Form 990 (2009)
Page 5
TEEA0105 02/12/10
Part V
Statements Regarding Other IRS Filings and Tax Compliance
1 a Enter the number reported in Box 3 of form 1096, Annual Summary and Transmittal of U.S.
Information Returns. Enter -0- if not applicable
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1 a
b Enter the number of Forms W-2G included in line 1a. Enter -0- if not applicable
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1 b
c Did the organization comply with backup withholding rules for reportable payments to vendors and reportable gaming
(gambling) winnings to prize winners?
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1 c
2 a
Enter the number of employees reported on Form W-3, Transmittal of Wage and Tax Statements, filed for the
calendar year ending with or within the year covered by this return
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2 a
2 b If at least one is reported on line 2a, did the organization file all required federal employment tax returns?
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2 b
Note. If the sum of lines 1a and 2a is greater than 250, you may be required to e-file this return. (see instructions)
3 a Did the organization have unrelated business gross income of $1,000 or more during the year covered by
this return?
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3 a
b If 'Yes' has it filed a Form 990-T for this year? If 'No,' provide an explanation in Schedule O
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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)?
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4 a
b If 'Yes,' enter the name of the foreign country: G
See the instructions for exceptions and filing requirements for Form TD F 90-22.1, Report of Foreign Bank and
Financial Accounts.
5 a Was the organization a party to a prohibited tax shelter transaction at any time during the tax year?
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5 a
b Did any taxable party notify the organization that it was or is a party to a prohibited tax shelter transaction?
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5 b
c If 'Yes,' to line 5a or 5b, did the organization file Form 8886-T, Disclosure by Tax-Exempt Entity Regarding Prohibited
Tax Shelter Transaction?
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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?
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6 a
b If 'Yes,' did the organization include with every solicitation an express statement that such contributions or gifts were not
deductible?
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6 b
Yes
No
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?
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7 a
b If 'Yes,' did the organization notify the donor of the value of the goods or services provided?
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7 b
c Did the organization sell, exchange, or otherwise dispose of tangible personal property for which it was required to file
Form 8282?
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7 c
BAA
Form 990 (2009)
d If 'Yes,' indicate the number of Forms 8282 filed during the year
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7 d
e Did the organization, during the year, receive any funds, directly or indirectly, to pay premiums on a personal
benefit contract?
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7 e
f Did the organization, during the year, pay premiums, directly or indirectly, on a personal benefit contract?
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7 f
g For all contributions of qualified intellectual property, did the organization file Form 8899 as required?
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7 g
h For contributions of cars, boats, airplanes, and other vehicles, did the organization file a Form 1098-C as required?
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7 h
8
Sponsoring organizations maintaining donor advised funds and section 509(a)(3) supporting organizations. Did the
supporting organization, or a donor advised fund maintained by a sponsoring organization, have excess business
holdings at any time during the year?
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8
9
Sponsoring organizations maintaining donor advised funds.
a Did the organization make any taxable distributions under section 4966?
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9 a
b Did the organization make any distribution to a donor, donor advisor, or related person?
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9 b
10
Section 501(c)(7) organizations. Enter:
a Initiation fees and capital contributions included on Part VIII, line 12
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10 a
b Gross Receipts, included on Form 990, Part VIII, line 12, for public use of club facilities
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10 b
11
Section 501(c)(12) organizations. Enter:
a Gross income from other members or shareholders
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11 a
b Gross income from other sources (Do not net amounts due or paid to other sources against
amounts due or received from them.)
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11 b
12 a Section 4947(a)(1) non
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exempt charitable trusts. Is the organization filing Form 990 in lieu of Form 1041?
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12 a
b If 'Yes,' enter the amount of tax-exempt interest received or accrued during the year
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12 b
MEDICAL TOURISM ASSOCIATION, INC
26-0753785
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