Professional Documents
Culture Documents
OMB No 15450047
For i 990 Return of Organization Exempt from Income Tax
Under section 501(c), 527, or 4947(axl) of the Internal Revenue Code
2003
(except black lung benefit trust or private foundation) Open to Public
Department of the Treasury
Internal Revenue Service l a- The ration may have to use a copy of this return to satisfy state reporting requirements Inspection
A For the 2003 calendar or tax year beginning 2003, and ending ,
7 Employer Identification Number
B Check if applicable
Please use
Address change IRS label 34-0898576
or pool
Name change or type . 82758 ******AQTO**5-DIGIT 94708 . Telephone number
See NATIONAL FOOTBALL MUSEUMS INC
Initial return specific I 330-456-82 07
instruc- PRO FOOTBALL BALL OF FAME P 164 R
Final rehun Uons. 2121 GEORGE [iALAS DR NW B 15 S - Accounbnp Cash X Accrual
method :
CANTON OH 44708-2699
Amended return n Other (specify) "
uApplication pending " Section 501(cx3) organizations and 4947(aX1) nonexempt H and I are not applicable to section 527 organizations
charitable trusts must attach a completed Schedule A H (d) Is this a group return for affiliates a Yes No
(Form 990 or 990-EZ). N
H (b) If 'Yes,' enter number of affiliates
G Web site: " www . profootballhof . com
H (C) Are all affiliates included ayes a No
J Organization type (IF'No ; attach a list See instructions)
(ChBfk only one ~ X 501(c) 3 4 (insert no ) 4947(a)(1) or 527
H (d) Is this a separate return filed by an
K Check here O' if the organization's gross receipts are normally not more than
organization covered by a group rulings
F] Yes n No
$25,000 . The organization need not file a return with the IRS, but if the organization
received a Form 990 Package in the mad, it should file a return without financial data . I Group Ex . Number
Some states require a complete return . M Check it the organization is not required
L Gross receipts : Add lines 6b, Sb, 9b, and lOb to line 12 11, 7, 126, 994 . to attach SO e B (Form 990, 990-EZ or 990-PF) .
Revenue, Ex penses, and Chan ges in Net Assets or Fund Balances
1 Contributions, gifts, grants, and similar amounts received :
a Direct public support 1a 687,695 .- .
b Indirect public support 1b
c Government contributions (grants) 1c
d Total~p~9~lj~~(~a~ $ 417, 025 . noncas, $ 270, 670 : 3 ld 687, 695 .
klu
2 Program service revenue including government fees and contracts (from Part VII, line 93) 2 1,327,269 .-
3 Membership dues and assessments 3
4 Interest on savings and temporary cash investments 4 8,570 .-
5 Dividends and interest from securities 5 11,401 .
6a Gross rents 6a 5,400 .
b Less rental expenses 6b 3,574 .
c Net rental income or (loss) (subtract line 6b from line 6a) 6c 1,826 .
j~ R 7 Other investment income _. . ~ 7
(A) Securities (B) Other
8a Gross moun s t th
than i entor' ~U~ ~ 8a
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(Grants and allocations $ ) 3,433,123 .
b
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(Grants and allocations $ )
c
------------------------------------------------------
------------------------------------------------------
(Grants and allocations $ )
d
------------------------------------------------------
------------------------------------------------------
(Grants and allocations $ )
e Other program ser vices (Grants and allocat ions $
f Total of Service I line 44, column (B), Program 0.1 3,433,123 .
BAA TEEA0102L 10/03/03 Form 990 (2003)
Form 990 (2003)' NATIONAL FOOTBALL MUSEUM INC 34-0898576 Page 3
Note : Where required, attached schedules and amounts within the description (A) (B)
column should be for end-of-year amounts only Beginning of year End of year
BAA
.3L
TEEA010 10/01/03
Form 99p (2003) NATIONAL FOOTBALL MUSEUM INC 34-0898576 Pa g e 4
a Total revenue, gams, and other support a Total expenses and losses per audited
per audited financial statements 10 a1 4,116,015 . financial statements ~ a 4, 149, 465 .
