Schedule IN-UBI                                            Indiana Department of Revenue
State Form 57071
(8-21)                                                     Indiana Unrelated Business Income

Name of Organization                                                                             Federal Employer Identification Number

Complete Schedule IN-UBI if this nonprofit organization has unrelated business income from more than one line of business.  
                                                            Column A            Column B         Column C                     Column D 
                Entries from Form IT-20NP 
                                                           Unrelated Business Unrelated Business Unrelated Business           Unrelated Business

       Name of unrelated business - see instructions

Line 1: UBI Before NOL from this line of business

Line 2: Non-unitary partnership income

Line 3: Specific deduction attributable to line of business

Line 4: Subtract Line 2 and Line 3 from Line 1
Line 5: Enter add-back or deduction name and code 
___________________________                   ___ ___ ___
Line 6: Enter add-back or deduction name and code
___________________________                   ___ ___ ___
Line 7: Enter add-back or deduction name and code
___________________________                   ___ ___ ___
Line 8: Enter add-back or deduction name and code
___________________________                   ___ ___ ___

Line 9: Unrelated business income. Add Lines 4 through 8
Line 10: Enter Indiana apportionment percentage 
       (round percent to two decimals)                     .         %          .        %       .                          % .        %

Line 11: Multiply Line 9 times Line 10

Line 12: Indiana non-unitary partnership income
Line 13: Indiana Unrelated Business from line of business. 
       Add Line 11 and Line 12

                                                           *24100000000*
                                                                     24100000000