organization
2.
Employer identification number
Exempt Controlled Organizations
3.
Net unrelated income (loss)
(see instructions)
4.
Total of specified payments made
5.
Part of column 4 that is included
in the controlling organization's
gross income
6.
Deductions directly connected with income in column 5
(1)
(2)
(3)
(4)
Nonexempt Controlled Organizations
7.
Taxable income
8.
Net unrelated
income (loss)
(see instructions)
9.
Total of specified payments made
10.
Part of column 9
that is included in the
controlling organization's
gross income
11.
Deductions directly connected with
income in column 10
(1)
(2)
(3)
(4)
Add columns 5 and 10.
Enter here and on Part I,
line 8, column (A)
Add columns 6 and 11.
Enter here and on Part I,
line 8, column (B)
Totals
.........................►
0
0
Part VII
Investment Income of a Section 501(c)(7), (9), or (17) Organization
(see instructions)
1.
Description of income
2.
Amount of income
3.
Deductions directly connected
(attach statement)
4.
Set-asides
(attach statement)
5. Total deductions and set-asides
(add columns 3 and 4)
(1)
(2)
(3)
(4)
Totals
.........►
Add amounts in column 2.
Enter here and on Part I,
line 9, column (A)
0
Add amounts in column 5.
Enter here and on Part I,
line 9, column (B)
0
Part VIII
Exploited Exempt Activity Income, Other Than Advertising Income
(see instructions)
1
Description of exploited activity:
2
Gross unrelated business income from trade or business. Enter here and on Part I, line 10, column (A)
...
2
3
Expenses directly connected with production of unrelated business income. Enter here and on Part I, line 10, column (B)
...............................
3
4
Net income (loss) from unrelated trade or business. Subtract line 3 from line 2. If a gain, complete
lines 5 through 7
.............................
4
5
Gross income from activity that is not unrelated business income
..............
5
6
Expenses attributable to income entered on line 5
...................
6
7
Excess exempt expenses. Subtract line 5 from line 6, but do not enter more than the amount on line 4. Enter here and on Part II, line 12
..........................
7
Schedule A (Form 990-T) 2020
Schedule A (Form 990-T) 2020
Page
4
Part IX
Advertising Income
1
Name(s) of periodical(s). Check box if reporting two or more periodicals on a consolidated basis.
A
B
C
D
Enter amounts for each periodical listed above in the corresponding column.
A
B
C
D
2
Gross advertising income
......
a
Add columns A through D. Enter here and on Part I, line 11, column (A)
.............►
0
3
Direct Advertising costs by periodical
..
a
Add columns A through D. Enter here and on Part I, line 11, column (B)
.............►
0
4
Advertising gain (loss). Subtract line 3 from line 2. For any column in line 4 showing a gain, complete lines 5 through 8. For any column in line 4 showing a loss or zero, do not complete lines 5 through 7, and enter zero on line 8
............
5
Readership costs
........
6
Circulation income
........
7
Excess readership costs. If line 6 is less than line 5, subtract line 6 from line 5. If line 5 is less than line 6, enter zero
.....
8
Excess readership costs allowed as a deduction. For each column showing a gain on line 4, enter the lesser of line 4 or line 7
.
a
Add line 8, columns A through D. Enter the greater of the columns total or zero here and on Part II, line 13
..►
0
Part X
Compensation of Officers, Directors, and Trustees
(see instructions)
1.
Name
2.
Title
3.
Percentage
of time devoted
to business
4.
Compensation
attributable to
unrelated business
(1)
(2)
(3)
(4)
Total.
Enter here and on Part II, line 1
.........................►
0
Part XI
Supplemental Information
(see instructions)
Schedule A (Form 990-T) 2020
Additional Data
Software ID:
Software Version:
-
TIN:
SCHEDULE A
(Form 990-T)
Department of the Treasury
Internal Revenue Service
Unrelated Business Taxable Income
From an Unrelated Trade or Business
►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
20
Open to Public Inspection for 501(c)(3) Organizations Only
A
Name of the organization
IHC HEALTH SERVICES INC
B
Employer identification number
94-2854057
C
Unrelated business activity code (see instructions) ►
901101
D
Sequence:
1
of
12
E
Describe the unrelated trade or business ►
K-1 INVESTMENT FLOW-THROUGH
Part I
Unrelated Trade or Business Income
(A) Income
(B) Expenses
(C) Net
1a
Gross receipts or sales
1,022,390
b
Less returns and allowances
c
Balance ►
1c
1,022,390
2
Cost of goods sold (Part III, line 8)
.........