Add amounts on lines (1) through (4) b 147,987 . Add amounts on lines (1) through (4) ~ b 147,987 .
c Line a minus line b c 3,968,028 . c Line a minus line b ~ c 4,001,478 .
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Add amounts on lines (1) and (2) 01 d Add amounts on lines (1) and (2) ~ d
e Total revenue per line 12, Form e Total expenses per line 17, Form
990 (line c plus line d) 1 1. e 3, 968, 028 . 990 (line c plus ~ne d) Do- e 4, 001, 478 .
Rapt V List of Officers, Director Trustees, and Key Em plo yees (List each one even if not compensated; see instructions .)
(B) Title and average hours (C) Compensation (D) Contributions to (E) Expense
per week devoted (if not paid, employee benefit account and other
(A) Name and address to position enter -0-) plans and deferred allowances
compensation
SEE ATTACHED SCHEDULE 0. 0. 0.
None
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75 Did any officer, director, trustee, or key employee receive aggregate compensation of more
than $100,000 from your organization and all related organizations, of which more than
$10,000 was provided by the related organizations? . . . . . ~ Yes XaNo
If 'Yes,' attach schedule - see instructions .
BAA Form 990 (2003)
TEEA0104L 10102/03
Form 99q (2003) NATIONAL FOOTBALL MUSEUM INC 34-0898576
Other Information . Yes No
76 Did the organization engage in any activity not previously reported to the IRS? If 'Yes,'
attach a detailed description of each activity 76 X
77 Were any changes made in the organizing or governing documents but not reported to the IRS? 77 X
If 'Yes,' attach a conformed copy of the changes
78a Did the organization have unrelated business gross income of $1,000 or more during the year covered by this return? 78a X
b If 'Yes,' has it filed a tax return on Form 990-T for this year? .. .. 78b N A
80a Is the organization related (other than by association with a statewide or nationwide organization) through common
membership, governing bodies, trustees, officers, etc, to any other exempt or nonexempt organization? 80a X
b If 'Yes,' enter the name of the organization " PFHOF ENSHRINEES ASSISTANCE FOUNDATION
- and check whether it is X exempt or nonexempt.
81 a Enter direct and indirect political expenditures . See line 81 instructions . . I 81 a I 0.
b Did the organization file Form 1120-POL for this year? 81b X
82 a Did the or ganization receive donated services or the use of materials, equipment, or facilities at no charge or at
substantially less than fair rental value? ... 82a ~ X
b If 'Yes,' you may indicate the value of these items here . Do not include this amount as
revenue m Part I or as an expense m Part II . (See instructions m Part III .) 1 82 N
83a Did the organization comply with the public inspection requirements for returns and exemption applications? 83a X
b Did the organization comply with the disclosure requirements relating to quid pro quo contributions 83b X
84a Did the organization solicit any contributions or gifts that were not tax deductible? 84a X
b If 'Yes,' did the organization include with every solicitation an express statement that such contributions or gifts were
not tax deductible . 8ab N A
85 501(c)(4), (5), or (6) organizations a Were substantially all dues nondeductible by members? 85a ~N A
b Did the organization make only in-house lobbying expenditures of $2,000 or less? 85b1 N.YA
If 'Yes' was answered to either 85a or 85b, do not complete 85c through 85h below unless the organization received a
waiver for proxy tax owed for the prior year .
c Dues, assessments, and similar amounts from members 85c N/A
d Section 162(e) lobbying and political expenditures 85d N/A
e Aggregate nondeductible amount of section 6033(e)(1)(A) dues notices . 85e N/A
f Taxable amount of lobbying and political expenditures (line 85d less 85e) I 85f ~ N/A
g Does the organization elect to pay the section 6033(e) tax on the amount on line 85f? 859 NIA
h If section 6033(e)(1)(A) dues notices were sent, does the organization agree to add the amount on line 85f to its reasonable estimate of
dues allocable to nondeductible lobbying and political expenditures for the following tax year? 85h N 1'A
86 501(c)(7) organizations Enter : a Initiation fees and capital contributions included on
line 12 . . . 86a N/A
b Gross receipts, included on line 12, for public use of club facilities . .. 86b N/A
87 501(c)(12) organizations Enter : a Gross income from members or shareholders 87a N/A
b Gross income from other sources . (Do not net amounts due or paid to other sources
against amounts due or received from them ) . .. 87b N/A
88 At any time during the year, did the organization own a 50% or greater interest in a taxable corporation or partnership,
or an entity disregarded as separate from the organization under Regulations sections 301 7701-2 and 301 7701 .3?
