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Form 990 (2016) SANTA CLARITA VALLEY HISTORICAL SOCIETY 95-3003205 Page 5
Part V Statements Regarding Other IRS Filings and Tax Compliance
Check if Schedule O contains a response or note to any line in this Part V . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
Yes No
1 a Enter the number reported in Box 3 of Form 1096. Enter -0- if not applicable . . . . . . . . . . . . . . 1 a 0
b Enter the number of Forms W-2G included in line 1a. Enter -0- if not applicable. . . . . . . . . . . . 1 b 0
c Did the organization comply with backup withholding rules for reportable payments to vendors and reportable gaming
(gambling) winnings to prize winners?. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1 c
2 a Enter the number of employees reported on Form W-3, Transmittal of Wage and Tax State-
ments, filed for the calendar year ending with or within the year covered by this return . . . . . 2 a 0
b If at least one is reported on line 2a, did the organization file all required federal employment tax returns? . . . . . . . . . . . . . 2 b
Note. If the sum of lines 1a and 2a is greater than 250, you may be required to e-file (see instructions)
3 a Did the organization have unrelated business gross income of $1,000 or more during the year?. . . . . . . . . . . . . . . . . . . . . . . . 3 a X
b If 'Yes,' has it filed a Form 990-T for this year? If 'No' to line 3b, provide an explanation in Schedule O. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 3 b
4 a At any time during the calendar year, did the organization have an interest in, or a signature or other authority over, a
financial account in a foreign country (such as a bank account, securities account, or other financial account)? . . . . . . . . . 4 a X
b If 'Yes,' enter the name of the foreign country: G
See instructions for filing requirements for FinCEN Form 114, Report of Foreign Bank and Financial Accounts (FBAR).
5 a Was the organization a party to a prohibited tax shelter transaction at any time during the tax year? . . . . . . . . . . . . . . . . . . . 5 a X
b Did any taxable party notify the organization that it was or is a party to a prohibited tax shelter transaction?. . . . . . . . . . . . 5 b X
c If 'Yes,' to line 5a or 5b, did the organization file Form 8886-T?. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 5 c
6 a Does the organization have annual gross receipts that are normally greater than $100,000, and did the organization
solicit any contributions that were not tax deductible as charitable contributions?. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 6 a X
b If 'Yes,' did the organization include with every solicitation an express statement that such contributions or gifts were
not tax deductible?. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 6 b
7 Organizations that may receive deductible contributions under section 170(c).
a Did the organization receive a payment in excess of $75 made partly as a contribution and partly for goods and
services provided to the payor?. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 7 a X
b If 'Yes,' did the organization notify the donor of the value of the goods or services provided? . . . . . . . . . . . . . . . . . . . . . . . . . . 7 b
c Did the organization sell, exchange, or otherwise dispose of tangible personal property for which it was required to file
Form 8282? . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 7 c X
d If 'Yes,' indicate the number of Forms 8282 filed during the year. . . . . . . . . . . . . . . . . . . . . . . . . . 7 d
e Did the organization receive any funds, directly or indirectly, to pay premiums on a personal benefit contract?. . . . . . . . . . 7 e X
f Did the organization, during the year, pay premiums, directly or indirectly, on a personal benefit contract?. . . . . . . . . . . . . . 7 f X
g If the organization received a contribution of qualified intellectual property, did the organization file Form 8899
as required?. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 7 g
h If the organization received a contribution of cars, boats, airplanes, or other vehicles, did the organization file a
Form 1098-C? . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 7 h
8 Sponsoring organizations maintaining donor advised funds. Did a donor advised fund maintained by the sponsoring
organization have excess business holdings at any time during the year?. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 8
9 Sponsoring organizations maintaining donor advised funds.
a Did the sponsoring organization make any taxable distributions under section 4966? . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 9 a
b Did the sponsoring organization make a distribution to a donor, donor advisor, or related person?. . . . . . . . . . . . . . . . . . . . . . 9 b
10 Section 501(c)(7) organizations. Enter:
a Initiation fees and capital contributions included on Part VIII, line 12 . . . . . . . . . . . . . . . . . . . . . . 10a
b Gross receipts, included on Form 990, Part VIII, line 12, for public use of club facilities. . . . . 10b
11 Section 501(c)(12) organizations. Enter:
a Gross income from members or shareholders. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 11a
b Gross income from other sources (Do not net amounts due or paid to other sources
against amounts due or received from them.). . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 11b
12a Section 4947(a)(1) non-exempt charitable trusts. Is the organization filing Form 990 in lieu of Form 1041?. . . . . . . . . . . . . . 12a
b If 'Yes,' enter the amount of tax-exempt interest received or accrued during the year. . . . . . . 12b
13 Section 501(c)(29) qualified nonprofit health insurance issuers.
a Is the organization licensed to issue qualified health plans in more than one state? . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 13a
Note. See the instructions for additional information the organization must report on Schedule O.
b Enter the amount of reserves the organization is required to maintain by the states in
which the organization is licensed to issue qualified health plans. . . . . . . . . . . . . . . . . . . . . . . . . . 13b
c Enter the amount of reserves on hand. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 13c
14a Did the organization receive any payments for indoor tanning services during the tax year?. . . . . . . . . . . . . . . . . . . . . . . . . . . . 14a X
b If 'Yes,' has it filed a Form 720 to report these payments? If 'No,' provide an explanation in Schedule O. . . . . . . . . . . . . . . . 14b
BAA TEEA0105L 11/16/16 Form 990 (2016)