2
996,308
3
Gross profit. Subtract line 2 from line 1c
.......
3
1,022,390
1,022,390
4a
Capital gain net income (attach Sch D (Form 1041 or Form
1120)) (see instructions)
............
4a
b
Net gain (loss) (Form 4797) (attach Form 4797)
(see instructions)
4b
4,173,192
4,173,192
c
Capital loss deduction for trusts
4c
5
Income (loss) from a partnership or an S corporation (attach statement)
................
5
4,344,675
4,344,675
6
Rent income (Part IV)
.............
6
0
0
7
Unrelated debt-financed income (Part V)
.......
7
0
0
131,577
8
Interest, annuities, royalties, and rents from a controlled
organization (Part VI)
.............
8
0
0
9
Investment income of section 501(c)(7), (9), or (17)
organizations (Part VII)
............
9
0
0
10
Exploited exempt activity income (Part VIII)
......
10
11
Advertising income (Part IX)
...........
11
0
0
12
Other income (see instructions; attach statement)
....
12
13
Total.
Combine lines 3 through 12
.........
13
4,344,675
0
4,344,675
Part II
Deductions Not Taken Elsewhere
(See instructions for limitations on deductions) Deductions must be directly connected with the unrelated business income
1
Compensation of officers, directors, and trustees (Part X)
.................
1
0
2
Salaries and wages
............................
2
66,500
3
Repairs and maintenance
..........................
3
2,010
4
Bad debts
...............................
4
5
Interest (attach statement) (see instructions)
...................
5
159
6
Taxes and licenses
.............................
6
30,913
7
Depreciation (attach Form 4562) (see instructions)
.........
7
41,569
8
Less depreciation claimed in Part III and elsewhere on return
.....
8a
8b
41,569
9
Depletion
...............................
9
10
Contributions to deferred compensation plans
.....................
10
321,388
11
Employee benefit programs
..........................
11
19,950
12
Excess exempt expenses (Part VIII)
.......................
12
13
Excess readership costs (Part IX)
........................
13
0
14
Other deductions (attach statement)
......................
14
927,017
15
Total deductions.
Add lines 1 through 14
.....................
15
1,013,467
16
Unrelated business income before net operating loss deduction. Subtract line 15 from Part I, line 13, column (C)
16
3,331,208
17
Deduction for net operating loss (see instructions)
..................
17
0
18
Unrelated business taxable income.
Subtract line 17 from line 16
.............
18
3,331,208
For Paperwork Reduction Act Notice, see instructions.
Cat. No. 74036O
Schedule A (Form 990-T) 2020
Schedule A (Form 990-T) 2020
Page
2
Part III
Cost of Goods Sold
Enter method of inventory valuation ►
1
Inventory at beginning of year
........................
1
0
2
Purchases
...............................
2
0
3
Cost of labor
..............................
3
0
4
Additional section 263A costs (attach statement)
..................
4
0
5
Other costs (attach statement)
........................
5
996,308
6
Total.
Add lines 1 through 5
..........................
6
996,308
7
Inventory at end of year
...........................
7
0
8
Cost of goods sold.
Subtract line 7 from line 6. Enter here and in Part I, line 2
..........
8
996,308
9
Do the rules of section 263A (with respect to property produced or acquired for resale) apply to the organization?
Yes
No
Part IV
Rent Income (From Real Property and Personal Property Leased with Real Property)
1
Description of property (property street address, city, state, ZIP code). Check if a dual-use (see instructions)
A
B
C
D
A
B
C
D
2
Rent received or accrued
a
From personal property (if the percentage of rent for personal property is more than 10% but not more than 50%)
......
b
From real and personal property (if the percentage of rent for personal property exceeds 50% or if the rent is based on profit or income)
..........
c
Total rents received or accrued by property. Add lines 2a and 2b, columns A through D
.
3
Total rents received or accrued. Add line 2c columns A through D. Enter here and on Part I, line 6, column (A)
.►
0
4
Deductions directly connected with the income in lines 2(a) and 2(b) (attach statement)
.
5
Total deductions.