If 'Yes,' complete Part IX . . .. ss I I X
89a 501(c)(3) organizations . Enter : Amount of tax imposed on the organization during the year under .
section 4911 . 0. ; section 4912 . 0 . ; section 4955 ~ 0.
b 501(c)(3) and 501(c)(4) organizations Did the organization engage m any section 4958 excess benefit transaction
during the year or did it become aware of an excess benefit transaction from a prior year? If 'Yes,' attach a statement
explaining each transaction .. . .. ...... . , I 89b 1 X
c Enter : Amount of tax im posed on the or g anization managers or disqualified persons during the
year under sections 4912, 4455, and 49.58 . . . . . .. . 11~ Q.
d Enter : Amount of tax on line 89c, above, reimbursed by the organization . . 0- 0.
90a List the states with which a copy of this return is filed " OHIO
b Number of employees employed in the pay period that includes March 12, 2003 (See instructions .) . . 90b 50
91 The books are in care of - JOHN BANKERT Telephone number ~ 330-456-8207
Located at - 2121 GEORGE HALAS DR NW, CANTON, OH ZIP +4 - 44708-2630
92 Section 4947(a)(1) nonexempt charitable trusts filing Form 990 In lieu of Form 1041- Check here N/A
and enter the amount of tax-exempt interest received or accrued during the tax year ~I 92 ,I N/A
BAA Form 990 (2003)
TEEA0105L 12/23/03
Form 99 2003 ~ NATIONAL FOOTBALL MUSEUM INC 34-0898576 Page 6
Part VII Analysis of Income-Producin g Activities (See instructions
Unrelated business income Excluded b section 512, 513, or 514
Note : Enter gross amounts unless (q) (g) (C) (D) Relatednonexempt
otherwise Indicated Business code Amount Exclusion code Amount function income
93 Program service revenue :
a FEES COLLECTED ADMIS 1 , 327 , 269 .
b
c
d
e
f Medicare/Medicaid payments
g Fees & contracts from government agencies
94 Membership dues and assessments
95 Interest on savings & temporary cash invmnts 14 8,570 .
96 Dividends & interest from securities 14 11,401 .
97 Net rental income or (loss) from real estate
a debt-financed property
b not debt-financed property . 16 1,826 .
98 Net rental income or (loss) from pers prop
99 Other investment income
100 Gain or (loss) from sales of assets
other than inventory
101 Net income or (loss) from special events 1 162,388 . 700,000 .
102 Gross profit or (loss) from sales of inventory 934 ,705 .
103 Other revenue a
b PHOTOGRAPHY INCOME 15,477 .
c ROYALTIES 15 66,470 .
d VENDING MACH COMM, ET 3 52,227 .
e
104 Subtotal (add columns (B), (D), and (E)) 302,882 . 2, 977, 451 .
105 Total (add line 104, columns (B), (D), and (E)) 1 1. 3,280,333 .
Note : Line 105 plus line Id, Part 1, should equal the amount on line 12, Part 1
Part V1l1 Relationshi p of Activities to the Accom plishment of Exem pt Pur poses (See instructions)
Line No . Explain how each activity for which income is reported in column (E) of Part VII contributed importantly to the accomplishment
of the organization's exempt purposes (other than by providing funds for such purposes) .
See Statement 10
Part X I Information Regarding Transfers Associated i Personal Benefit Contracts see instructions
a Did the organization, during the year, receive any funds, directly or indirectly, to pay
b Did the organization, during the year, pay premiums, directly or in
Note : If 'Yes' to b, file Form 8870 and Form 4720 (see instruction
Under penalties of penury, I declar that I have examined this return, mcludinc,
true, correct, and complete Declj'' io~ of pre~arerc~ er than office) is base
_TbN W, ~R
Si
Here
or print name
Paid Prepares
signature 00- (
~
Pre-
parer's Firm~s name (or Mestel, Long & Schrade,' Inc .
yours if self-
Use em p loyed) ~ 116 Cleveland Ave . N .W ., #52
Only address and
, Canton, OH 44702
aa,a
Organization Exempt Under
OMB No 1545-0047
34-0898576
~J Compensation of the Five Highest Paid Employees Other Than Officers, Directors, and Trustees
(See instructions . List each one . If there are none, enter 'None.')
(a) Name and address of each (b) Title and average (c) Compensation (d) Contributions (e) Expense
employee paid more hours per week I I to employee benefit I account and other
than $50,000 devoted to position plans and deferred allowances
compensation
None
(a) Name and address of each independent contractor paid more than $50,000 (b) Type of service (c) Compensation
TEEA0401L 08f28/03
Schedulq A (Form 990 or 990-EZ 2003 NATIONAL FOOTBALL MUSEUM INC 34-0898576 Page
1 During the year, has the organization attempted to influence national, state, or local legislation, including any attempt
to influence public opinion on a legislative matter or referendums If 'Yes,' enter the total expenses paid
. $ N/A
or incurred in connection with the lobbying activities
(Must equa) amounts on line 38, Part VI-A, or line i of Part VI-B .) . . 1 X
Organizations that made an election under section 501(h) by filing Form 5768 must complete Part VI-A Other
organizations checking 'Yes,' must complete Part VI-B AND attach a statement giving a detailed description of the
lobbying activities.
2 During the year, has the organization, either directly or indirectly, engaged in any of the following acts with any
substantial contributors, trustees, directors, officers, creators, key employees, or members of their families, or with any
taxable organization with which any such person is affiliated as an officer, director, trustee, majority owner, or principal
beneficiary? (If the answer to any question is 'Yes, ' attach a detailed statement explaining the transactions )
See Statement 11
a Sale, exchange, or leasing of property? 2a X
3a Do you make grants for scholarships, fellowships, student loans, etc? (If 'Yes,' attach an
explanation of how you determine that recipients qualify to receive payments .) 3a X
b Do you have a section 403(b) annuity plan for your employees? . 3b X
4 Did you maintain any separate account for participating donors where donors have the right to provide advice
on the use or distribution of funds?
The organization is not a private foundation because it is : (Please check only ONE applicable box )
5 A church, convention of churches, or association of churches . Section 170(b)(1)(A)(i) .
6 A school . Section 170(b)(1)(A)(u) . (Also complete Part V )
7 A hospital or a cooperative hospital service organization . Section 170(b)(1)(A)(iiQ .
8 A Federal, state, or local government or governmental unit . Section 170(b)(1)(A)(v)
9 ~ A medical research organization operated in conjunction with a hospital . Section 170(b)(1)(A)(w) . Enter the hospital's name, city,
and state
10 ~ An organization operated for the benefit of a college or university owned or operated by a governmental unit . Section 170(b)(1)(A)(iv) .
(Also complete the Support Schedule m Part IV-A )
11 a Xa An organization that normally receives a substantial part of its support from a governmental unit or from the general public
Section 170(b)(1)(A)(vi) . (Also complete the Support Schedule in Part IV-A .)
11 b n A community trust . Section 170(b)(1)(A)(w) . (Also complete the Support Schedule in Part IV-A .)
12 F] An organization that normally receives : (1) more than 33-113% of its support from contributions, membership fees, and gross receipts
from activities related to its charitable, etc, functions - subject to certain exceptions, and (2) no more than 33-113% of its support
from gross investment income and unrelated business taxable income (less section 511 tax) from businesses acquired by the
organization after June 30, 1975 . See section 509(a)(2) (Also complete the Support Schedule m Part IV-A .)