Add line 4 columns A through D. Enter here and on Part I, line 6, column (B)
.....►
0
Part V
Unrelated Debt-Financed Income
(see instructions)
1
Description of debt-financed property (street address, city, state, ZIP code). Check if a dual-use (see instructions)
A
B
C
D
A
B
C
D
2
Gross income from or allocable to debt-financed property
........
256,973
327,586
3
Deductions directly connected with or allocable to debt-financed property
a
Straight line depreciation (attach statement)
104,307
28,582
b
Other deductions (attach statement)
...
65,236
0
c
Total deductions (add lines 3a and 3b, columns A through D)
..........
169,543
28,582
4
Amount of average acquisition debt on or allocable to debt-financed property (attach statement)
...........
1,301,909
1,506,986
5
Average adjusted basis of or allocable to debt-financed property (attach statement)
...
3,914,523
4,396,507
6
Divide line 4 by line 5
.......
33.260 %
34.280 %
7
Gross income reportable. Multiply line 2 by line 6
85,469
112,296
8
Total gross income
(add line 7, columns A through D). Enter here and on Part I, line 7, column (A)
....►
0
9
Allocable deductions. Multiply line 3c by line 6
56,390
9,798
10
Total allocable deductions.
Add line 9, columns A through D. Enter here and on Part I, line 7, column (B)
..►
0
11
Total dividends-received deductions
included in line 10
.................►
0
Schedule A (Form 990-T) 2020
Schedule A (Form 990-T) 2020
Page
3
Part VI
Interest, Annuities, Royalties, and Rents from Controlled Organizations
(see instructions)
1.
Name of controlled organization
2.
Employer identification number
Exempt Controlled Organizations
3.
Net unrelated income (loss)
(see instructions)
4.
Total of specified payments made
5.
Part of column 4 that is included
in the controlling organization's
gross income
6.
Deductions directly connected with income in column 5
(1)
(2)
(3)
(4)
Nonexempt Controlled Organizations
7.
Taxable income
8.
Net unrelated
income (loss)
(see instructions)
9.
Total of specified payments made
10.
Part of column 9
that is included in the
controlling organization's
gross income
11.
Deductions directly connected with
income in column 10
(1)
(2)
(3)
(4)
Add columns 5 and 10.
Enter here and on Part I,
line 8, column (A)
Add columns 6 and 11.
Enter here and on Part I,
line 8, column (B)
Totals
.........................►
0
0
Part VII
Investment Income of a Section 501(c)(7), (9), or (17) Organization
(see instructions)
1.
Description of income
2.
Amount of income
3.
Deductions directly connected
(attach statement)
4.
Set-asides
(attach statement)
5. Total deductions and set-asides
(add columns 3 and 4)
(1)
(2)
(3)
(4)
Totals
.........►
Add amounts in column 2.
Enter here and on Part I,
line 9, column (A)
0
Add amounts in column 5.
Enter here and on Part I,
line 9, column (B)
0
Part VIII
Exploited Exempt Activity Income, Other Than Advertising Income
(see instructions)
1
Description of exploited activity:
2
Gross unrelated business income from trade or business. Enter here and on Part I, line 10, column (A)
...
2
3
Expenses directly connected with production of unrelated business income. Enter here and on Part I, line 10, column (B)
...............................
3
4
Net income (loss) from unrelated trade or business. Subtract line 3 from line 2. If a gain, complete
lines 5 through 7
.............................
4
5
Gross income from activity that is not unrelated business income
..............
5
6
Expenses attributable to income entered on line 5
...................
6
7
Excess exempt expenses. Subtract line 5 from line 6, but do not enter more than the amount on line 4. Enter here and on Part II, line 12
..........................
7
Schedule A (Form 990-T) 2020
Schedule A (Form 990-T) 2020
Page
4
Part IX
Advertising Income
1
Name(s) of periodical(s). Check box if reporting two or more periodicals on a consolidated basis.
A
B
C
D
Enter amounts for each periodical listed above in the corresponding column.
A
B
C
D
2
Gross advertising income
......
a
Add columns A through D. Enter here and on Part I, line 11, column (A)
.............►
0
3
Direct Advertising costs by periodical
..
a
Add columns A through D. Enter here and on Part I, line 11, column (B)
.............►
0
4
Advertising gain (loss). Subtract line 3 from line 2. For any column in line 4 showing a gain, complete lines 5 through 8. For any column in line 4 showing a loss or zero, do not complete lines 5 through 7, and enter zero on line 8
............