13 [-1 An organization that is not controlled by any disqualified persons (other than foundation managers) and supports organizations
described m (1) lines 5 through 12 above ; or (2) section 501(c)(4), (5), or (6), if they meet the test of section 509(a)(2) . (See
section 509(a)(3) .)
Provide the following information about the supported organizations . (See instructions
14 n An organization organized and operated to test for public safety . Section 509(a)(4) . (See instructions .)
29 Does the organization have a racially nondiscriminatory policy toward students by statement in its charter, bylaws,
other governing instrument, or in a resolution of its governing body? 29
30 Does the organization include a statement of its racially nondiscriminatory policy toward students in all its brochures,
catalogues, and other written communications with the public dealing with student admissions, programs,
and scholarships? 30
31 Has the organization publicized its racially nondiscriminatory policy through newspaper or broadcast media during
the period of solicitation for students, or during the registration period if it has no solicitation program, in a way that
makes the policy known to all parts of the general community it serves? . . 31
If 'Yes,' please describe ; if 'No,' please explain . (If you need more space, attach a separate statement.)
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32 Does the organization maintain the following :
a Records indicating the racial composition of the student body, faculty, and administrative staff 32a
b Records documenting that scholarships and other financial assistance are awarded on a racially
nondiscriminatory basis 32
c Copies of all catalogues, brochures, announcements, and other written communications to the public dealing
with student admissions, programs, and scholarships? . . . .. 32c
d Copies of all material used by the organization or on its behalf to solicit contributions?
If you answered 'No' to any of the above, please explain . (If you need more space, attach a separate statement .)
If you answered 'Yes' to any of the above, please explain . (If you need more space, attach a separate statement .)
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34a Does the organization receive any financial aid or assistance from a governmental agency? 34a
b Has the organization's right to such aid ever been revoked or suspended? 34b
If you answered 'Yes' to either 34a or b, please explain using an attached statement .
35 Does the organization certify that it has ed with the applicable requirements of
sections 4.01 through 4 .05 of Rev Proc 1975-2 C .B . 587, covering racial
nondiscrimination? If 'No,' attach an ex ~ in 35
BAA TEEA0404L 08/28/03 e A (Form 990 or 9
Schedule,A Form 990 or 990-E 2003 NATIONAL FOOTBALL MUSEUM INC 34-0898576 Page 5
PartVt-A Lobbying Expenditures by Electing Public Charities see instructions .)
(To be completed ONLY by an eligible organization that filed Form 57 68) N/A
Check 0- a if the or ganization belong s to an affiliated g rou p . Check " b 1-1 if y ou checked 'a' and 'limited control' p rovisions a pp ly .
45 Lobbying nontaxable
amount
47 Total lobbying
expenditures
48 Grassroots non-
taxable amount
50 Grassroots lobbying
expenditures
I-B Lobbying Activity by Nonelecting Public Charities
(For reporting only by organizations that did not complete Part VI-A) (See instructions ) N/A
During the year, did the organization attempt to influence national, state or local legislation, including any
attempt to influence public opinion on a legislative matter or referendum, through the use of . Yes No Amount
a Volunteers
b Paid staff or management (Include compensation m expenses reported on lines c through h .)
c Media advertisements . . . . . . . , ., ,
d Mailings to members, legislators, or the public . . . ..
e Publications, or published or broadcast statements . . . . . , . . .
f Grants to other organizations for lobbying purposes
g Direct contact with legislators, their staffs, government officials, or a legislative body
h Rallies, demonstrations, seminars, conventions, speeches, lectures, or any other means
i Total lobbying expenditures (add fines c through h.) ~'. ~. . ~ . . . . . . . . . .