5
Readership costs
........
6
Circulation income
........
7
Excess readership costs. If line 6 is less than line 5, subtract line 6 from line 5. If line 5 is less than line 6, enter zero
.....
8
Excess readership costs allowed as a deduction. For each column showing a gain on line 4, enter the lesser of line 4 or line 7
.
a
Add line 8, columns A through D. Enter the greater of the columns total or zero here and on Part II, line 13
..►
0
Part X
Compensation of Officers, Directors, and Trustees
(see instructions)
1.
Name
2.
Title
3.
Percentage
of time devoted
to business
4.
Compensation
attributable to
unrelated business
(1)
(2)
(3)
(4)
Total.
Enter here and on Part II, line 1
.........................►
0
Part XI
Supplemental Information
(see instructions)
Schedule A (Form 990-T) 2020
Additional Data
Software ID:
Software Version:
-
TIN:
SCHEDULE A
(Form 990-T)
Department of the Treasury
Internal Revenue Service
Unrelated Business Taxable Income
From an Unrelated Trade or Business
►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
20
Open to Public Inspection for 501(c)(3) Organizations Only
A
Name of the organization
IHC HEALTH SERVICES INC
B
Employer identification number
94-2854057
C
Unrelated business activity code (see instructions) ►
901101
D
Sequence:
1
of
12
E
Describe the unrelated trade or business ►
K-1 INVESTMENT FLOW-THROUGH
Part I
Unrelated Trade or Business Income
(A) Income
(B) Expenses
(C) Net
1a
Gross receipts or sales
1,022,390
b
Less returns and allowances
c
Balance ►
1c
1,022,390
2
Cost of goods sold (Part III, line 8)
.........
2
996,308
3
Gross profit. Subtract line 2 from line 1c
.......
3
1,022,390
1,022,390
4a
Capital gain net income (attach Sch D (Form 1041 or Form
1120)) (see instructions)
............
4a
b
Net gain (loss) (Form 4797) (attach Form 4797)
(see instructions)
4b
4,173,192
4,173,192
c
Capital loss deduction for trusts
4c
5
Income (loss) from a partnership or an S corporation (attach statement)
................
5
4,344,675
4,344,675
6
Rent income (Part IV)
.............
6
0
0
7
Unrelated debt-financed income (Part V)
.......
7
0
0
131,577
8
Interest, annuities, royalties, and rents from a controlled
organization (Part VI)
.............
8
0
0
9
Investment income of section 501(c)(7), (9), or (17)
organizations (Part VII)
............
9
0
0
10
Exploited exempt activity income (Part VIII)
......
10
11
Advertising income (Part IX)
...........
11
0
0
12
Other income (see instructions; attach statement)
....
12
13
Total.
Combine lines 3 through 12
.........
13
4,344,675
0
4,344,675
Part II
Deductions Not Taken Elsewhere
(See instructions for limitations on deductions) Deductions must be directly connected with the unrelated business income
1
Compensation of officers, directors, and trustees (Part X)
.................
1
0
2
Salaries and wages
............................
2
66,500
3
Repairs and maintenance
..........................
3
2,010
4
Bad debts
...............................
4
5
Interest (attach statement) (see instructions)
...................
5
159
6
Taxes and licenses
.............................
6
30,913
7
Depreciation (attach Form 4562) (see instructions)
.........
7
41,569
8
Less depreciation claimed in Part III and elsewhere on return
.....
8a
8b
41,569
9
Depletion
...............................
9
10
Contributions to deferred compensation plans
.....................
10
321,388
11
Employee benefit programs
..........................
11
19,950
12
Excess exempt expenses (Part VIII)
.......................
12
13
Excess readership costs (Part IX)
........................
13
0
14
Other deductions (attach statement)
......................
14
927,017
15
Total deductions.
Add lines 1 through 14
.....................
15
1,013,467
16
Unrelated business income before net operating loss deduction. Subtract line 15 from Part I, line 13, column (C)
16
3,331,208
17
Deduction for net operating loss (see instructions)
..................
17
0
18
Unrelated business taxable income.
Subtract line 17 from line 16
.............