If 'Yes' to any of the above, also attach a statement giving a detailed description of the lobbying activities
BAA Schedule A (Form 990 or 990-EZ) 2003
TEEA0405L 08/28/03
Schedule A Form 990 or 990-E 2003 NATIONAL FOOTBALL MUSEUM INC 34-0898576 Page 6
Pad VIC Information Regarding Transfers To and Transactions and Relationships With Noncharitable
Exempt Organizations see instructions)
51 Did the reporting organization directly or indirectly engage m any of the following with any other organization described in section 501(c)
of the Code (other than section 501(c)(3) organizations) or in section 527, relating to political organizations?
a Transfers from the reporting organization to a nonchantable exempt organization of . Yes No
(i)Cash .. .. . .. 51 a i X
(ii)Other assets a ii X
b Other transactions :
(i)Sales or exchanges of assets with a noncharitable exempt organization b i X
(ii)Purchases of assets from a noncharitable exempt organization b ii X
(M)Rental of facilities, equipment, or other assets b iii X
(w) Reimbursement arrangements b iv X
(v)Loans or loan guarantees . . . . ... .. b (v) X
(vi)Performance of services or membership or fundraising solicitations . .. .. ... b (vi) X
c Sharing of facilities, equipment, marling lists, other assets, or paid employees .. I c
d If the answer to any of the above is 'Yes,' complete the following schedule . Column (b) should always show the fair market value of
the oods, other assets, or services given by the re ortin orqanization . If the organization received less than fair market value in
an transaction or sharing arrangement, show m column Fd) the value of the oods, other assets, or services received :
(a) (b) (c) (d)
Line no . Amount involved Name of noncharitable exempt organization Description of transfers, transactions, and sharing arrangements
52a Is the organization directly or indirectly affiliated with, or related to, one or more tax-exempt organizations
described in section 501(c) of the Code (other than section 501(c)(3)) or in section 527? 1` F] Yes W No
Statement 1
Form 990, Part I, Line 9
Net Income (Loss) from Special Events
Statement 2
Form 990, Part I, Line 10
Gross Profit (Loss) From Sales Of Inventory
$ 3,092,831 .
Statement 3
Form 990, Part II, Line 43
Other Expenses
Statement 4
Form 990, Part III, Line a
Statement of Program Service Accomplishments
Program
Grants and Service
Description Allocations Expenses
THE NATIONAL FOOTBALL MUSEUM IS AN EDUCATIONAL ORGANIZATION
DEDICATED TO PROVIDING INFORMATION AND EXHIBITS FOR THE
GENERAL PUBLIC ON THE SPORT OF PROFESSIONAL FOOTBALL, ITS
ROLE AS A NATIONAL TRADITION AND ITS EFFECT ON THE AMERICAN
PUBLIC . 3,433,123 .
0. 3,433,123 .
Statement 5
Form 990, Part IV, Line 54
Investments - Securities
Valuation
Other Publicly Traded Securities Method Amount
PIMCO LOW DURATION FUND CL A Cost $ 502,197 .
Total 502,19 7 .
Valuation
Other Securities Method Amount
MFS HIGH INCOME FUND A Cost 40,471 .
IDS LIFE FLEXIBLE ANNUITY Cost 20,854 .
Total 61,325 .
Statement 6
Form 990, Part IV, Line 55b
Investments - Land, Buildings, and Equipment
Accum . Book
Category Basis Deprec . Value
Buildings $ 67,580 . $ 67,580 . $ 0.
Land 68 900 . 68 , 900 .
Total 136,480 . 67,580 . 68,900 .
2003 Federal Statements Page 31
NATIONAL FOOTBALL MUSEUM INC
PRO FOOTBALL HALL OF FAME 34-08985761
Statement 7
Form 990, Part IV, Line 57
Land, Buildings, and Equipment
Accum . Book
Category Basis Deprec . Value
Furniture and Fixtures $ 600,942 . $ 352,104 . $ 248,838 .
Machinery and Equipment 781,297 . 534,948 . 246,349 .
Buildings 15,037,473 . 6,247,203 . 8,790,270 .
Improvements 1,904,653 . 473,294 . 1,431,359 .
Land 210 850 . 210 850 .
Total 18,535,215. ,607, 49 . 10,92 7 ,66b .
Statement 8
Form 990, Part IV, Line 58
Other Assets
Statement 9
Form 990, Part IV, Line 64b
Mortgages and Other Notes Payable
Total 1,589,144 .