18
3,331,208
For Paperwork Reduction Act Notice, see instructions.
Cat. No. 74036O
Schedule A (Form 990-T) 2020
Schedule A (Form 990-T) 2020
Page
2
Part III
Cost of Goods Sold
Enter method of inventory valuation ►
1
Inventory at beginning of year
........................
1
0
2
Purchases
...............................
2
0
3
Cost of labor
..............................
3
0
4
Additional section 263A costs (attach statement)
..................
4
0
5
Other costs (attach statement)
........................
5
996,308
6
Total.
Add lines 1 through 5
..........................
6
996,308
7
Inventory at end of year
...........................
7
0
8
Cost of goods sold.
Subtract line 7 from line 6. Enter here and in Part I, line 2
..........
8
996,308
9
Do the rules of section 263A (with respect to property produced or acquired for resale) apply to the organization?
Yes
No
Part IV
Rent Income (From Real Property and Personal Property Leased with Real Property)
1
Description of property (property street address, city, state, ZIP code). Check if a dual-use (see instructions)
A
B
C
D
A
B
C
D
2
Rent received or accrued
a
From personal property (if the percentage of rent for personal property is more than 10% but not more than 50%)
......
b
From real and personal property (if the percentage of rent for personal property exceeds 50% or if the rent is based on profit or income)
..........
c
Total rents received or accrued by property. Add lines 2a and 2b, columns A through D
.
3
Total rents received or accrued. Add line 2c columns A through D. Enter here and on Part I, line 6, column (A)
.►
0
4
Deductions directly connected with the income in lines 2(a) and 2(b) (attach statement)
.
5
Total deductions.
Add line 4 columns A through D. Enter here and on Part I, line 6, column (B)
.....►
0
Part V
Unrelated Debt-Financed Income
(see instructions)
1
Description of debt-financed property (street address, city, state, ZIP code). Check if a dual-use (see instructions)
A
B
C
D
A
B
C
D
2
Gross income from or allocable to debt-financed property
........
256,973
327,586
3
Deductions directly connected with or allocable to debt-financed property
a
Straight line depreciation (attach statement)
104,307
28,582
b
Other deductions (attach statement)
...
65,236
0
c
Total deductions (add lines 3a and 3b, columns A through D)
..........
169,543
28,582
4
Amount of average acquisition debt on or allocable to debt-financed property (attach statement)
...........
1,301,909
1,506,986
5
Average adjusted basis of or allocable to debt-financed property (attach statement)
...
3,914,523
4,396,507
6
Divide line 4 by line 5
.......
33.260 %
34.280 %
7
Gross income reportable. Multiply line 2 by line 6
85,469
112,296
8
Total gross income
(add line 7, columns A through D). Enter here and on Part I, line 7, column (A)
....►
0
9
Allocable deductions. Multiply line 3c by line 6
56,390
9,798
10
Total allocable deductions.
Add line 9, columns A through D. Enter here and on Part I, line 7, column (B)
..►
0
11
Total dividends-received deductions
included in line 10
.................►
0
Schedule A (Form 990-T) 2020
Schedule A (Form 990-T) 2020
Page
3
Part VI
Interest, Annuities, Royalties, and Rents from Controlled Organizations
(see instructions)
1.
Name of controlled organization
2.
Employer identification number
Exempt Controlled Organizations
3.
Net unrelated income (loss)
(see instructions)
4.
Total of specified payments made
5.
Part of column 4 that is included
in the controlling organization's
gross income
6.
Deductions directly connected with income in column 5
(1)
(2)
(3)
(4)
Nonexempt Controlled Organizations
7.
Taxable income
8.
Net unrelated
income (loss)
(see instructions)
9.
Total of specified payments made
10.
Part of column 9
that is included in the
controlling organization's
gross income
11.
Deductions directly connected with
income in column 10
(1)
(2)
(3)
(4)
Add columns 5 and 10.
Enter here and on Part I,
line 8, column (A)
Add columns 6 and 11.
Enter here and on Part I,
line 8, column (B)
Totals
.........................►
0
0
Part VII
Investment Income of a Section 501(c)(7), (9), or (17) Organization
(see instructions)
1.
Description of income
2.
Amount of income
3.
Deductions directly connected
(attach statement)
4.
Set-asides
(attach statement)
5. Total deductions and set-asides
(add columns 3 and 4)
(1)
(2)
(3)
(4)
Totals
.........►
Add amounts in column 2.
Enter here and on Part I,
line 9, column (A)
0
Add amounts in column 5.
Enter here and on Part I,
line 9, column (B)
0
Part VIII
Exploited Exempt Activity Income, Other Than Advertising Income
(see instructions)
1
Description of exploited activity:
2
Gross unrelated business income from trade or business. Enter here and on Part I, line 10, column (A)
...
2
3
Expenses directly connected with production of unrelated business income. Enter here and on Part I, line 10, column (B)
...............................
3
4
Net income (loss) from unrelated trade or business. Subtract line 3 from line 2. If a gain, complete
lines 5 through 7
.............................
4
5
Gross income from activity that is not unrelated business income
..............
5
6
Expenses attributable to income entered on line 5
...................
6
7
Excess exempt expenses. Subtract line 5 from line 6, but do not enter more than the amount on line 4. Enter here and on Part II, line 12
..........................
7
Schedule A (Form 990-T) 2020
Schedule A (Form 990-T) 2020
Page
4
Part IX
Advertising Income
1
Name(s) of periodical(s). Check box if reporting two or more periodicals on a consolidated basis.
A
B
C
D
Enter amounts for each periodical listed above in the corresponding column.
A
B
C
D
2
Gross advertising income
......
a
Add columns A through D. Enter here and on Part I, line 11, column (A)
.............►
0
3
Direct Advertising costs by periodical
..
a
Add columns A through D. Enter here and on Part I, line 11, column (B)
.............►
0
4
Advertising gain (loss). Subtract line 3 from line 2. For any column in line 4 showing a gain, complete lines 5 through 8. For any column in line 4 showing a loss or zero, do not complete lines 5 through 7, and enter zero on line 8
............
5
Readership costs
........
6
Circulation income
........
7
Excess readership costs. If line 6 is less than line 5, subtract line 6 from line 5. If line 5 is less than line 6, enter zero
.....
8
Excess readership costs allowed as a deduction. For each column showing a gain on line 4, enter the lesser of line 4 or line 7
.
a
Add line 8, columns A through D. Enter the greater of the columns total or zero here and on Part II, line 13
..►
0
Part X
Compensation of Officers, Directors, and Trustees
(see instructions)
1.
Name
2.
Title
3.
Percentage
of time devoted
to business
4.
Compensation
attributable to
unrelated business
(1)
(2)
(3)
(4)
Total.
Enter here and on Part II, line 1
.........................►
0
Part XI
Supplemental Information
(see instructions)
Schedule A (Form 990-T) 2020
Additional Data
Software ID:
Software Version:
-
TIN:
SCHEDULE A
(Form 990-T)
Department of the Treasury
Internal Revenue Service
Unrelated Business Taxable Income
From an Unrelated Trade or Business
►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
20
Open to Public Inspection for 501(c)(3) Organizations Only
A
Name of the organization
IHC HEALTH SERVICES INC
B
Employer identification number
94-2854057
C
Unrelated business activity code (see instructions) ►
901101
D
Sequence:
1
of
12
E
Describe the unrelated trade or business ►
K-1 INVESTMENT FLOW-THROUGH
Part I
Unrelated Trade or Business Income
(A) Income
(B) Expenses
(C) Net
1a
Gross receipts or sales
1,022,390
b
Less returns and allowances
c
Balance ►
1c
1,022,390
2
Cost of goods sold (Part III, line 8)
.........
2
996,308
3
Gross profit. Subtract line 2 from line 1c
.......
3
1,022,390
1,022,390
4a
Capital gain net income (attach Sch D (Form 1041 or Form
1120)) (see instructions)
............
4a
b
Net gain (loss) (Form 4797) (attach Form 4797)
(see instructions)
4b
4,173,192
4,173,192
c
Capital loss deduction for trusts
4c
5
Income (loss) from a partnership or an S corporation (attach statement)
................
5
4,344,675
4,344,675
6
Rent income (Part IV)
.............
6
0
0
7
Unrelated debt-financed income (Part V)
.......
7
0
0
131,577
8
Interest, annuities, royalties, and rents from a controlled
organization (Part VI)
.............
8
0
0
9
Investment income of section 501(c)(7), (9), or (17)
organizations (Part VII)
............