Statement 10
Form 990, Part VIII
Relationship of Activities to the Accomplishment of Exempt Purposes
101 TELEVISING THE ANNUAL HALL OF FAME GAME IN CONJUNCTION WITH THE HALL OF
FAME'S ANNUAL ENSHRINEMENT PROCEEDINGS FURTHERS ITS EDUCATIONAL PURPOSES
BY INCREASING PUBLIC AWARENESS AND UNDERSTANDING OF THE SPORT OF
2003 Federal Statements Page 4
NATIONAL FOOTBALL MUSEUM INC
Client 1395 PRO FOOTBALL HALL OF FAME 34-0898576
5/26/04 02 59PM
Statement 10 (continued)
Form 990, Part VUI
Relationship of Activities to the Accomplishment of Exempt Purposes
103b AMOUNTS RECEIVED FROM THE SALE OF PHOTOGRAPHS OF PAST ENSHRINEES OF THE
HALL OF FAME FURTHERS ITS EDUCATIONAL PURPOSES BY INCREASING PUBLIC
AWARENESS OF THE SPORT OF PROFESSIONAL FOOTBALL, ITS HISTORY AND ROLE IN
AMERICAN SOCIETY AND THE HISTORY OF THE PRO FOOTBALL HALL OF FAME .
Statement 11
Schedule A, Part III, Line 2
Transactions with Trustees, Directors, Etc .
Note : Only complete Part // ityou have already been granted an automatic 3-month extension on a previously filed
Form 8868.
0 If you are filing for an Automatic 3-Month Extension, comp lete onl y Part I (on p a g e 1 ) .
'Part t1 Additional not automatic 3-Month Extension of Time - Must File Ori g inal and One Co
Name of Exempt Organization Employer identification number
CANTON, OH 44708-2630
Check type of return to be filed (file a separate application for each return) .
n Form 990
Form 990-BL
n Form 990-EZ
IForm 990-PF
n Form 990-T (Section 401(a) or 408(a) trust)
f I Form 990-T (trust other than above
Form 1041-A
Form 4720
Form 5227
Form 6069
Stop : Dc not complete Par: 11 ii you were not already granted an autioinatic 3-month extension on a previously filed Form 8868 .
A
~ Form 8870
" If the organization does not have an office or place of business in the United States, check this box P.- F
" If this is for a Group Return, enter the organizations four digit Group Exemption Number (GEN) . If this is for the
whole group, check this box - F] If it is part of the group, check this box 0- ~ and attach a list with the names and EINs of all
members the extension is for .
4 I request an additional 3-month extension of time until 11/15 , 20 04
5 For calendar year 2003 , or other tax year beginning , 20 and ending - , 20
6 If this tax year is for less than 12 months, check reason ~ Initial return Final return Change m accounting period
7 State in detail why you need the extension - Additional time is required in order to obtain the
information necessary to f file a complete and accurate return .- -- _ --
8a If this application is for Form 990-BL, 990-PF, 990-T, 4720, or 6069, enter the tentative tax, less any
nonrefundable credits See instructions
b If this application is for Form 990-PF, 990-T, 4720, or 6069, enter any refundable credits and estimated tax
payments made Include any prior year overpayment allowed as a credit and any amount paid previously with
Form 8868
c Balance due. Subtract line Sb from line 8a . Include your payment with this form, or, if required, deposit with
FTD coupon or, if required, by using EFTPS (Electronic Federal Tax Payment System). See instructions $
Signature and Verification
Under penalties of penury, I declare that I have examined this form, including accompanying schedules and statements, and to the best of my knowledge and belief, it is true,
correct, and complete, a nd that I am authorized to prepare this form
18A
- By
Director C IN! SI N,
Alternate Mailing Address - Enter the address if you want the copy of this application for an additional 3-month extension returned to an
address different than the one entered above 11 11 9 7 9nnn
Name
Canton, OH 44702
BAA FIFZ0502L 01/05/04 Form 8868 (Rev 12-2000)