9
0
0
10
Exploited exempt activity income (Part VIII)
......
10
11
Advertising income (Part IX)
...........
11
0
0
12
Other income (see instructions; attach statement)
....
12
13
Total.
Combine lines 3 through 12
.........
13
4,344,675
0
4,344,675
Part II
Deductions Not Taken Elsewhere
(See instructions for limitations on deductions) Deductions must be directly connected with the unrelated business income
1
Compensation of officers, directors, and trustees (Part X)
.................
1
0
2
Salaries and wages
............................
2
66,500
3
Repairs and maintenance
..........................
3
2,010
4
Bad debts
...............................
4
5
Interest (attach statement) (see instructions)
...................
5
159
6
Taxes and licenses
.............................
6
30,913
7
Depreciation (attach Form 4562) (see instructions)
.........
7
41,569
8
Less depreciation claimed in Part III and elsewhere on return
.....
8a
8b
41,569
9
Depletion
...............................
9
10
Contributions to deferred compensation plans
.....................
10
321,388
11
Employee benefit programs
..........................
11
19,950
12
Excess exempt expenses (Part VIII)
.......................
12
13
Excess readership costs (Part IX)
........................
13
0
14
Other deductions (attach statement)
......................
14
927,017
15
Total deductions.
Add lines 1 through 14
.....................
15
1,013,467
16
Unrelated business income before net operating loss deduction. Subtract line 15 from Part I, line 13, column (C)
16
3,331,208
17
Deduction for net operating loss (see instructions)
..................
17
0
18
Unrelated business taxable income.
Subtract line 17 from line 16
.............
18
3,331,208
For Paperwork Reduction Act Notice, see instructions.
Cat. No. 74036O
Schedule A (Form 990-T) 2020
Schedule A (Form 990-T) 2020
Page
2
Part III
Cost of Goods Sold
Enter method of inventory valuation ►
1
Inventory at beginning of year
........................
1
0
2
Purchases
...............................
2
0
3
Cost of labor
..............................
3
0
4
Additional section 263A costs (attach statement)
..................
4
0
5
Other costs (attach statement)
........................
5
996,308
6
Total.
Add lines 1 through 5
..........................
6
996,308
7
Inventory at end of year
...........................
7
0
8
Cost of goods sold.
Subtract line 7 from line 6. Enter here and in Part I, line 2
..........
8
996,308
9
Do the rules of section 263A (with respect to property produced or acquired for resale) apply to the organization?
Yes
No
Part IV
Rent Income (From Real Property and Personal Property Leased with Real Property)
1
Description of property (property street address, city, state, ZIP code). Check if a dual-use (see instructions)
A
B
C
D
A
B
C
D
2
Rent received or accrued
a
From personal property (if the percentage of rent for personal property is more than 10% but not more than 50%)
......
b
From real and personal property (if the percentage of rent for personal property exceeds 50% or if the rent is based on profit or income)
..........
c
Total rents received or accrued by property. Add lines 2a and 2b, columns A through D
.
3
Total rents received or accrued. Add line 2c columns A through D. Enter here and on Part I, line 6, column (A)
.►
0
4
Deductions directly connected with the income in lines 2(a) and 2(b) (attach statement)
.
5
Total deductions.
Add line 4 columns A through D. Enter here and on Part I, line 6, column (B)
.....►
0
Part V
Unrelated Debt-Financed Income
(see instructions)
1
Description of debt-financed property (street address, city, state, ZIP code). Check if a dual-use (see instructions)
A
B
C
D
A
B
C
D
2
Gross income from or allocable to debt-financed property
........
256,973
327,586
3
Deductions directly connected with or allocable to debt-financed property
a
Straight line depreciation (attach statement)
104,307
28,582
b
Other deductions (attach statement)
...
65,236
0
c
Total deductions (add lines 3a and 3b, columns A through D)
..........
169,543
28,582
4
Amount of average acquisition debt on or allocable to debt-financed property (attach statement)
...........
1,301,909
1,506,986
5
Average adjusted basis of or allocable to debt-financed property (attach statement)
...
3,914,523
4,396,507
6
Divide line 4 by line 5
.......
33.260 %
34.280 %
7
Gross income reportable. Multiply line 2 by line 6
85,469
112,296
8
Total gross income
(add line 7, columns A through D). Enter here and on Part I, line 7, column (A)
....►
0
9
Allocable deductions. Multiply line 3c by line 6
56,390
9,798
10
Total allocable deductions.
Add line 9, columns A through D. Enter here and on Part I, line 7, column (B)
..►
0
11
Total dividends-received deductions
included in line 10
.................►
0
Schedule A (Form 990-T) 2020
Schedule A (Form 990-T) 2020
Page
3
Part VI
Interest, Annuities, Royalties, and Rents from Controlled Organizations
(see instructions)
1.
Name of controlled organization
2.
Employer identification number
Exempt Controlled Organizations
3.
Net unrelated income (loss)
(see instructions)
4.
Total of specified payments made
5.
Part of column 4 that is included
in the controlling organization's
gross income
6.
Deductions directly connected with income in column 5
(1)
(2)
(3)
(4)
Nonexempt Controlled Organizations
7.
Taxable income
8.
Net unrelated
income (loss)
(see instructions)
9.
Total of specified payments made
10.
Part of column 9
that is included in the
controlling organization's
gross income
11.
Deductions directly connected with
income in column 10
(1)
(2)
(3)
(4)
Add columns 5 and 10.
Enter here and on Part I,
line 8, column (A)
Add columns 6 and 11.
Enter here and on Part I,
line 8, column (B)
Totals
.........................►
0
0
Part VII
Investment Income of a Section 501(c)(7), (9), or (17) Organization
(see instructions)
1.
Description of income
2.
Amount of income
3.
Deductions directly connected
(attach statement)
4.
Set-asides
(attach statement)
5. Total deductions and set-asides
(add columns 3 and 4)
(1)
(2)
(3)
(4)
Totals
.........►
Add amounts in column 2.
Enter here and on Part I,
line 9, column (A)
0
Add amounts in column 5.
Enter here and on Part I,
line 9, column (B)
0
Part VIII
Exploited Exempt Activity Income, Other Than Advertising Income
(see instructions)
1
Description of exploited activity:
2
Gross unrelated business income from trade or business. Enter here and on Part I, line 10, column (A)
...
2
3
Expenses directly connected with production of unrelated business income. Enter here and on Part I, line 10, column (B)
...............................
3
4
Net income (loss) from unrelated trade or business. Subtract line 3 from line 2. If a gain, complete
lines 5 through 7
.............................
4
5
Gross income from activity that is not unrelated business income
..............
5
6
Expenses attributable to income entered on line 5
...................
6
7
Excess exempt expenses. Subtract line 5 from line 6, but do not enter more than the amount on line 4. Enter here and on Part II, line 12
..........................
7
Schedule A (Form 990-T) 2020
Schedule A (Form 990-T) 2020
Page
4
Part IX
Advertising Income
1
Name(s) of periodical(s). Check box if reporting two or more periodicals on a consolidated basis.
A
B
C
D
Enter amounts for each periodical listed above in the corresponding column.
A
B
C
D
2
Gross advertising income
......
a
Add columns A through D. Enter here and on Part I, line 11, column (A)
.............►
0
3
Direct Advertising costs by periodical
..
a
Add columns A through D. Enter here and on Part I, line 11, column (B)
.............►
0
4
Advertising gain (loss). Subtract line 3 from line 2. For any column in line 4 showing a gain, complete lines 5 through 8. For any column in line 4 showing a loss or zero, do not complete lines 5 through 7, and enter zero on line 8
............
5
Readership costs
........
6
Circulation income
........
7
Excess readership costs. If line 6 is less than line 5, subtract line 6 from line 5. If line 5 is less than line 6, enter zero
.....
8
Excess readership costs allowed as a deduction. For each column showing a gain on line 4, enter the lesser of line 4 or line 7
.
a
Add line 8, columns A through D. Enter the greater of the columns total or zero here and on Part II, line 13
..►
0
Part X
Compensation of Officers, Directors, and Trustees
(see instructions)
1.
Name
2.
Title
3.
Percentage
of time devoted
to business
4.
Compensation
attributable to
unrelated business
(1)
(2)
(3)
(4)
Total.
Enter here and on Part II, line 1
.........................►
0
Part XI
Supplemental Information
(see instructions)
Schedule A (Form 990-T) 2020
Additional Data
Software ID:
Software Version: