starting a tax-exempt organization: form 1023 and form 990 a tax exempt... · the national society...

NATIONAL SOCIETY OF TAX PROFESSIONALS

Developed, Written and Instructed by

Nina Tross, EA, MBA

NSTP Executive Director

Where the Crossroads of Tax Education and Service to the Tax Professional Meet

Starting a Tax-Exempt Organization: Form 1023 and

Form 990

Presents the

June 27, 2018

Clarion Hotel Williamsburg

3032 Richmond Rd

Williamsburg, VA 23185

DISCLAIMER STATEMENT

Copyright © 2018 Nina Tross, EA, MBA

These materials may not be reproduced or re-transmitted without the express written permission

of Nina Tross, EA, MBA

Seminar materials and seminar presentations are intended to stimulate thought and discussion and

to provide attendees with useful ideas and guidance in the areas of federal taxation. These materials

as well as the comments of the instructors do not constitute and should not be treated as tax advice

regarding the use of any particular tax procedure, tax planning technique or device or suggestion or

any of the tax consequences associated with them.

Although the author has made every effort to ensure the accuracy of the materials and the seminar

presentation, neither the author, the presenter nor the National Society of Tax Professionals assumes

any responsibility for any individual’s reliance on the written or oral information presented during

the presentation. Each attendee should verify independently all statements made in the materials

and during the seminar presentation before applying them to a particular fact pattern and should

determine independently the tax and other consequences of using any particular device, technique

or suggestion before recommending the same to a client or implementing the same on a client’s or

on his or her own behalf.

i

TABLE OF CONTENTS

I. Starting a Tax-Exempt Organization: Form 1023 and Form 990

A. Primer on Tax‑Exempt Status ............................................................................................ 1

B. State Law Governs Nonprofit Status .................................................................................. 6

C. How to Start a 501(c)(x) Tax‑Exempt Organization .......................................................... 7

D. Unique Rules for Churches ................................................................................................. 9

E. Acquiring Nonprofit Tax‑Exempt Status .......................................................................... 11

F. Applying for Tax‑Exempt Status ...................................................................................... 13

G. Requirements to Maintain Tax‑Exempt Status................................................................ 15

H. Form 1023, Application for Recognition of Exemption Under §501(c)(3) of the Internal

Revenue Code .................................................................................................................... 17

I. Top Ten Tips to Shorten the Tax‑Exempt Application Process ....................................... 19

J. Form 1023‑EZ, Streamlined Application for Recognition of Exemption Under §501(c)

(3) of the Internal Revenue Code ..................................................................................... 20

K. How are Forms 1023 and 1023‑EZ Different? ................................................................. 23

L. Form 990 – Which Form to File ....................................................................................... 27

M. Unrelated Business Income Tax Returns (UBIT) ............................................................ 31

N. GDPR – What is It? ........................................................................................................... 34

ii

TABLE OF CONTENTS

II. Resources

1. Publication 4220, Applying for 501(c)(3) ........................................................................ 36

2. Tax Exempt and Government Entities: FY 2017 Accomplishments ............................... 50

3. Form 1023, Application for Recognition of Exemption .................................................. 60

4. Form 1023, Application for Recognition of Exemption .................................................. 86

5. Form 1024‑A, Application for Recognition of Exemption ............................................. 114

6. Sample Conflict of Interest Policy .................................................................................. 118

7. Sample Article of Incorporation ..................................................................................... 121

8. Form 990, Return of Organization Exempt From Income Tax ..................................... 123

9. Form 990‑EZ, Short Form Return of Organization Exempt From Income Tax ........... 127

10. The Board’s Role in Reviewing Form 990 ...................................................................... 131

11. How to Verify the 501(c)(3) Status of a Nonprofit ......................................................... 139

12. Form 990 Checklist ......................................................................................................... 142

1 The National Society of Tax Professionals

Starting a Tax‑Exempt Organization: Form 1023 and Form 990

I. Starting a Tax-Exempt Organization: Form 1023 and

Form 990

A. Primer on Tax-Exempt Status

1. To be organized exclusively for a charitable purpose, the organization must

be a corporation (or unincorporated association), community chest, fund,

or foundation. A charitable trust is a fund or foundation and will qualify.

However, an individual will not qualify. The organizing documents must

limit the organization’s purposes to exempt purposes in §501(c)(3) and must

not expressly empower it to engage, other than as an insubstantial part of

its activities, in activities that are not in furtherance of one or more of those

purposes. This requirement may be met if the purposes stated in the organizing

documents are limited by reference to §501(c)(3).

2. An organization’s assets must be permanently dedicated to an exempt purpose.

This means that if an organization dissolves, its assets must be distributed

for an exempt purpose, to the federal government, or to a state or local

government for a public purpose. To establish that an organization’s assets

will be permanently dedicated to an exempt purpose, its organizing documents

should contain a provision ensuring their distribution for an exempt purpose

in the event of dissolution. If a specific organization is designated to receive

the organization’s assets upon dissolution, the organizing document must state

that the named organization must be a §501(c)(3) organization when the assets

are distributed. Although reliance may in some cases be placed upon state law

to establish permanent dedication of assets for exempt purposes, the IRS can

process an organization’s application more rapidly if its organizing documents

include a provision ensuring permanent dedication of assets for exempt

purposes.

The National Society of Tax Professionals 2


3. §501(c)(3)

a. Charitable, Educational or Religious organization

b. A §501(c)(3) organization must not be organized or operated for the

benefit of private interests, such as the creator or the creator’s family,

shareholders of the organization, other designated individuals, or persons

controlled directly or indirectly by such private interests. No part of the

net earnings of a §501(c)(3) organization may inure to the benefit of any

private shareholder or individual. A private shareholder or individual

is a person having a personal and private interest in the activities of the

organization.

c. The exempt purposes set forth in §501(c)(3) are charitable, religious,

educational, scientific, literary, testing for public safety, fostering

national or international amateur sports competition, and preventing

cruelty to children or animals. The term charitable is used in its generally

accepted legal sense and includes relief of the poor, the distressed, or the

underprivileged; advancement of religion; advancement of education or

science; erecting or maintaining public buildings, monuments, or works;

lessening the burdens of government; lessening neighborhood tensions;

eliminating prejudice and discrimination; defending human and civil

rights secured by law; and combating community deterioration and

juvenile delinquency.

d. Under the Internal Revenue Code, all §501(c)(3) organizations are

absolutely prohibited from directly or indirectly participating in, or

intervening in, any political campaign on behalf of (or in opposition

to) any candidate for elective public office. Contributions to political

campaign funds or public statements of position (verbal or written) made

on behalf of the organization in favor of or in opposition to any candidate

for public office clearly violate the prohibition against political campaign



activity. Voter education or registration activities with evidence of bias

that (a) would favor one candidate over another; (b) oppose a candidate

in some manner; or (c) have the effect of favoring a candidate or group

of candidates, will constitute prohibited participation or intervention.

Violating this prohibition may result in denial or revocation of tax‑exempt

status and the imposition of certain excise taxes.

i. Under the substantial part test, an organization that conducts

excessive lobbying in any taxable year may lose its tax‑exempt

status, resulting in all of its income being subject to tax. In addition,

§501(c)(3) organizations that lose their tax‑exempt status due to

excessive lobbying, other than churches and private foundations,

are subject to an excise tax equal to five percent of their lobbying

expenditures for the year in which they cease to qualify for

exemption.

ii. Organizations (other than churches and private foundations) may

elect the expenditure test under §501(h) as an alternative method

for measuring lobbying activity. Under the expenditure test, the

extent of an organization’s lobbying activity will not jeopardize

its tax‑exempt status, provided its expenditures, related to such

activity, do not normally exceed an amount specified in §4911.

Under the expenditure test, an organization that engages in

excessive lobbying activity over a four‑year period may lose its

tax‑exempt status, making all of its income for that period subject

to tax. Should the organization exceed its lobbying expenditure

dollar limit in a particular year, it must pay an excise tax equal to 25

percent of the excess.

e. Certain activities or expenditures may not be prohibited depending on the

facts and circumstances. For example, certain voter education activities

(including presenting public forums and publishing voter education



guides) conducted in a non‑partisan manner do not constitute prohibited

political campaign activity. In addition, other activities intended to

encourage people to participate in the electoral process, such as voter

registration and get‑out‑the‑vote drives, would not be prohibited political

campaign activity if conducted in a non‑partisan manner.

4. §501(c)(4)

a. Rev. Proc 2018‑10 contains revised guidance for organizations applying

for §501(c)(4) status. A new form, Form 1024‑A, Application for

Recognition Under §501(c)(4), must be used for such organizations to

obtain a determination letter.

b. Social Welfare Organizations‑a social welfare organization described in

Internal Revenue Code (IRC) §501(c)(4), an organization must not be

organized for profit and must be operated exclusively to promote social

welfare.

i. Airport on land owned by a local government

ii. Community association that works to improve public services

iii. Community association devoted to preserving community traditions

iv. Organization which tries to encourage industrial development

v. Organization which holds annual festivals of regional customs and

tradition

c. Local Associations of Employees‑a local association of employees under

Internal Revenue Code §501(c)(4) is an organization whose membership

is limited to employees of a designated person or persons in a particular

municipality, and whose net earnings will be devoted exclusively to

charitable, educational, or recreational purposes.

5. §501(c)(6)

a. Business Leagues: trade associations and professional associations

b. Chambers of Commerce: merchants and traders in a city



c. Real Estate Boards: improving conditions in the real estate field

d. Boards of Trade: persons engaged in similar lines of business

e. Professional Football Leagues: whether or not provide pension fund

6. §501(c)(7)

a. Social Clubs which provide an opportunity for personal contact among

members and membership is limited. The club must be support by

membership dues, dues and/or assessments.

i. College social/academic fraternities and sororities

ii. Country clubs

iii. Amateur sports clubs

iv. Dinner clubs

v. Hobby clubs

7. §501(c)(8)

a. Fraternal societies must be a domestic organization where the purpose

of membership is based on a common goal or pursuit of a common

objective.

8. §501(c)(19) or §501(c)(23)

a. Veterans’ Organizations which benefit veterans of the U.S. Armed

Services

i. §501(c)(19) organizations must either serve past or present

members of the U.S. Armed Services, be an auxiliary unit, or a trust

or foundation.

ii. §501(c)(23) must have been organized before 1880, more than 75%

of the members are past or present members of the U.S. Armed

Forces and has a principal purpose of providing insurance and other

benefits to veterans and their dependents.



B. State Law Governs Nonprofit Status

1. Nonprofit status is a state law concept. Nonprofit status may make an

organization eligible for certain benefits, such as state sales, property, and

income tax exemptions. Although most federal tax‑exempt organizations are

nonprofit organizations, organizing as a nonprofit organization at the state

level does not automatically grant the organization exemption from federal

income tax. To qualify as exempt from federal income tax, an organization

must meet requirements set forth in the Internal Revenue Code.

2. A charity’s organizing document must limit the organization’s purposes to

exempt purposes set forth in §501(c)(3) and must not expressly empower it

to engage, other than as an insubstantial part of its activities, in activities that

do not further those purposes. This requirement may be met if the purposes

stated in the organizing document are limited by reference to §501(c)(3).

3. In addition, an organization’s assets must be permanently dedicated to an

exempt purpose. This means that if an organization dissolves, its assets must

be distributed for an exempt purpose described in §501(c)(3), or to the federal

government or to a state or local government for a public purpose.

4. To establish that an organization’s assets will be permanently dedicated to an

exempt purpose, the organizing document should contain a provision insuring

their distribution for an exempt purpose if the organization dissolves.

5. 40 states and the District of Columbia require §501(c)(3) organizations to

register with their Department of Charities prior to soliciting donations

from the public. This department is usually a division of either the Attorney

General’s office or the Secretary of State.



C. How to Start a 501(c)(x) Tax-Exempt Organization

1. Determine the type of nonprofit organization

2. Limit your purpose:

a. Charitable

b. Religious

c. Educational

d. Scientific

e. Literary

f. Testing for public safety

g. Fostering national or international amateur sports competitions

h. Preventing cruelty to children or animals

3. Choose a name for the organization and submit application to the state

4. Formulate the mission statement. Some samples:

a. “The mission of St. Jude Children’s Research Hospital is to advance cures,

and means of prevention, for pediatric catastrophic diseases through

research and treatment.”

b. “The National Mental Health Association is dedicated to promoting

mental health, preventing mental disorders, and achieving victory over

mental illness through advocacy, education, research, and service.”

c. “The National Consumer Supporter Technical Assistance Center’s

purpose is to strengthen consumer organizations by providing technical

assistance in the forms of research, informational material and financial

aid.”



d. “The mission of Texas Mental Health Consumers is to organize,

encourage, and educate mental health consumers in Texas. TMHC

supports and promotes the mental health recovery process through peer

directed and operated services, advocacy, economic development, and

participation in public mental health policy decision.

5. Hire an attorney to prepare Articles of Incorporation and Bylaws

6. File documents with appropriate agencies (state specific)

7. Hire an accountant to assist with determining finances

8. Apply for an Employer Identification Number (EIN)

9. Develop a budget

10. Develop a recordkeeping system

11. Consult with an insurance agent on types of insurance needed

12. Apply for recognition of tax‑exempt status

13. Dedicate your assets to exempt purposes

14. Request to expedite application (if necessary): the IRS may be willing to

expedite the application if there is a pending grant that is necessary for the

continued operations of the organization.

15. Apply for state and local tax exemptions (if allowable by the state and/or

county law) for exemption from income, sales, or property taxes.

16. Draft Bylaws

17. Form a Board of Directors



D. Unique Rules for Churches

1. Not required to file Form 1023: Churches, interchurch organizations of local

units of a church, conventions or associations of churches, or integrated

auxiliaries of a church, such as a men’s or women’s organization, religious

school, mission society, or youth group are exempt automatically if they meet

the requirements of §501(c)(3).

2. Automatically Tax‑Exempt: According to IRS Code §508(c)(1)(A):

Special rules with respect to §501(c)(3) organizations.

(a) New organizations must notify secretary that they are applying

for recognition of §501(c)(3) status.

(c) Exceptions.

(1) Mandatory exceptions. Subsections (a) and (b) shall not apply

to—

(A) churches, their integrated auxiliaries, and conventions or

associations of churches.

This is referred to as the “mandatory exception” rule. Thus, we see from

the IRS’ own publications, and the tax code, that it is not necessary for any

church to apply for tax‑exempt status. In the IRS’ own words a church “is

automatically tax‑exempt.”

3. Automatically Tax‑Deductible: Contributions can be deducted only if made to a

qualified organization. To become a qualified organization most organizations,

other than churches and governments, must apply to the IRS. Again, according

to the IRS a church “is automatically tax‑deductible.”



4. Every organization exempt from federal income tax under Internal Revenue

Code §501(a) must file an annual information return except (but not limited

to):

a. A church, an interchurch organization of local units of a church, a

convention or association of churches,

b. An integrated auxiliary of a church,

c. A church‑affiliated organization that is exclusively engaged in managing

funds or maintaining retirement programs,

d. A school below college level affiliated with a church or operated by a

religious order,

e. Church‑affiliated mission societies if more than half of their activities are

conducted in, or are directed at persons in, foreign countries, or

f. An exclusively religious activity of any religious order.



E. Acquiring Nonprofit Tax-Exempt Status

1. Provide a detailed, narrative description of the organization’s activities – past,

present, and future. For each activity explain how:

a. it furthers an exempt purpose of the organization and the percentage of

time the group will devote to it,

b. when it was begun (or will begin),

c. where and by whom the activity will be conducted, and

d. how it will be funded

2. Provide compensation and financial information. Information will be needed

regarding any financial arrangements with:

a. Initial directors,

b. Initial officers of the Board of Directors

c. Trustees

d. The five top‑paid employees earning more than $50,000 annually

e. The five top‑paid independent contractors who will be paid more than

$50,000 annually

3. Who will receive goods and services from the nonprofit must be identified and

reported. Non‑discriminatory language is needed to show that services are

available to all members of the target group for the nonprofit purpose.

4. If the nonprofit is a successor to an existing for‑profit organization then

additional information will be requested to distinguish between the for‑profit

and non‑profit operations.

5. Specific activities must be identified in order to distinguish those that may be

considered political in nature or involve restricted fundraising activities such

as bingo or gaming activities.



6. A statement of revenues and expenses as well as a balance sheet must also be

provided. Under rules in effect since September 9, 2008, an organization that

has been in existence for five years or more must provide financial data for its

most recent five years. Other groups must provide financial data for each year

they have been in existence and good faith estimates for future years for a total

of three or four years, depending on how long the organization has been in

existence.

These revised financial data requirements relate to IRS rules that automatically

classify all new §501(c)(3) groups as public charities as long as they can show

in their Form 1023 that they reasonably expect to receive qualifying public

support. If the nonprofit is a public charity, then the application will need to

include all the information necessary to avoid misclassification as a private

foundation.

7. Public Charity or Private Foundation:

a. Public charities, which include churches, schools, hospitals, and many

other groups derive most of their support from the public or receive

most of their revenue from activities related to tax‑exempt purposes.

Most groups want to be classified as a public charity because private

foundations are subject to strict operating rules and regulations.

Under IRS regulations effective September 9, 2008, all new §501(c)(3)

groups will automatically be classified as public charities for the first

five years if they demonstrate in their Form 1023 that they reasonably

expect to receive qualifying public support. These rules eliminate the

requirement that new groups applying for §501(c)(3) tax‑exempt status

seek an advance ruling on their public charity status. For the first five

years, the group will maintain its public charity status regardless of how



much public support it receives. After the initial five‑year period, the

IRS will start to monitor whether the group receives the public support

necessary to qualify as a public charity.

b. A private foundation is a nonprofit organization which is usually created

via a single primary donation from an individual or a business and

whose funds and programs are managed by its own trustees or directors.

As such, rather than funding its ongoing operations through periodic

donations, a private foundation generates income by investing its initial

donation, often disbursing the bulk of its investment income each year to

desired charitable activities.

F. Applying for Tax-Exempt Status

1. Preparation of state Articles of Incorporation, file and publish (refer to state

law)

2. Prepare Bylaws

3. Develop Conflict of Interest Policy

4. Build the Board of Directors

5. File Form SS‑4, Application for Employer Identification Number

6. Prepare Form 1023, Application for Recognition of Exemption Under §501(c)

(3) of the Internal Revenue Code (or Form 1023‑EZ, Streamlined Application

for Recognition of Exemption Under §501(c)(3) of the Internal Revenue Code

7. Complete Form 2848, Power of Attorney and Declaration of Representative

8. While the application is pending approval, the organization may operate as a

tax‑exempt organization



9. Although donors have no assurance that contributions are tax‑deductible for

federal income tax purposes until the application is approved, contributions

made while an application is pending would qualify if the application is

approved

10. If the application is disallowed, contributions would not qualify. Moreover,

the organization would be liable for filing federal income tax returns unless its

income is otherwise excluded from federal taxation

11. Include appropriate filing fee

12. Mail completed application to:

Internal Revenue Service

PO Box 12192

Covington, KY 41012‑0192

Express mail or deliver to:


201 West Rivercenter Blvd.

Attn: Extracting Stop 312

Covington, KY 41011



G. Requirements to Maintain Tax-Exempt Status

1. Political Activity: Generally, §501(c)(3) organizations may not participate in

any political or substantial lobbying activity. Specifically, they may not make

contributions to political campaign funds nor promote a specific candidate.

2. Non‑Exempt Activity: The §501(c)(3) organization’s activities and income

must be focused on the purpose as reported to the IRS. In other words, if

your organization’s exemption is based on the purpose of providing clothing

to homeless people, your activities and income must focus on that purpose. If

instead, you use donated funds to pay exorbitant salaries while failing to help

any homeless people, you will likely lose your tax‑exempt status.

3. Inurement or Personal Benefit: Inurement, which occurs if a shareholder

or other insider receives personal benefits from the organization, is strictly

prohibited for §501(c)(3) organizations. For example, the nonprofit may not

sell property of the organization to a board member for less than the fair

market value, nor may a shareholder receive free services from the nonprofit

that others pay for. Employees and directors can, however, receive reasonable

compensation for work completed, but exorbitant salaries would likely violate

the rule.



4. Unrelated Business Income: Although all organizations need some income to

operate, exempt organizations may not have substantial, unrelated business

income. This includes money made from activities that are not related to the

organization’s purpose, such as renting out office space or selling merchandise.

Most of the organization’s efforts must go to the exempt purpose of the

organization, but some unrelated business income is permitted. Typically,

exempt organizations must pay taxes on unrelated business income and

report the income on Form 990‑T, Exempt Organization Business Income Tax

Return.

5. Reporting and Taxes: Generally, the IRS requires exempt organizations to file

an annual report. However, certain exempt organizations, including churches

and some nonprofits with very small budgets, are not required to do so. The

state where the organization is located may also require the organization to file

reports annually or biannually. Although §501(c)(3) organizations are exempt

from certain taxes, many nonprofits must pay employment tax, excise tax,

unrelated business income tax, as well as state and local taxes.



H. Form 1023, Application for Recognition of Exemption Under §501(c)

(3) of the Internal Revenue Code

1. Assemble the application and materials in the following order:

a. Form 1023 Checklist

b. Form 2848, Power of Attorney and Declaration of Representative

c. Form 8821, Tax Information Authority (if filing)

d. Expedite request (if requesting)

e. Application – Form 1023 and appropriate schedules

f. Article of Organization

g. Amendments to Articles (if applicable)

h. Bylaws or other rules of operation and amendment

i. Documentation of nondiscriminatory policy for schools, as required by

Schedule B

j. Form 5768, Election/Revocation of Election by an Eligible §501(c)(3)

Organization to Make Expenditures to Influence Legislation (if filing)

k. All other attachments, including explanations, financial data, and printed

materials or publications. Label each page with name and EIN.

2. User fee payment placed in envelope on top of checklist. Do not staple or

otherwise attach check or money order to the application, just place it in the

envelope.

3. Employer Identification Number (EIN)

4. Completed Parts I through XI of the application, including any requested

information and any required Schedules A through H

a. Provide specific details about past, present and planned activities



b. Generalizations or failure to answer questions in the Form 1023

application will prevent the IRS from recognizing the organization as tax

exempt

c. Describe the purposes and proposed activities in specific easily

understood terms

d. Financial information should correspond with proposed activities

5. Schedules – submit only those schedules that apply to the organization

6. An exact copy of the complete Articles of Organization (creating document).

Absence of the proper purpose and dissolution clauses is the number one

reason for delays in the issuance of determination letters.

7. Signature of an officer, director, trustee, or other official who is authorized

to sign the application (cannot be signed by the POA unless one of the listed

signatories)

8. Changes announced in Rev. Proc 2018‑5:

a. Added a new public charity status for agricultural research organizations

b. Eliminated a question regarding about the advance ruling process

c. Eliminated an outdated question about organizations applying for

§501(c)(3) recognition more than 27 months after formation.

d. Increased financial data reporting requirements for organizations older

than one year



I. Top Ten Tips to Shorten the Tax-Exempt Application Process

1. Provide the required information on the principal officers and Board of

Directors

2. Ensure a director, trustee, principal officer or other authorized individual signs

the Form 1023

3. Submit a copy of the adopted bylaws

4. Include all the necessary financial data

5. Include the month the organization’s annual accounting period ends

6. Attach all required schedules

7. Complete all required pages

8. Provide enough information about the organization’s activities to show us how

it will achieve the exempt purpose

9. Attach a complete copy of the organizing document and all amendments

10. Include the correct user fee – changed with Rev. Proc. 2018‑5

a. Form 1023‑EZ: $275.00

b. Form 1023 – new user fee: $600

c. Form 1024 / 1024‑A‑ $600



J. Form 1023-EZ, Streamlined Application for Recognition of

Exemption Under §501(c)(3) of the Internal Revenue Code

1. Streamlined process for seeking §501(c)(3) status for certain, small nonprofit

organizations

2. For small applicant organizations who:

a. Anticipate less than $50,000 in annual gross receipts each year for the

first three years, and

b. Have already had less than $50,000 in annual gross receipts for all 3 prior

three years (if applicable), and

c. Have total assets valued at under $250,000.

3. Nonprofit organizations with foreign origins may not qualify to use the

1023‑EZ if:

a. They are organized under the laws of a foreign country, or

b. Have a primary mailing address in a foreign country.

4. Applicants cannot be:

a. Organized as an LLC

b. A successor to or controlled by any organization which has had its own

tax‑exempt status revoked due to terrorism activity or connections

c. A successor to a for‑profit entity

d. An organization that had its §501(c)(3) status revoked for any reason

(other than a failure to file Form 990 for 3 consecutive years)

e. An organization that had its §501(c)(3) revoked for failure to file Form

990 for 3 consecutive years that is now seeking retroactive reinstatement

f. Seeking status as a private operating foundation



5. Form 1023‑EZ eligibility is dependent on the purpose of the organization.

The organizational entities listed below are usually required to supply more

information regarding their activities than is allowable for the streamlined

process:

a. Organizations investing more than 5% of assets in non‑publicly traded

securities

b. Nonprofits exclusively purposed to test consumer products for public

safety

c. Accountable Care Organizations

d. Health Maintenance Organizations

e. Credit counseling purposes (including budgeting, personal finance,

financial literacy, mortgage foreclosure assistance, etc.)

f. Supporting organizations formed to support another specific §501(c)(3)

g. Charitable risk pools

h. Cooperative service organizations

i. Cooperative hospital service organizations

j. Hospitals and medical research organizations

k. Schools, colleges, and universities

l. Churches and churches associations

m. Organizations maintaining one or more donor advised funds

6. Form 1023‑EZ Revisions: The IRS revised Form 1023‑EZ, Streamlined

Application for Recognition of Exemption Under §501(c)(3) of the Internal

Revenue Code, and its instructions to help small charities apply for §501(c)(3)

tax‑exempt status. These revisions don’t change the Form 1023‑EZ user fee.

Here’s a summary of the revisions we made to the Form 1023‑EZ.



a. A text box was added to Part III requesting a brief description of the

organization’s mission or most significant activities. This change was

recommended by the IRS National Taxpayer Advocate and is designed to

provide a better understanding of the most significant activities that an

organization engages in to further its exempt purposes.

b. Questions about annual gross receipts, total assets and public charity

classification was added to the Form 1023‑EZ. These questions are also

on the Form 1023‑EZ Eligibility Worksheet in the Instructions for Form

1023‑EZ that organizations must certify they have completed.

c. Question 29 on the Form 1023‑EZ Eligibility Worksheet now requires

that an automatically revoked organization applying for reinstatement

must seek the same foundation classification they had at the time

of automatic revocation to be eligible to use the Form 1023‑EZ.

Organizations that are not seeking that same foundation classification

must file a full Form 1023.



K. How are Forms 1023 and 1023-EZ Different?

1. Form 1023:

Form 1023 is 11 pages long, not including 8 possible schedules, some of which

may or may not need to be completed depending on the type of organization

and its circumstances. The schedules are for (A) churches; (B) schools,

colleges, and universities; (C) hospitals and medical research organizations;

(D) supporting organizations; (E) organizations not filing Form 1023

within 27 months of formation; (F) homes for the elderly or handicapped

and low‑income housing; (G) successors to other organizations; and (H)

organizations providing scholarships, fellowships, educational loans, or

educational grants to individuals and private foundations requesting advance

approval of individual grant procedures.

2. There are many questions on Form 1023 that require detailed narrative

answers regarding:

• Past, present, and planned activities

• Compensation of directors, officers, trustees, and certain highly

paid employees and contractors (“Close Personnel”)

• Compensation of Close Personnel from related organizations

• Sales and/or contracts between the organization and any Close

Personnel (including any organizations they have certain

affiliations with)

• Family and business relationships among directors, officers, and

trustees

• Goods, services, and/or funds (grants) provided to individuals or

organizations

• Fundraising programs



In addition, the Form 1023 requires:

• Articles of incorporation

• Bylaws

• Conflict of interest policy or explanation of how the organization

manages conflicts of interest

• Financials (actual and/or projected) for 3 or 4 years

3. Form 1023‑EZ:

Form 1023‑EZ is an online form that is 3 pages long. It requires no narrative

responses and consists of mostly check box attestations. By checking just one

box, the applicant is attesting that it will do all of the following:

• Refrain from supporting or opposing candidates in political

campaigns in any way.

• Ensure that its net earnings do not inure in whole or in part to

the benefit of private shareholders or individuals (that is, board

members, officers, key management employees, or other insiders).

• Not further non‑exempt purposes (such as purposes that benefit

private interests) more than insubstantially.

• Not be organized or operated for the primary purpose of

conducting a trade or business that is not related to its exempt

purpose(s).

• Not devote more than an insubstantial part of its activities

attempting to influence legislation or, if the organization made

a §501(h) election, not normally make expenditures in excess of

expenditure limitations outlined in §501(h).

• Not provide commercial‑type insurance as a substantial part of

your activities.

4. Filing the Form 1023‑EZ



Pros:

(a) It’s much easier to prepare; and

(b) It’s typically processed in less than half the time it takes to process

Form 1023 (the IRS has reportedly processed the Form 1023‑EZ in

as few as two weeks).

Cons:

a. It does not provide sufficient guidance to the organization or the IRS

about whether the organization is organized to meet the requirements

of §501(c)(3). According to the National Taxpayer Advocate, in a

blistering criticism of Form 1023‑EZ, 37% of a representative sample

of Form 1023‑EZ applicants whose applications were approved by the

IRS were not, as a matter of law, §501(c)(3) organizations (i.e., they did

not qualify and could run into major problems if they ever get audited).

The report showed that a for‑profit corporation was granted §501(c)(3)

status because the IRS never reviewed its articles of incorporation (it is

not required with a 1023‑EZ application) and the applicant checked the

wrong box.

b. It does not require the organization to develop a business plan consistent

with §501(c)(3) before obtaining §501(c)(3) status, which is very likely

to cause greater compliance problems. While the Instructions to Form

1023‑EZ provide some information about what is necessary to operate

consistent with §501(c)(3), the organization is never required to identify

specifics about its operations (apart from checking a few boxes) to be

vetted by the IRS.

c. It will produce an IRS determination letter, assuming it is not rejected,

that will reveal to knowledgeable funders that Form 1023‑EZ was used to

obtain tax‑exemption. This may make the organization a less attractive



grantee because its governance structures, insider compensation and

transactions, and planned activities were not considerered by the IRS

unlike with organizations that received tax‑exempt status by filing Form

1023. [2017 UPDATE: The IRS has expressed that it has changed this

practice of issuing a different determination letter for applicants using the

Form 1023‑EZ.]

d. National Taxpayer Advocate’s Recommended Changes to the Form

1023‑EZ

i. Revise Form 1023‑EZ to require applicants, other than corporations

in states that make articles of incorporation publicly available online

at no cost, to submit their organizing documents.

ii. Revise Form 1023‑EZ to require applicants to provide a description

of their actual or planned activities and submit summary financial

information such as past and projected revenues and expenses.

iii. Make a determination only after reviewing the Form 1023‑EZ

application, the applicant’s organizing documents, its description of

actual or planned activities, and its financial information.

iv. Where there is a deficiency in an organizing document, require

an applicant to submit a copy of an amendment to its organizing

document that corrects the deficiency and has been approved by

the state, even where the documents are available online at no cost,

before conferring exempt status.



L. Form 990 – Which Form to File

1. Form 990N, Electronic Notice (e‑Postcard) for Tax‑Exempt Organizations Not

Required to File Form 990 or Form 990EZ:

a. The Pension Protection Act of 2006 added an annual filing requirement

for small tax‑exempt organizations to ensure that the IRS and potential

donors have current information about the organization.

b. Gross receipts are normally $50,000 or less,

c. Completed and filed electronically. There is no paper form.

d. Due every year by the 15th day of the 5th month after the close of the tax

year. The e‑Postcard cannot be filed until after the tax year ends.

e. No penalty assessed for late filing.

f. Failure to file for three consecutive years will result in automatic loss of

tax‑exempt status. Revocation occurs on the filing due date of the third

consecutively missed year.

2. Form 990N requires eight items of basic information:

a. Employer identification number,

b. Tax year,

c. Legal name and mailing address,

d. Any other the names the organization uses,

e. Name and address of a principal officer,

f. Web site address if the organization has one,

g. Confirmation that the organization’s annual receipts are $50,000 or less,

and

h. If applicable, a statement that the organization has terminated or is

terminating.

3. Form 990EZ, Short Form Return of Organization Exempt From Income Tax:



a. Gross receipts are more than $50,000 but less than $200,000 during the

tax year

b. Total valuation of assets less than $500,000. If assets exceed $500,000 file

Form 990 regardless of revenue

4. Form 990, Return of Organization Exempt From Income Tax:

a. Gross receipts greater than or equal to $200,000

b. Total valuation of assets equal to or greater than $500,000

5. Form 990‑PF, Return of Private Foundation or §4947(a)(1) Trust Treated as

Private Foundation:

a. Private foundations are typically not engaged in public‑facing, charitable

programs. Nor is it customary for a private foundation to be soliciting the

public for donations. It is far more normal that a private foundation be

closely funded and primarily grant money to public charities to assist the

charities in their activities.

b. Foundations often have investments and/or endowments, therefore,

considerable attention is generally given to investment earnings and

capital gains. Surprisingly to some, foundations are subject to a small

excise tax, usually 2% or less, on investment income. This excise tax is

something public charities do not pay.

c. Another area of focus unique to Form 990‑PF is the required

expenditures for charitable purposes. Per the IRS,“Private foundations

are required to spend annually a certain amount of money or property for

charitable purposes, including grants to other charitable organizations.”

d. Where Form 990‑PF differs greatly is in the filing threshold based on

gross receipts…there is none. Where public charities file a version of Form

990 that gets progressively more complex as gross revenues increase,

private foundations are liable for the entire Form 990‑PF, regardless of



income. In fact, if a private foundation has zero gross revenue for the

year, and even takes a loss on its investments, it still must prepare and

submit a complete return.

6. Schedules for Form 990 and Form 990‑EZ:

a. Schedule A: Organizations that file Form 990 or Form 990‑EZ use this

schedule to provide required information about public charity status and

public support.

b. Schedule B: Organizations that file Form 990 or Form 990‑EZ use this

schedule to provide information on contributions they received

c. Schedule C: §501(c) organizations, and §527 organizations use this

schedule to furnish additional information on political campaign

activities or lobbying activities

d. Schedule D: Organizations that file Form 990 use this schedule to

provide required reporting of donor advised funds, conservation

easements, certain art and museum collections, escrow accounts and

custodial arrangements, endowment funds, and supplemental financial

information.

e. Schedule E: Organizations that file Form 990 or Form 990‑EZ use this

schedule to report information on private schools.

f. Schedule F: Organizations that file Form 990 use this schedule to provide

information on their activities conducted outside the United States at any

time during the tax year.

g. Schedule G: Organizations that file Form 990 or Form 990‑EZ use this

schedule to report professional fundraising services, fundraising events,

and gaming.



h. Schedule H: Hospital organizations (File Form 990) use this schedule

to provide information on the activities and policies of, and community

benefit provided by, its hospital facilities and other non‑hospital health

care facilities that it operated during the tax year.

i. Schedule I: Organizations that file Form 990 use this schedule to

provide information on grants and other assistance made by the filing

organization during the tax year to organizations, governments, and

individuals in the United States.

j. Schedule J: Organizations that file Form 990 use this schedule to report

compensation information for certain officers, directors, individual

trustees, key employees, and highest compensated employees, and

information on certain compensation practices.

k. Schedule K: Organizations that file Form 990 use this schedule to provide

certain information on their outstanding liabilities associated with

tax‑exempt bond issues.

l. Schedule L: Organizations that file Form 990 or Form 990‑EZ use

this schedule to provide information on certain financial transactions

or arrangements between the organization and disqualified persons

under §4958 or other interested persons. This schedule is also used to

determine whether a member of the organization’s governing body is an

independent member.

m. Schedule M: Organizations that file Form 990 use this schedule to report

the types of noncash contributions they received during the year and

certain information regarding such contributions.

n. Schedule N: Organizations that file Form 990 or Form 990‑EZ use

this schedule to provide information relating to going out of existence

or disposing of more than 25 percent of their net assets through a

contraction, sale, exchange, or other disposition.



o. Schedule O: An organization should use this schedule, rather than

separate attachments, to provide the IRS with narrative information

required for responses to specific questions on Form 990 or 990‑EZ, and

to explain the organization’s operations or responses to various questions.

p. Schedule R: Organizations that file Form 990 use this schedule to provide

information on related organizations, on certain transactions with related

organizations, and on certain unrelated partnerships through which they

conduct significant activities.

M. Unrelated Business Income Tax Returns (UBIT)

1. For most organizations, a business activity generates unrelated business

income subject to taxation if:

a. It is a trade or business,

b. It is regularly carried on, and

c. It is not substantially related to furthering the exempt purpose of the

organization.

2. A trade or business includes the selling of goods or services with the intention

of having a profit.

3. An activity is regularly carried on if it occurs with a frequency and continuity,

similar to what a commercial entity would do if it performed the same activity.

4. An activity is substantially related to furthering the exempt purpose of the

organization if the activity contributes importantly to accomplishing the

organization’s purpose, other than for the sake of producing the income itself.



5. If a nonprofit organization receives income from providing services to

outside entities and the performance of those services does not further the

organization’s mission of the organization, the income may be unrelated

business income.

6. If a nonprofit organization sells advertising in print or on the organization’s

web site, the income is typically unrelated business income if the

advertisements promote the advertiser’s business and not the nonprofit

organization.

7. If a nonprofit organization licenses its intangible property and promotes an

outside entity’s business, the income may be unrelated business income. On

the other hand, if the nonprofit organization licenses its intangible property

and performs no other services related to the licensing, then the income is

considered passive income and it is typically not unrelated business income.

8. If a nonprofit organization has ownership in an S corporation, the income from

the S corporation is typically unrelated business income. Gain or loss from

the sale of stock in the S corporation stock is also typically unrelated business

income.

9. The IRS taxes unrelated business income at the corporate tax rates.

10. Certain types of income are not considered unrelated business income, such as

income from dividends; interest; royalties; rental of real property; research for

a federal, state, or local government; and charitable contributions, gifts, and

grants.

11. In addition, unrelated business income does not include income derived from

the work of unpaid volunteers, income from the sale of donated goods, income

from trade shows and conventions, income from legal gaming.



12. The Internal Revenue Service does not consider the receipt of assets from a

closely related tax‑exempt organization to be unrelated business income.

13. Form 990‑T, Exempt Organization Business Income Tax Return, must be

completed by tax‑exempt organizations to report income from unrelated

activities.

14. Changes under the Tax Cuts and Jobs Act (TCJA): under prior law exempt

organizations could combine their UBI from all sources, deduct the related

expenses, and pay any tax on the resulting net taxable income.

The new law, effective for tax years beginning after December 31, 2017,

requires exempt organizations conducting more than one unrelated trade or

business to calculate UBI separately for each unrelated trade or business. This

will prevent the practice of using losses from one specific unrelated trade or

business to offset income from another unrelated trade or business. Exempt

organizations with a net operating loss (NOL) incurred after the effective date

may only offset future income from that same trade or business. Additionally,

exempt organization NOL’s incurred after the effective date are further limited

to 80% of taxable income from that separate activity. Pre‑2018 NOL’s may

still be carried forward to future years without the percentage of income

limitations.



N. GDPR – What is It?

1. General Data Protection Regulation adopted in May 2016 and went into effect

on May 25, 2018.

2. The regulation coordinates a set of data and privacy protection laws for

individuals across 28 European countries, plus Iceland, Liechtenstein, and

Norway (known as the European Economic Area (EEA)).

3. GDPR’s 99 articles apply not only to European businesses, but to any company

or organization with personal information about individuals located in the

affected countries regardless of where they are located.

4. Under the new regulations, European residents have the right to:

a. Access their personal data,

b. rectify incomplete or inaccurate data,

c. be forgotten, and

d. restrict the processing of their data.

5. Personal data is defined by the European Commission as “any information

relating to an individual, whether it relates to his or her private, professional,

or public life. It can be anything from a name, a photo, an email address, bank

details, your posts on social networking websites, your medical information, or

computer’s IP address.”

6. The regulations also prohibit the processing, without consent, of sensitive data

on racial or ethnic origin, political opinions, religious or philosophical beliefs,

trade union membership, and sex life or sexual orientation.



7. Cvent, a provider of event management software, is used by the association

market to manage their meetings registration and recordkeeping. In keeping

with the compliance requirements of the GDPR, they used a data‑mapping

exercise required by the law to assure compliance.

8. Critical to the data‑mapping exercise are five key questions:

a. What data does the organization handle?

b. Where does it come from?

c. How is it being processed?

d. Why is it being collected?

e. Is it necessary for business operations?

9. The GDPR is seen as a fundamental shift in how data is processed and secured

and it is expected that other countries will adopt similar regulations.



II. Resources1. Publication 4220, Applying for 501(c)(3)

501(c)(3)501(c)(3)

501(c)(3)501(c)(3)501(c)(3)501(c)(3)

APPLYING for 501(c)(3) Tax-Exempt Status

Inside:

Why apply for 501(c)(3) tax-exempt status?

Who is eligible for 501(c)(3) status?

What responsibilities accompany 501(c)(3) status?

How do you apply for 501(c)(3) status?

Tax Exempt and Government Entities

EXEMPT ORGANIZATIONS

Publication 4220 (Rev. 3-2018) Catalog Number 37053T Department of the Treasury Internal Revenue Service www.irs.gov



1

Contents

Why Apply for 501(c)(3) Status? . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .3

Who is Eligible for 501(c)(3) Status? . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .3

501(c)(3) Organizations . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .4

Public Charities and Private Foundations . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .5

What Responsibilities Accompany 501(c)(3) Status? . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .6

Recordkeeping . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .6

Filing Requirements . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .6

Disclosure Requirements . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .7

Recordkeeping Requirements . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .8

How Do You Apply for 501(c)(3) Status? . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .8

When to File . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .9

Determination Letter. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .10

While Your Application is Pending . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .10

How Do You Get IRS Assistance and Information? . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 10

Specialized Assistance for Tax-Exempt Organizations . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .10

Tax Publications for Exempt Organizations . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .11

Forms for Exempt Organizations . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .12



2

501(c)(3)Applying for 501(c)(3) Tax-Exempt Status,

Federal tax law provides tax benefits to nonprofit organizations recognized as exempt

from federal income tax under Section 501(c)(3) of the Internal Revenue Code (IRC).

It requires that most organizations apply to the Internal Revenue Service (IRS) for that status.

This IRS Publication 4220 presents general guidelines for organizations that seek tax-exempt

status under IRC Section 501(c)(3). Content includes references to the statute, Treasury

Regulations, other IRS publications that explain the requirements for tax-exempt status and

IRS forms with instructions. Publication 4220 is neither comprehensive nor intended to

address every situation. As an alternative to applying for exemption, an organization may

obtain many of the benefits of 501(c)(3) status by affiliating with an existing charity that acts as

its agent. It is important to note that the existing charity must be given full control and author-

ity over the program.

To learn more about the rules and procedures that pertain to organizations applying for

exemption from federal income tax under IRC Section 501(c)(3), see

Publication 557,

Tax-Exempt Status for Your Organization. For assistance on 501(c)(3) status, you may also

want to consult a tax adviser.



3

Why Apply for 501(c)(3) Status?

The benefits of having 501(c)(3) status include exemption from federal income tax

and eligibility to receive tax-deductible charitable contributions. To qualify for these

benefits, most organizations must file an application with, and be recognized by,

the IRS as described in this publication. Another benefit is that some organizations

may be exempt from certain employment taxes.

Individual and corporate donors are more likely to support organizations with

501(c)(3) status because their donations can be tax deductible. Recognition of

exemption under IRC Section 501(c)(3) assures foundations and other grant-making

institutions that they are issuing grants or sponsorships to permitted beneficiaries.

An IRS determination of 501(c)(3) status is recognized and accepted for other

purposes. For example, state and local officials may grant exemption from income,

sales or property taxes. In addition, the U.S. Postal Service offers reduced postal

rates to certain organizations.

Who is Eligible for 501(c)(3) Status?

There are three key components for an organization to be exempt from federal

income tax under IRC Section 501(c)(3). A not-for-profit (in other words nonprofit)

organization must be organized and operated exclusively for one or more exempt

purposes.

Organized – A 501(c)(3) organization must be organized as a corporation, trust

or unincorporated association. An organization’s organizing documents (articles

of incorporation, trust documents, articles of association) must:

■ ■■ limit its purposes to those described in IRC Section 501(c)(3);

■ ■■ not expressly permit activities that do not further its exempt purposes, in other

words unrelated activities; and,

■ ■■ permanently dedicate its assets to exempt purposes.

Operated – Because a substantial portion of an organization’s activities must

further its exempt purpose, certain other activities are prohibited or restricted

including, but not limited to, the following activities. A 501(c)(3) organization:

■ ■■ must absolutely refrain from participating in the political campaigns of candidates

for local, state or federal office;

■ ■■ must restrict its lobbying activities to an insubstantial part of its total activities;

■ ■■ must ensure that its earnings do not inure to the benefit of any private

shareholder or individual;

■ ■■ must not operate for the benefit of private interests such as those of its founder,

the founder’s family, its shareholders or persons controlled by these interests;



4

■ ■■ must not operate for the primary purpose of conducting a trade or business that

is not related to its exempt purpose, such as a school’s operation of a factory; and,

■ ■■ must not have purposes or activities that are illegal or violate fundamental

public policy.

Exempt Purpose – To be tax exempt, an organization must have one or more

exempt purposes, stated in its organizing document. IRC Section 501(c)(3) lists the

following exempt purposes: charitable, educational, religious, scientific, literary,

fostering national or international sports competition, preventing cruelty

to children or animals, and testing for public safety.

501(c)(3) Organizations,

The most common types of 501(c)(3) organizations are charitable, educational and

religious.

CHARITABLE

Charitable organizations conduct activities that promote:

- relief of the poor, the distressed or the underprivileged

- advancement of religion

- advancement of education or science

- erection or maintenance of public buildings, monuments or works

- lessening the burdens of government

- lessening neighborhood tensions

- eliminating prejudice and discrimination

- defending human and civil rights secured by law

- combating community deterioration and juvenile delinquency

EDUCATIONAL

Educational organizations include:

- schools such as a primary or secondary school, a college, or a professional or trade school

- organizations that conduct public discussion groups, forums, panels, lectures or similar programs

- organizations that present a course of instruction by means of correspondence or through the use of television or radio

- museums, zoos, planetariums, symphony orchestras or similar organizations

- nonprofit day-care centers

- youth sports organizations

501 (c )(3 )



5

RELIGIOUS,

The term church includes synagogues, temples, mosques and similar types of organizations.

Although the IRC excludes these organizations from the requirement to file an application

for exemption, many churches voluntarily file applications for exemption. This recognition by the

IRS assures church leaders, members and contributors that the church is tax exempt under

IRC Section 501(c)(3) and qualifies for related tax benefits. Other religious organizations that

do not carry out the functions of a church, such as mission organizations, speakers’ organiza-

tions, nondenominational ministries, ecumenical organizations or faith-based social agencies,

may qualify for exemption. These organizations must apply for exemption from the IRS. See

Publication 1828, Tax Guide for Churches and Religious Organizations, for more details.

Public Charities and Private Foundations,

Every organization that qualifies for tax-exempt status under IRC Section 501(c)(3)

is further classified as either a public charity or a private foundation. Under

IRC Section 508(b), every organization is automatically classified as a private

foundation unless it meets one of the exceptions listed in Sections 508(c) or 509(a).

For some organizations, the primary distinction between a classification as a

public charity or a private foundation is the organization’s source of financial

support. Generally, a public charity has a broad base of support while a private

foundation has very limited sources of support. This classification is important

because different tax rules apply to the operations of each. Deductibility of

contributions to a private foundation is more limited than deductibility of

contributions to a public charity. See

Publication 526, Charitable Contributions, for

more information on deductibility of contributions. In addition, private foundations

are subject to excise taxes that are not imposed on public charities. For more

information about the special tax rules that apply to private foundations, see

Publication 4221-PF, Compliance Guide for 501(c)(3) Private Foundations, and the

Life Cycle of a Private Foundation website.

Organizations statutorily classified as public charities under IRC Section 509(a) are:

■■ ■churches;

■■ ■schools;

■■ ■organizations that provide medical or hospital care (including the provision of

medical education and in certain cases, medical research);

■■ ■organizations that receive a substantial part of their support in the form of

contributions from publicly supported organizations, governmental units and/or

from the general public;

■■ ■organizations that normally receive not more than one-third of their support

from gross investment income and more than one-third of their support from

contributions, membership fees and gross receipts from activities related to their

exempt functions; and,

■■ ■organizations that support other public charities.

If the organization requests public charity classification based on receiving support

from the public, it must continue to seek significant and diversified public support



6

in later years. Beginning with the organization’s sixth year of existence and for all

succeeding years, the organization must demonstrate in its annual return that it

receives the required amount of public support. If the organization does not meet

the public support requirement, it could be reclassified as a private foundation.

In addition, to avoid unexpectedly losing its public charity classification, the

organization should keep careful track of its public support information throughout

the year, so that it will have the information it needs to complete Schedule A,

Form 990 or 990-EZ. Unless the organization is committed to raising funds from

the public, it may be more appropriate to consider an alternate statutorily based

public charity classification. See

Publication 557, Tax-Exempt Status for Your

Organization, for assistance with determining how your organization would be

classified.

What Responsibilities Accompany 501(c)(3) Status?

While conferring benefits on 501(c)(3) organizations, federal tax law also imposes

responsibilities on organizations receiving that status.

Recordkeeping,

Section 501(c)(3) organizations are required to keep books and records detailing

all activities, both financial and nonfinancial. Financial information, particularly

information on its sources of support (contributions, grants, sponsorships and

other sources of revenue) is crucial to determining an organization’s private

foundation status. See Publications

4221-PC, 4221-PF, 557 and the instructions to

Forms 990, 990-EZ and 990-PF for more information.

Filing Requirements,

Annual Information Returns – Organizations recognized as tax exempt under

IRC Section 501(c)(3) may be required to file an annual information return - Form

990, Form 990-EZ, Form 990-N (see below) or Form 990-PF along with certain

schedules that may be required for your organization. Certain categories of

organizations are excepted from filing Form 990 or Form 990-EZ, including

churches. See the instructions with each of these forms and the publications in the

“Recordkeeping” section above for more information and guidance.

Annual Electronic Notice – To meet their annual filing requirement, organizations

with gross receipts normally $50,000 or less may choose to submit an annual

electronic notice using Form 990-N, Electronic Notice (e-Postcard) for Tax-Exempt

Organizations Not Required To File Form 990 or Form 990-EZ. The e-Postcard can

only be filed electronically; there is no paper version.

Any organization that fails to file a required annual return or notice for three

consecutive years will automatically lose its tax-exempt status, by act of law, as

of the due date of the return for the third consecutive year.



7

Unrelated Business Income Tax – In addition to filing Form 990, 990-EZ or

990-PF, an exempt organization must file Form 990-T if it has $1,000 or more of

gross income from an unrelated trade or business during the year. The organization

must make quarterly payments of estimated tax on unrelated business income if

it expects its tax liability for the year to be $500 or more. The organization may

use Form 990-W to help calculate the amount of estimated payments required. In

general, the tax is imposed on income from a regularly carried-on trade or business

that does not further the organization’s exempt purposes (other than by providing

funds). See

Publication 598, Tax on Unrelated Business Income of Exempt

Organizations, and the Form 990-T instructions for more information.

Disclosure Requirements,

Public Inspection of Exemption Applications and Returns – Section 501(c)(3)

organizations must make their applications (Form 1023 or 1023-EZ) and the

annual returns (Form 990, Form 990-EZ or Form 990-PF) available to the public

for inspection, upon request and without charge (except for a reasonable charge

for copying). Each annual return must be made available for a three-year period

starting with the filing date of the return. The IRS is also required to make these

documents available for public inspection and copying. These documents must be

made available at the organization’s principal office during regular business hours.

The requests may be made in person or in writing. See

Publication 557 for more

information.

For tax years beginning after August 17, 2006, Section 501(c)(3) organizations that

file unrelated business income tax returns (Forms 990-T) must make them available

for public inspection, and the IRS must make those returns publicly available.

Organizations should not include private information of donors or other individuals,

such as a Social Security number, in any information return.

Charitable Contributions—Substantiation and Disclosure – Organizations that

are tax exempt under IRC Section 501(c)(3) must meet certain requirements for

documenting charitable contributions. The federal tax law imposes two general

disclosure rules: 1) donors must obtain a written acknowledgment from a

charity for any single contribution of $250 or more before the donors can claim

a charitable contribution on their federal income tax returns and 2) a charitable

organization must provide a written disclosure to a donor who makes a payment

in excess of $75 partly as a contribution and partly for goods and services

provided by the organization. See Publication 1771, Charitable Contributions –

Substantiation and Disclosure Requirements, for more information.



8

Recordkeeping Requirements,

A donor cannot claim a tax deduction for any contribution of cash, a check or

other monetary gift made on or after January 1, 2007, unless the donor maintains

a record of the contribution in the form of either a bank record (such as a cancelled

check) or a written communication from the charity (such as a receipt or a letter)

showing the name of the charity, the date of the contribution and the amount of the

contribution.

How Do You Apply for 501(c)(3) Status?

Organizations that want to apply for 501(c)(3) status should be aware of the forms

required, the user fee, the filing deadline and the processing procedures.

FORMS TO FILE

Form SS-4,

An Employer Identification Number (EIN) is your account number with the IRS and is required regardless

of whether the organization has employees. Include the organization’s EIN on all correspondence to the

IRS. Apply for an EIN by faxing or mailing a completed Form SS-4, Application for Employer Identification

Number, to the IRS by calling or by submitting an online version of the form. (International applicants may

request an EIN by telephone.) Form SS-4 is available at Social Security Administration offices, by request

through the IRS at 800-829-3676 and by downloading the form from www.irs.gov. For more information

about EINs, see Publication 1635, Understanding Your EIN.

Do not apply for an EIN until your organization is legally formed. Applying for an EIN signals to IRS computer

systems that an organization has been created, and therefore triggers filing requirements.

TYPES OF APPLICATIONS,

Form 1023

Complete Form 1023, Application for Recognition of Exemption Under Section 501(c)(3) of the Internal Revenue Code, and mail to the address indicated in the instructions. If you submit a substantially incom-plete Form 1023, we’ll return the application package and user fee to you with a letter of explanation. We’ll also return your application package and user fee if you do not use the current version of Form 1023.

A substantially complete application includes:

- The current version of the application form found at www.irs.gov

- The correct user fee

- A signature by an authorized individual

- An employer identification number

- A statement of receipts and expenses

- A copy of your organizing document that meets the requirements of a conformed copy

- A detailed narrative of your proposed activities

- A copy of your bylaws or similar governing rules, if adopted

Note: If your particular letter request doesn’t require a listed element, we won’t consider that element when determining whether your application is substantially complete.

If we return your application package, our records won’t show a pending application for a determination let-ter. If you still want a determination letter, you must resubmit your entire application package, including the missing information and the correct user fee.



9

Form 1023-EZ

Small organizations may file Form 1023-EZ, Streamlined Application for Recognition of Exemption Under Section 501(c)(3) of the Internal Revenue Code, instead of Form 1023, and pay the required user fee. Form 1023-EZ must be filed electronically. For more information, see IRS.gov/charities-non-profits.

Form 1023, Interactive

Interactive version of Form 1023, Application for Recognition of Exemption Under Section 501(c)(3) of the Internal Revenue Code, includes helpful hints and links to help you submit a complete application.

Forms 2848 and 8821

Attach Form 2848, Power of Attorney and Declaration of Representative, if someone other than your princi-pal officer or director will represent you on matters about the application. Attach , Tax Information Authorization, if you want the IRS to be able to provide information about your application to someone other than a principal officer or director.

Form 8821

When to File,

Most organizations must file this application by the end of the 27th month after

they were legally formed.

Formation date: A corporation is legally formed when its articles of incorporation

are filed with the state, an unincorporated association is legally formed when its

organizing document is adopted by the signature of at least two individuals, and a

trust is legally formed when all non-charitable interests in the trust property expire

or when it is funded if there are no non-charitable interests.

An organization that is not a private foundation is not required to file an application

unless its annual gross receipts are normally more than $5,000. An organization

must file an application within 90 days of the end of the tax year in which it exceeds

this threshold.

Example 1: An organization that was created on January 1, 2016, and exceeds the

gross receipts threshold, must file an application by April 30, 2018.

Example 2: An organization that was created on January 1, 2015, but did not

exceed the gross receipts threshold until its tax year ending December 31, 2017,

must file an application by March 31, 2018.

An organization that files its application before the deadline will usually be

recognized as tax exempt under IRC Section 501(c)(3) from the date of

its creation, if it meets exemption requirements. An organization that files an

application after the deadline will usually be recognized as tax exempt from the

date of the application. It may also request exemption retroactive as of the date

of creation. See the instructions to the application form for more information.



10

Determination Letter,

The IRS tax specialist reviewing an application may request additional information

in writing. If all information received establishes that an organization meets the

requirements for exemption, the IRS will issue a determination letter recognizing

the organization’s exempt status and providing its foundation classification. This

is an important document that you should keep in the organization’s permanent

records.

While Your Application is Pending,

While an organization’s application is waiting for processing by the IRS, the

organization may operate as a tax-exempt organization.

Most organizations are required to file an annual information return (Form 990,

Form 990-EZ or Form 990-PF) or electronic notice (Form 990-N) while their

application for exemption is pending. An organization’s exempt status can be

automatically revoked while its application is pending if it has not filed a required

return or notice for three consecutive tax periods after its formation date. These

returns are subject to public disclosure. If the organization has unrelated business

income of more than $1,000, it must also file a Form 990-T. See Publication

4221-PC

or 4221-PF for more information.

Although donors have no assurance that contributions are tax-deductible for

federal income tax purposes until the application is approved, contributions

made while an application is pending would qualify if the application is approved.

However, if the application is disallowed, contributions would not qualify. Moreover,

the organization would be liable for filing federal income tax returns unless its

income is otherwise excluded from federal taxation.

The IRS Exempt Organizations website provides information about how to find out

about the status of an application for tax-exempt status.

How Do You Get IRS Assistance and Information?

The IRS offers help through live telephone assistance and with reading material that

is accessible either online, via mail or at IRS walk-in offices in many areas across

the country. IRS forms and publications can be downloaded from the internet and

ordered by telephone.

Specialized Assistance for Tax-Exempt Organizations,

Get help with questions about applying for tax-exempt status, annual filing

requirements and information about

exempt organizations.



11

EO Website www.irs.gov/filing/charities-non-profits,

Highlights:

■ ■■ Applying for Tax Exempt Status provides information about how to apply for IRS

recognition of tax-exempt status.

■■ ■Annual Reporting & Filing describes 990-series forms, requirements and filing

tips.

■■ ■Revoked? Reinstated? Learn More provides information about the automatic

revocation process and how to be reinstated.

■■ ■EO Select Check allows you to search for an organization’s tax-exempt status

and Form 990-N filings.

■■ ■How to Stay Exempt provides resources for tax-exempt nonprofit organizations.

■■ ■StayExempt.IRS.gov provides tax basics for exempt organizations.

■■ ■Educational Resources and Guidance provides EO related publications, forms,

official guidance and other materials.

Subscribe to the EO Update, an electronic newsletter with information for

tax-exempt organizations and tax practitioners who represent them.

EO Customer Service, 877-829-5500,

EO Determinations Office Mailing Address,


Exempt Organizations Determinations

Room 4024

P.O. Box 2508

Cincinnati, OH 45201

Fax Number 855-204-6184

Tax Publications for Exempt Organizations,

Download these publications or order a copy by calling the IRS at 800-829-3676.

Pub 15, Circular E, Employer’s Tax Guide,

Pub 15-A, Employer’s Supplemental Tax Guide,

Pub 15-B, Employer’s Tax Guide to Fringe Benefits

Pub 463, Travel, Entertainment, Gift, and Car Expenses

Pub 517, Social Security and Other Information for Members of the Clergy and

Religious Workers

Pub 526, Charitable Contributions,

Pub 538, Accounting Periods and Methods



12

Pub 557, Tax-Exempt Status for Your Organization,

Pub 583, Starting a Business and Keeping Records

Pub 598, Tax on Unrelated Business Income of Exempt Organizations

Pub 892, How to Appeal an IRS Determination on Tax-Exempt Status

Pub 1546, Taxpayer Advocate Service We are Here to Help You

Pub 1771, Charitable Contributions—Substantiation and Disclosure Requirements,

Pub 1828, Tax Guide for Churches and Religious Organizations,

Pub 3079, Tax-Exempt Organizations and Gaming,

Pub 3833, Disaster Relief, Providing Assistance Through Charitable Organizations,

Pub 4302, A Charity’s Guide to Vehicle Donation,

Pub 4303, A Donor’s Guide to Vehicle Donation,

Pub 4221-NC, Compliance Guide for Tax-Exempt Organizations (Other than 501(c)(3)

Public Charities and Private Foundations),

Pub 4221-PC, Compliance Guide for 501(c)(3) Public Charities

Pub 4221-PF, Compliance Guide for 501(c)(3) Private Foundations

Pub 4573, Group Exemptions

Pub 4779, Facts about Terminating or Merging Your Exempt Organization

Pub 5248, IRS Form 990-N Electronic Filing System (e-Postcard) User Guide

Forms for Exempt Organizations,

Download these forms or order a copy by calling the IRS at 800-829-3676.

Form SS-4, Application for Employer Identification Number

Form 911, Request for Taxpayer Advocate Service Assistance (And Application for

Taxpayer Assistance Order)

Form 941, Employer’s Quarterly Federal Tax Return,

Form 990, Return of Organization Exempt From Income Tax,

Form 990-EZ, Short Form Return of Organization Exempt From Income Tax,

Form 990-PF, Return of Private Foundation or Section 4947(a)(1) Nonexempt

Charitable Trust Treated as a Private Foundation

Form 990-N, Electronic Notice (e-Postcard) For Tax-Exempt Organizations Not

Required to File Form 990 or 990-EZ (available electronically only),

Form 990-T, Exempt Organization Business Income Tax Return,

Form 990-W, Estimated Tax on Unrelated Business Taxable Income for

Tax-Exempt Organizations,



13

Form 1023, Application for Recognition of Exemption Under Section 501(c)(3)

of the Internal Revenue Code

Form 1023, Interactive,

Form 1023-EZ, Streamlined Application for Recognition of Exemption Under

Section 501(c)(3) of the Internal Revenue Code

Form 1041, U.S. Income Tax Return for Estates and Trusts

Form 2848, Power of Attorney and Declaration of Representative

Form 3115, Application for Change in Accounting Method

Form 4720, Return of Certain Excise Taxes Under Chapters 41 and 42 of the

Internal Revenue Code,

Form 5578, Annual Certification of Racial Nondiscrimination for a Private School

Exempt from Federal Income Tax

Form 5768, Election/Revocation of Election by an Eligible Section 501(c)(3)

Organization to Make Expenditures to Influence Legislation,

Form 8282, Donee Information Return

Form 8283, Noncash Charitable Contributions

Form 8821, Tax Information Authorization

Form 8822, Change of Address

Form 8868, Application for Automatic Extension of Time To File an Exempt

Organization Return

Form 8879-EO, IRS e-file Signature Authorization for an Exempt Organization

FinCEN Form 114, Report of Foreign Bank and Financial Accounts

(filed with Treasury Department),



2. Tax Exempt and Government Entities: FY 2017 Accomplishments

Tax Exempt and Government Entities FY 2017 Accomplishments

March 19, 2018



Page 1 of 9

Contents

Message from the TE/GE Commissioners ................................................................................ 2

Exempt Organizations................................................................................................................ 3

Examinations – Exempt Organizations ................................................................................................. 3

Examinations – Federal State and Local Governments ..................................................................... 5

ACA Oversight ......................................................................................................................................... 5Compliance Checks ............................................................................................................................... 6

EO Determinations ................................................................................................................................. 6

Employee Plans............................................................................... ............................................7

Examinations ........................................................................................................................................... 7

Compliance Checks ............................................................................................................................... 7

EP Determinations ................................................................................................................................. 8

EP Voluntary Compliance ..................................................................................................................... 8

EP Technical ........................................................................................................................................... 8

Indian Tribal Governments & Tax-Exempt Bonds......................... .............................................9

Examinations ........................................................................................................................................... 9

Compliance Checks ............................................................................................................................... 9



Page 2 of 9

Message from the TE/GE Commissioners

In our FY 2018 Workplan Program Letter released on September 28, 2017, we promised to release the complete FY 2017 accomplishments under a separate document when final

results became available.

We are pleased to announce that these results are now available and encourage you to read the functions’ briefing documents below to learn more about the contributions of our tax

administration programs.

Photo and Signature Block for TE/GE Acting Commissioner

David W. Horton

Acting Commissioner, TE/GE

Photo and Signature Block for Acting Deputy TE/GE Commissioner

Robert S. Choi

Acting DeputyCommissioner, TE/GE



Page 3 of 9

Exempt Organizations

Examinations – Exempt Organizations

For fiscal year 2017, Exempt Organizations (EO) completed 6,101 examinations. Below is a general breakout by primary issue examined for each return closed for the fiscal year.

Fiscal Year 2017 Closures by Primary Issue Total

Filing, Organizational, Operational 2,332Employment Tax Issues 1,905Unrelated Business Income 603Revocation/Termination 216Inurement/Private Benefit 109Political, Legislative, Governance 93Other 843Total Closures 6,101

• The Filing, Operational, and Organizational subcategory includes closures where the primary issue involves verifying the exempt activities of the organization or its filing requirements. Many instances involve the securing of delinquent returns.

• Employment Tax Issues includes unreported compensation, tips, accountable plans, worker reclassifications, and noncompliance with FICA, FUTA, and backup withholding requirements.

• The Unrelated Business Income subcategory items includes gaming, nonmember income, expense allocation issues, NOL adjustments, rental activity, advertising, debt financed property rentals and investment income.

• The Revocation subcategory includes actual revocations, terminations, and foundation status changes (see additional information, below).

• The Inurement/Private Benefit subcategory includes closures with advisories on the potential for an organization’s activities to inure or provide private benefit to a disqualified person or other key individual associated with the organization. Adjustments in this category may include excise taxes.

• The Political, Legislative, and Governance subcategory includes closures with a primary emphasis on political, legislative and governance issues, including exempt function vs. taxable expenditures, financial oversight of the governing body, net investment income adjustments, and political expenditures of 501(c)(3) organizations.

• The Other subcategory items includes miscellaneous excise tax on gaming returns, taxes on self-dealing and failure to distribute income, healthcare issues, Chapter 41 and 42 taxes, and other abatements and penalties.



Page 4 of 9

Exempt Organizations (cont.)

Below is a table of final revocations resulting from examinations for fiscal year 2017 and the primary reason for the revocations.

Fiscal Year 2017 Final Revocations by Issue Total

Not Operating for an Exempt Purpose 36Inurement/Private Benefit 3 Non-member use of facilities – IRC 501(c)(7) 3 Other 21 Total Revocations 63

• Other instances of revocation include those due to discontinued operations, failure to provide records and/or record requests, and operating as a different subsection (self-declarer).

Post Determination Compliance Program: In fiscal year 2017, we completed examinations of 1,400 exempt organizations that filed Form 1023 or Form 1024 and were approved pursuant to thestreamlined process. The organizations were selected through a statistically valid sampling process. Roughly 57% of the examined returns closed with no changes. The remaining 43% of the examined returns had changes ranging from amendments to organizational documents and failure to file returns. Fourteen organizations were revoked or terminated.Another phase of post determination compliance exams was started in fiscal year 2017 with a stratified random sample of 418 exempt organizations which were granted exemption under the streamlined determination process. These examinations were conducted to identify organizations that filed a Form 1023 or Form 1024 and attested to perfect their organizing documents during the determination process. As of the end of September 2017, 38 of the organizations have been examined and closed. Forty-five percent of those examined returns were closed with no changes. The remaining 55% closed with either amendments to their organizing documents or other written advisories.We also continued post determination compliance examinations of exempt organizations that were granted tax exempt status through submission of a Form 1023EZ. A statistically valid random sample was used to select 1,182 organizations. As of the end of the fiscal year, 565 organizations have been examined and approximately 49% of those closed with no changes. The remaining 51% closed with amendments to their organizing documents or various other written advisories. Five of the examinations resulted in either terminations or revocations.Return Selection Using Modeling Techniques: During fiscal year 2017, we implemented Forms 990, 990-EZ, and 990-PF case selection modeling technique that use filters previously tested. For the fiscal year, we closed 1,505 returns selected through this process with an examination change rate of 83%. This is a good development, showing our selection modeling is improving. Our overall change rate for all cases closed for the fiscal year was 82%.



Page 5 of 9


Examinations – Federal State and Local Governments

During FY 2017, the Federal, State and Local Governments (FSLG) function was moved into Exempt Organizations (EO) from Government Entities (GE). The following table shows FSLG examination returns closed for the fiscal year.

Fiscal Year 2017 Closures by Segment Total

Entities with Employment Tax Wages $0<$2.5M 202Entities with Employment Tax Wages $2.5<$10M 371Entities with Employment Tax Wages $10<$40M 638Entities with Employment Tax Wages $40<$100M 229Entities with Employment Tax Wages > $100M 172Information Return Examinations 15Total Closures 1,627

FSLG employment tax issues included unreported compensation, worker reclassifications, noncompliance with accountable plans, FICA coverage, and backup withholding requirements.

Early Retirement Incentive Plan Compliance Initiative Project (CIP): This project addresses entities that provide "cash" (and other) options to their employees as an incentive to encourage them to voluntarily retire early. These options often result in employment tax issues that were not handled correctly by taxing the benefits under constructive receipt rules. As of the end of FY 2017, 304 Forms 941 were examined, resulting in assessed tax of over $7.8M.

ACA Oversight

As required by the Patient Protection and Affordable Care Act (ACA), we continue to review hospitals for compliance with IRC section 501(r). For the fiscal year, we completed 1,193 reviews and referred 388 hospitals for field examination. Issues for which referrals were made included:

• Lack of a Community Health Needs Assessment (CHNA) under IRC 501(r)(3)

• No Financial Assistance and/or Emergency Medical Care Policies under IRC 501(r)(4)

• Billing & Collection Requirements under IRC 501(r)(6).



Page 6 of 9


Compliance Checks

Exempt Organizations Compliance Unit (EOCU) addresses EO non-compliance issues. For the fiscal year, we had 1,289 Compliance Check closures.Projects conducted:

• Combined Annual Wage Reporting (CAWR) Employment Tax Non-Filers• 501(c)(7), Form 990T Non-filers• Modernized Electronic Filing (MEF) Enforcement• Charitable Remainder Trusts Non-filers• Non-Exempt Charitable Trust (NECT) 1041 Non-filers• 170(b)(1)(A)(vi) Self Declarer PF• 990PF Non-filers.

EO Determinations

In FY 2017, Exempt Organizations Rulings and Agreements (R&A) received more applications than projected, and closed fewer applications than expected due to staffing attrition and increased hours per case. However, R&A implemented several processing changes to enforce the tax law more effectively. Changes included proposing adverse determinations where organizations do not provide complete responses to requested information and issuing rebuttal letters rather than revised proposed adverse letters when protests to proposed adverse determinations do not change the proposed determinations.Form 1023-EZ submissions comprised 65% of total applications received for exemption under IRCSection 501(c)(3), slightly higher than expected. We worked with the Office of Chief Counsel to modify some of the Form 1023-EZ eligibility criteria. Changes included prohibiting organizationscurrently or previously exempt under a different subsection from using Form 1023-EZ to apply forrecognition of exemption under IRC 501(c)(3) and prohibiting organizations with any pendingapplication on file from submitting a Form 1023-EZ in lieu of the pending application. Thesechanges were implemented in Revenue Procedure 2017-5.

As required by the Protecting Americans from Tax Hikes Act of 2015 (the PATH Act), wecontinued to process Form 8976, Notice of Intent to Operate Under Section 501(c)(4), implemented in July 2016. In FY 2017, we received 2,182 notifications. We approved 82% of thenotifications received, and rejected 17% (with the remaining notifications in process at year end).The most common reasons for rejection were failure to pay the user fee and unnecessarynotification (e.g., the organizations were already exempt).

Fiscal Year 2017 EO Determination Cases Total

Receipts 95,177Closed Exemption Granted 91,975Closed Denial of Exemption 68



Page 7 of 9

Employee Plans

Examinations

For the 2017 fiscal year, Employee Plans (EP) completed 6,487 examinations. The categories of closed casework (conducted as field work and office correspondence, as appropriate) were:

Fiscal Year 2017 Closures by Workstream Total

Specialty Programs 1,687 Traditional Casework 3,486Focused Supplemental Work 1,314Total Closures 6,487

• Specialty Programs included EP Team Audit (EPTA)/Large Case, multiemployer plans, IRC 403(b)/457 plans, cash balance plans, hybrid 401(k) plans (such as those with the age weighted new comparability feature), and leveraged/non-leveraged employee stock ownership plans.

• Traditional Casework included various plan types (profit sharing, money purchase, defined benefit) from within the risk-based audit program, as well as taxpayer and interagency referrals, 401(k) plans, claims, reported funding deficiencies, and non-bank trustee investigations.

• Focused Supplemental Work included project work supplemented by the Emerging Issues program, the Learn, Educate, Self-correct, Enforce (LESE) program, the Individual Retirement Arrangement (EPs, SAR-SEPs, SIMPLES) program and the Form 5500-EZ (one participant plan) program.

Compliance Checks

EP also used the Employee Plans Compliance Unit (EPCU) to identify areas of non-compliance in plan operation and form through compliance check contacts and continued with its mandated programs: (1) collection of multiemployer certifications and validations; (2) review non–bank trustee’s notifications; and, (3) review pension plan funding for funding deficiencies. During FY 2017, 3,564 compliance checks were initiated and 3,768 compliance checks were closed, respectively.Projects conducted in FY 2017 included:

• SIMPLE plans• Merger/consolidations/transfers/spinoffs relating to Form 5310A filings• Issues surrounding terminated/partially terminated plans• Inflated assets and/or unusual investments• SEP plan issues including coverage of employees• 403(b) plan document requirements.



Page 8 of 9

Employee Plans (cont.)

EP Determinations

Individually Designed Plans (IDP) Program: Key measures for the EP Determinations IDP program are shown below, broken down by receipts and closures.

Fiscal Year 2017 Individually Designed Plans Total

Case Receipts: 4,680 Individually Designed Plans - Form 5300 3,553

Terminations - Form 5310 and Form 5316 909

Adopters of Modified Volume Submitter Plans - Form 5307 218

Case Closures 10,024

For comparison purposes, total receipts for FY 2015 and FY 2016 were 8,973 and 11,353, respectively. Total closures for FY 2015 and FY 2016 were 9,780 and 7,738, respectively.

Pre-Approved Plan (PAP) Program: Key measures for the EP Determinations PAP program are shown below, broken down by receipts and closures.

Fiscal Year 2017 Pre-Approved Plans Total

Case Receipts 286Case Closures 750

For comparison purposes, total receipts for FY 2015 and FY 2016 were 679 and 593, respectively. Total closures for FY 2015 and FY 2016 were 198 and 106, respectively.

EP Voluntary Compliance

Key measures for the EP Voluntary Compliance program are shown below, broken down by receipts and closures.

Fiscal Year 2017 Voluntary Compliance Activity Total

Case Receipts 4,183Case Closures 3,169

For comparison purposes, total receipts for FY 2015 and FY 2016 were 3,437 and 4,098, respectively. Total closures for FY 2015 and FY 2016 were 3,990 and 4,001, respectively.

EP Technical

EP Technical produced 12 Issue Snapshots job aids that provide analysis and resources for agiven technical tax issue to be used by employees when working cases. These job aids canbe found on IRS.gov.



Page 9 of 9

Indian Tribal Governments & Tax Exempt Bonds

As part of its reorganization, TE/GE combined the Indian Tribal Governments (ITG) and Tax-Exempt Bonds (TEB) functions. The scope and mission of a combined ITG/TEB will remain the same as it was when the functions were separate: assist Indian Tribes with addressing their federal tax matters and administer federal tax laws applicable to tax-advantaged bonds. The Government Entities Compliance Unit (GECU) also provides additional support, as needed.

Examinations

For the 2017 fiscal year, ITG examinations focused on employment tax and fraud investigations, while TEB examinations focused on claims, referrals, prison financings, small issue bonds, private placement governmental bonds, and IRC 501(c)(3) bonds. Meanwhile, Government Entities Compliance Unit (GECU) examinations focused on claims and employment tax.

The following table shows ITG, TEB and GECU examination closures for the fiscal year.

Fiscal Year 2017 Closures by Function Total

Indian Tribal Governments 195Tax-Exempt Bonds 717Government Entities Compliance Unit 270Total Closures 1,182

Compliance Checks

During FY 2017, compliance check contacts included employment tax compliance checks and tip agreement work that converted the Tip Rate Determination Agreement (TRDA) to the more appropriate Gaming Industry Tip Compliance Agreement (GITCA).

The following table shows completed ITG and GECU compliance checks for the fiscal year.

Fiscal Year 2017 Compliance Checks by Function Total

Indian Tribal Governments 154Government Entities Compliance Unit 480Total Compliance Checks 634



3. Form 1023, Application for Recognition of Exemption

Form 1023-EZ(June 2014)

Streamlined Application for Recognition of Exemption Under Section 501(c)(3) of the Internal Revenue Code

Do not enter social security numbers on this form as it may be made public. Information about Form 1023-EZ and its separate instructions is at www.irs.gov/form1023.

Department of the Treasury Internal Revenue Service

OMB No. 1545-0056

Note: If exempt status is approved, this application will be open for public inspection.

Check this box to attest that you have completed the Form 1023-EZ Eligibility Worksheet in the current instructions, are eligible to apply for exemption using Form 1023-EZ, and have read and understand the requirements to be exempt under section 501(c)(3).

Part I Identification of Applicant

1a Full Name of Organization

b Address (number, street, and room/suite). If a P.O. box, see instructions. c City d State e Zip Code + 4

2 Employer Identification Number 3 Month Tax Year Ends (MM) 4 Person to Contact if More Information is Needed

5 Contact Telephone Number 6 Fax Number (optional) 7 User Fee Submitted

8 List the names, titles, and mailing addresses of your officers, directors, and/or trustees. (If you have more than five, see instructions.)First Name: Last Name: Title:

Street Address: City: State: Zip Code + 4:

First Name: Last Name: Title:








9 a Organization's Website (if available):

b Organization's Email (optional):

Part II Organizational Structure

1 To file this form, you must be a corporation, an unincorporated association, or a trust. Check the box for the type of organization.

Corporation Unincorporated association Trust

2 Check this box to attest that you have the organizing document necessary for the organizational structure indicated above.

(See the instructions for an explanation of necessary organizing documents.)

3 Date incorporated if a corporation, or formed if other than a corporation (MMDDYYYY):

4 State of incorporation or other formation:

5 Section 501(c)(3) requires that your organizing document must limit your purposes to one or more exempt purposes within section 501(c)(3).

Check this box to attest that your organizing document contains this limitation.

6 Section 501(c)(3) requires that your organizing document must not expressly empower you to engage, otherwise than as an insubstantial part of your activities, in activities that in themselves are not in furtherance of one or more exempt purposes.

Check this box to attest that your organizing document does not expressly empower you to engage, otherwise than as an insubstantial part of your activities, in activities that in themselves are not in furtherance of one or more exempt purposes.

7 Section 501(c)(3) requires that your organizing document must provide that upon dissolution, your remaining assets be used exclusively for section 501(c)(3) exempt purposes. Depending on your entity type and the state in which you are formed, this requirement may be satisfied by operation of state law.

Check this box to attest that your organizing document contains the dissolution provision required under section 501(c)(3) or that you do not need an express dissolution provision in your organizing document because you rely on the operation of state law in the state in which you are formed for your dissolution provision.

For Paperwork Reduction Act Notice, see the instructions. Catalog No. 66267N Form 1023-EZ (6-2014)

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You must complete the Form 1023-EZ Eligibility Worksheet in the Instructions for Form 1023-EZ todetermine if you are eligible to file this form. Form 1023-EZ is filed electronically only on Pay.gov.

Go to www.irs.gov/form1023ez for additional filing information.



Form 1023-EZ (6-2014) Page 2

Part III Your Specific Activities

1 Enter the appropriate 3-character NTEE Code that best describes your activities (See the instructions):

2 To qualify for exemption as a section 501(c)(3) organization, you must be organized and operated exclusively to further one or more of the following purposes. By checking the box or boxes below, you attest that you are organized and operated exclusively to further the purposes indicated. Check all that apply.

Charitable Religious Educational

Scientific Literary Testing for public safety

To foster national or international amateur sports competition Prevention of cruelty to children or animals

3 To qualify for exemption as a section 501(c)(3) organization, you must:

• Refrain from supporting or opposing candidates in political campaigns in any way.

• Ensure that your net earnings do not inure in whole or in part to the benefit of private shareholders or individuals (that is, board members, officers, key management employees, or other insiders).

• Not further non-exempt purposes (such as purposes that benefit private interests) more than insubstantially.

• Not be organized or operated for the primary purpose of conducting a trade or business that is not related to your exempt purpose(s).• Not devote more than an insubstantial part of your activities attempting to influence legislation or, if you made a section 501(h) election, not

normally make expenditures in excess of expenditure limitations outlined in section 501(h).• Not provide commercial-type insurance as a substantial part of your activities.

Check this box to attest that you have not conducted and will not conduct activities that violate these prohibitions and restrictions.

4 Do you or will you attempt to influence legislation? . . . . . . . . . . . . . . . . . . . . . .

(If yes, consider filing Form 5768. See the instructions for more details.)

Yes No

5 Do you or will you pay compensation to any of your officers, directors, or trustees? . . . . . . . . . . . . (Refer to the instructions for a definition of compensation.)

Yes No

6 Do you or will you donate funds to or pay expenses for individual(s)? . . . . . . . . . . . . . . . . Yes No

7 Do you or will you conduct activities or provide grants or other assistance to individual(s) or organization(s) outside the United States? . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Yes No

8 Do you or will you engage in financial transactions (for example, loans, payments, rents, etc.) with any of your officers, directors, or trustees, or any entities they own or control? . . . . . . . . . . . . . . . . . . . . Yes No

9 Do you or will you have unrelated business gross income of $1,000 or more during a tax year? . . . . . . . . . Yes No

10 Do you or will you operate bingo or other gaming activities? . . . . . . . . . . . . . . . . . . . Yes No

11 Do you or will you provide disaster relief? . . . . . . . . . . . . . . . . . . . . . . . . Yes No

Part IV Foundation Classification

Part IV is designed to classify you as an organization that is either a private foundation or a public charity. Public charity status is a more favorable tax status than private foundation status.

1 If you qualify for public charity status, check the appropriate box (1a – 1c below) and skip to Part V below.

a Check this box to attest that you normally receive at least one-third of your support from public sources or you normally receive at least 10 percent of your support from public sources and you have other characteristics of a publicly supported organization. Sections 509(a)(1) and 170(b)(1)(A)(vi).

b Check this box to attest that you normally receive more than one-third of your support from a combination of gifts, grants, contributions, membership fees, and gross receipts (from permitted sources) from activities related to your exempt functions and normally receive not more than one-third of your support from investment income and unrelated business taxable income. Section 509(a)(2).

c Check this box to attest that you are operated for the benefit of a college or university that is owned or operated by a governmental unit. Sections 509(a)(1) and 170(b)(1)(A)(iv).

2 If you are not described in items 1a – 1c above, you are a private foundation. As a private foundation, you are required by section 508(e) to have specific provisions in your organizing document, unless you rely on the operation of state law in the state in which you were formed to meet these requirements. These specific provisions require that you operate to avoid liability for private foundation excise taxes under sections 4941-4945.

Check this box to attest that your organizing document contains the provisions required by section 508(e) or that your organizing document does not need to include the provisions required by section 508(e) because you rely on the operation of state law in your particular state to meet the requirements of section 508(e). (See the instructions for explanation of the section 508(e) requirements.)

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Form 1023-EZ (6-2014) Page 3

Part V Reinstatement After Automatic Revocation

Complete this section only if you are applying for reinstatement of exemption after being automatically revoked for failure to file required annual returns or notices for three consecutive years, and you are applying for reinstatement under section 4 or 7 of Revenue Procedure 2014-11. (Check only one box.)

1 Check this box if you are seeking retroactive reinstatement under section 4 of Revenue Procedure 2014-11. By checking this box, you attest that you meet the specified requirements of section 4, that your failure to file was not intentional, and that you have put in place procedures to file required returns or notices in the future. (See the instructions for requirements.)

2 Check this box if you are seeking reinstatement under section 7 of Revenue Procedure 2014-11, effective the date you are filling this application.

Part VI Signature

I declare under the penalties of perjury that I am authorized to sign this application on behalf of the above organization and that I have examined this application, and to the best of my knowledge it is true, correct, and complete.

PLEASE SIGN HERE

(Type name of signer) (Type title or authority of signer)

(Signature of Officer, Director, Trustee, or other authorized official) (Date)

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Userid: CPM Schema: instrx Leadpct: 100% Pt. size: 9 Draft Ok to PrintAH XSL/XML Fileid: … /I1023EZ/201801/A/XML/Cycle06/source (Init. & Date) _______Page 1 of 23 14:20 - 26-Dec-2017The type and rule above prints on all proofs including departmental reproduction proofs. MUST be removed before printing.

Instructions for Form 1023-EZ(Rev. January 2018)Streamlined Application for Recognition of Exemption Under Section 501(c)(3) of the Internal Revenue Code

Department of the TreasuryInternal Revenue Service

Section references are to the Internal Revenue Code unless otherwise noted.Contents PageGeneral Instructions . . . . . . . . . . . . . . . . . . . . . . . . . 1

Purpose of Form . . . . . . . . . . . . . . . . . . . . . . . . 1Who Can File This Form . . . . . . . . . . . . . . . . . . . 1How To File . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1User Fee . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2When To File (Effective Date of Exemption) . . . . . 2Filing Assistance . . . . . . . . . . . . . . . . . . . . . . . . 2Signature Requirements . . . . . . . . . . . . . . . . . . . 2Annual Filing Requirements . . . . . . . . . . . . . . . . . 2Public Inspection . . . . . . . . . . . . . . . . . . . . . . . . 2State Registration Requirements . . . . . . . . . . . . . 3

Specific Instructions . . . . . . . . . . . . . . . . . . . . . . . . . 3Part I. Identification of Applicant . . . . . . . . . . . . . . 3Part II. Organizational Structure . . . . . . . . . . . . . . 4Part III. Your Specific Activities . . . . . . . . . . . . . . . 5Part IV. Foundation Classification . . . . . . . . . . . . . 8Part V. Reinstatement After Automatic

Revocation . . . . . . . . . . . . . . . . . . . . . . . . . . 12Part VI. Signature . . . . . . . . . . . . . . . . . . . . . . . 12

Form 1023-EZ Eligibility Worksheet (Must be completed prior to completing Form 1023-EZ) . . . . . . . . . . . . . . . . . . . . . . . . . . . . 13

National Taxonomy of Exempt Entities (NTEE) Codes. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 21

Future DevelopmentsFor the latest information about developments related to Form 1023-EZ and its instructions, such as legislation enacted after they were published, go to IRS.gov/Form 1023-EZ.ReminderDon’t include social security numbers on publicly disclosed forms. Because the IRS is required to disclose approved exemption applications and information returns, exempt organizations should not include social security numbers on these forms. Documents subject to disclosure include correspondence with the IRS about the filing.

Photographs of Missing ChildrenThe Internal Revenue Service is a proud partner with the National Center for Missing & Exploited Children® (NCMEC). Photographs of missing children selected by the Center may appear in instructions on pages that would otherwise be blank.You can help bring these children home by looking at the photographs and calling 1-800-THE-LOST (1-800-843-5678) if you recognize a child.

Email SubscriptionThe IRS has established a subscription-based email service for tax professionals and representatives of tax-exempt organizations. Subscribers will receive periodic updates from the IRS regarding exempt organization tax law and regulations, available services, and other information. To subscribe, visit IRS.gov/Charities.

General Instructions“You” and “Us”. Throughout these instructions and Form 1023-EZ, the terms “you” and “your” refer to the organization that is applying for tax-exempt status. The terms “us” and “we” refer to the Internal Revenue Service.Purpose of FormForm 1023-EZ is the streamlined version of Form 1023, Application for Recognition of Exemption Under Section 501(c)(3) of the Internal Revenue Code. Any organization may file Form 1023 to apply for recognition of exemption from federal income tax under section 501(c)(3). Only certain organizations are eligible to file Form 1023-EZ (see Who Can File This Form, below).Note. Most organizations seeking exemption from federal income tax under section 501(c)(3) are required to complete and submit an application. However, the following types of organizations may be considered tax exempt under section 501(c)(3) even if they do not file Form 1023 or Form 1023-EZ.

Churches, including synagogues, temples, and mosques.Integrated auxiliaries of churches and conventions or associations of churches.Any organization that has gross receipts in each taxable year of normally not more than $5,000.

Who Can File This FormOnly certain organizations are eligible to apply for exemption under section 501(c)(3) using Form 1023-EZ. To determine if you are eligible to file Form 1023-EZ, you must complete the Form 1023-EZ Eligibility Worksheet.

If you answer “Yes” to any of the worksheet questions, you are not eligible to apply for exemption under section 501(c)(3) using Form 1023-EZ. You must apply on Form

1023. If you answer “No” to all of the worksheet questions, you may apply using Form 1023-EZ.

Before completing either Form 1023 or Form 1023-EZ, we recommend reading “Life Cycle of an Exempt Organization” at IRS.gov/Charities.

How To FileForm 1023-EZ can only be filed electronically by going to IRS.gov/Form1023-EZ or Pay.gov (enter the term “Form 1023-EZ” in the search box). We will not accept printed copy submissions of the application.

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Page 2 of 23 Fileid: … /I1023EZ/201801/A/XML/Cycle06/source 14:20 - 26-Dec-2017The type and rule above prints on all proofs including departmental reproduction proofs. MUST be removed before printing.

We recommend you preview and print a copy of your application for your records before submitting it electronically.

User FeeA user fee is required to process your application. This fee must be paid through Pay.gov when you file your application. Payments can be made directly from your bank account or by credit/debit card. For the current exempt organization user fee amounts, go to IRS.gov/charities-non-profits/user-fess-for-tax-exempt-and-government-entities-division. You can also call 877-829-5500.When To File (Effective Date of Exemption)Generally, if you file Form 1023-EZ within 27 months after the end of the month in which you were legally formed, and we approve the application, the legal date of formation will be the effective date of your exempt status.

If you do not file Form 1023-EZ within 27 months of formation, the effective date of your exempt status will be the date you filed Form 1023-EZ (submission date).

If you do not file Form 1023-EZ within 27 months of formation, and you believe you qualify for an earlier effective date than the submission date, you can request the earlier date by sending correspondence to the address below. The correspondence should include your name, employer identification number (EIN), the effective date you are requesting, an explanation of why the earlier date is warranted, and any supporting documents. This correspondence should be sent after you receive your Determination Letter. Alternatively, you may complete Form 1023 in its entirety instead of completing Form 1023-EZ.Note. If you have been automatically revoked and are seeking retroactive reinstatement, see Part V. Reinstatement After Automatic Revocation of these instructions. Send effective date correspondence to: Internal Revenue ServiceExempt Organizations DeterminationsRoom 4024P.O. Box 2508Cincinnati, OH 45201Application ProcessSubmitting this application does not guarantee exemption will be recognized. If your application is incomplete or not completed correctly, it may be rejected. In addition, you may be contacted for additional information. Also, the IRS will select a statistically valid random sample of applications for pre-determination reviews, which may also result in requests for additional information.Filing AssistanceFor help in completing this form or general questions relating to an exempt organization, call Exempt Organization Customer Account Services toll free at 877-829-5500. You may also access information on our website at IRS.gov/Charities.

The following publications are available to you for further information.

Publication 517, Social Security and Other Information for Members of the Clergy and Religious WorkersPublication 526, Charitable ContributionsPublication 557, Tax-Exempt Status for Your Organization Publication 598, Tax on Unrelated Business Income of Exempt Organizations

TIPPublication 1771, Charitable Contributions–Substantiation and Disclosure RequirementsPublication 1828, Tax Guide for Churches and Religious OrganizationsPublication 3079, Tax-Exempt Organizations and GamingPublication 3833, Disaster Relief: Providing Assistance Through Charitable OrganizationsPublication 4220, Applying for 501(c)(3) Tax-Exempt StatusPublication 4221, Compliance Guide for 501(c)(3) Tax-Exempt Organizations

Signature RequirementsAn officer, director, or trustee listed in Part I, line 8, who is authorized to sign for the organization must sign Form 1023-EZ. The signature must be accompanied by the title or authority of the signer and the date.Annual Filing RequirementsGenerally, an organization that qualifies for exemption under section 501(c)(3) is required to file an annual return in accordance with section 6033(a). However, an eligible organization, other than a private foundation, that normally has gross receipts of less than $50,000 is not required to file an annual return, but must furnish an annual electronic notice on Form 990-N (e-Postcard) providing the information required by section 6033(i). See Rev. Proc. 2011-15, 2011-3 I.R.B. 322. Failure to file a required return or notice for three consecutive years will result in auto-revocation of your tax-exempt status.

An organization that is required to file a Form 990-series annual information return or submit Form 990-N must do so even if its application for recognition of exemption has not been filed or has been filed but not yet approved.

If an annual information return or tax return is due while Form 1023-EZ is pending, complete the return, check the “Application pending” box in the heading, and send the return to the address indicated in the instructions.

If Form 990-N is due while Form 1023-EZ is pending, the organization may need to contact the IRS at 877-829-5500 and ask for an account to be established for the organization so that it may file the notice.

Information on annual information return and electronic notice filing requirements and exceptions to the filing requirements may be found in Pub. 557 and at IRS.gov/Charities.

Form 1023-EZ does not allow you to request an exception to filing Form 990, Return of Organization Exempt From Income Tax; Form 990-EZ, Short Form Return of Organization Exempt From Income Tax; or Form 990-N. If your request for recognition of tax-exempt status is granted on Form 1023-EZ, you will be required to submit Form 990, 990-EZ, or 990-N depending on your gross receipts and assets. If you believe that you meet an exception to filing Form 990, 990-EZ, or 990-N, and wish to obtain that exception at the time of filing your application, then you should submit Form 1023 instead of Form 1023-EZ. Otherwise, you may request IRS recognition of this exception by filing Form 8940, Request for Miscellaneous Determination. A user fee must accompany Form 8940.Note. You do not need to notify the IRS that you are excepted from the annual filing requirement under section 6033(a) if your basis for the exception is that you are not a private foundation, your gross receipts are normally less than $50,000, and you are filing Form 990-N.Public InspectionInformation available for public inspection. If we approve exempt status under section 501(c)(3), both you and the IRS

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must make your application and related documents available for public inspection. For more information, please go to IRS.gov/Charities- &-Non-Profits/Exempt-Organization-Public-Disclosure-and-Availability-Requirements.State Registration RequirementsTax exemption under section 501(c)(3) is a matter of federal law. After receiving federal tax exemption, you may also be required to register with one or more states to solicit contributions or to obtain exemption from state taxes. The National Association of State Charity Officials (NASCO) maintains a website that provides informational links to the various states for these purposes. It can be accessed at nasconet.org.Donor Reliance on a Favorable DeterminationGenerally, donors and contributors may rely on an organization’s favorable Determination Letter under section 501(c)(3) until the IRS publishes notice of a change in status, unless the donor or contributor was responsible for or aware of the act or failure to act that results in the revocation of the organization’s Determination Letter. See Rev. Proc. 2011-33, 2011-25 I.R.B. 887.

Specific InstructionsBefore completing the Form 1023-EZ, you must complete the Form 1023-EZ Eligibility Worksheet. If you meet the eligibility requirements, you must check the box at the top of Form 1023-EZ to attest that you are eligible to file the form. By checking the box, you are also attesting that you have read and understand the requirements to be exempt under section 501(c)(3). You are not required to submit the eligibility worksheet with your form. However, you should retain the worksheet for your records.You must also check the boxes regarding your gross receipts and total assets. If you check “Yes” to those questions, you do not meet the requirements to submit Form 1023-EZ; instead, file Form 1023. For additional information regarding the gross receipts and assets requirements, see questions 1 through 3 on the Form 1023-EZ Eligibility Worksheet.Part I. Identification of ApplicantLine 1a. Full name of organization. Enter your complete name exactly as it appears in your organizing document, including amendments.Line 1b–1e. Mailing address. Enter your complete address where all correspondence will be sent. If mail is not delivered to the street address and you have a P.O. box, enter your box number instead of the street address.Line 2. Employer identification number (EIN). Enter the nine-digit EIN assigned to you.

You will not be able to submit this application until you have obtained an EIN.

All organizations must have an EIN. An EIN is required regardless of whether you have employees.

If the organization doesn't have an EIN, it must apply for one. An EIN can be applied for by visiting the IRS website at IRS.gov/EIN.

The organization may also apply for an EIN by faxing or mailing Form SS-4 to the IRS. Organizations outside the United States or U.S. possessions may also apply for an EIN by calling 267-941-1099 (toll call). Don't apply for an EIN more than once.

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Line 3. Month tax year ends (01-12). Enter the month that your tax year (annual accounting period) ends, using a two-digit number format. For example, if your annual accounting period ends in December, enter “12.” Your annual accounting period is the 12-month period on which your annual financial records are based. Your first tax year could be less than 12 months. Check your bylaws or other rules of operation for consistency with the annual accounting period entered on line 3.Line 4. Person to contact if more information is needed. Enter the name and title of the person to contact if more information is needed. The person to contact may be an officer, director, trustee, or other individual who is permitted to speak with us according to your bylaws or other rules of operation. Your person to contact may also be an “authorized representative,” such as an attorney, certified public accountant (CPA), or enrolled agent (EA).Note. We will request a Form 2848, Power of Attorney and Declaration of Representative, if we need to contact an authorized representative for additional information.Line 5. Contact telephone number. Provide a daytime telephone number for the contact listed on line 4.Line 6. Fax number. Provide a fax number for the contact listed on line 4.Line 7. User fee submitted. Enter the user fee amount paid.Line 8. List the names, titles, and mailing addresses of your officers, directors, and/or trustees. Enter the full names, titles, and mailing addresses of your officers, directors, and/or trustees. You may use the organization's address for mailing. If you have more than five, list only five in the order below.

1. President or chief executive officer or chief operating officer.2. Treasurer or chief financial officer.3. Chairperson of the governing body.4. Any officers, directors, and trustees who are substantial

contributors (not already listed above).5. Any other officers, directors, and trustees who are related to

a substantial contributor (not already listed above).6. Voting members of the governing body (not already listed

above).7. Officers (not already listed above).

If an individual serves in more than one office (for example, as both an officer and director), list this individual on only one line and list all offices held.

An officer is a person elected or appointed to manage the organization’s daily operations, such as president, vice president, secretary, treasurer, and, in some cases, board chair. The officers of an organization are determined by reference to its organizing document, bylaws, or resolutions of its governing body, or otherwise designated consistent with state law.

A director or trustee is a member of the organization’s governing body, but only if the member has voting rights.Line 9a. Organization’s website. Enter your current website address, as of the date of filing this application. If you do not maintain a website, enter “N/A” (not applicable).Line 9b. Organization’s email. Enter your email address to receive educational information from us in the future. Because of security concerns, we cannot send or respond to confidential information via email.

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Part II. Organizational StructureLine 1. Entity type. Only certain corporations, unincorporated associations, and trusts are eligible for tax-exempt status under section 501(c)(3). Sole proprietorships, partnerships, and loosely affiliated groups of individuals are not eligible. Check the appropriate box to indicate whether you are a corporation, an association, or a trust.Note. Even though limited liability companies (LLCs) are eligible to receive exemption under section 501(c)(3), they are not eligible to apply for exemption using this form.

Corporation. A “corporation” is an entity organized under a federal or state statute, or a statute of a federally recognized Indian tribal or Alaskan native government. A corporation’s organizing document is generally referred to as its “articles of incorporation.” A corporation must be incorporated under the non-profit or non-stock laws of the jurisdiction in which it incorporates.

Unincorporated association. An “unincorporated association” formed under state law must have at least two members who have signed a written document for a specifically defined purpose.

Trust. A trust may be formed by a trust agreement or a declaration of trust. A trust may also be formed through a will.Line 2. Necessary organizing document. See below for your organization type.

Corporation. If incorporated under a federal, state, or federally recognized Indian tribal or Alaskan native government statute, you have a “necessary organizing document” if your organizing document shows certification of filing. This means your organizing document shows evidence that on a specific date it was filed with and approved by an appropriate state authority.

Unincorporated association. In order to be a “necessary organizing document,” your articles of organization must include your name, your purpose(s), the date the document was adopted, and the signatures of at least two individuals.

Bylaws may be considered an organizing document only if they are properly structured to include your name, purpose(s), signatures, and intent to form an organization.

Trust. In order for your trust agreement or declaration of trust to be a “necessary organizing document,” it must contain appropriate signature(s) and show the exact date it was formed.Line 3. Formation date. See below for your organization type.

Corporation. If you are a corporation, you should enter the date that the appropriate authority filed your articles of incorporation or other organizing document.

Unincorporated association. If you are an unincorporated association, you should enter the date that your organizing document was adopted by the signatures of at least two individuals.

Trust. If your trust was formed by a trust agreement or a declaration of trust and does not provide for distributions to non-charitable interests, enter the date the trust was funded. Generally, a trust must be funded with property, such as money, real estate, or personal property, to be legally created.

If your trust document provides for distributions for non-charitable interests, enter the date on which these interests expired. If your trust agreement continues to provide for non-charitable interests, you will not qualify for tax-exempt status.

If you were formed by a will, enter the date of death of the testator or the date any non-charitable interests expired, whichever is later.

Note. If you amended your organizational documents to comply with the requirements of section 501(c)(3), enter the date of amendment, unless the amendment was nonsubstantive within the meaning of Rev. Proc. 2017-5, 2017-1 I.R.B. 230 (or its successor).Line 4. State of formation. Enter the jurisdiction (for instance, the state or the federally recognized tribal government) under the laws of which you were incorporated or otherwise formed. If you are a corporation, this may not be the place in which you are physically located. For example, if you are physically located in New York, but incorporated under Massachusetts law, enter Massachusetts.Line 5. Purpose(s) clause. Your organizing document must limit your purposes to those described in section 501(c)(3). Those purposes are: charitable, religious, educational, scientific, literary, testing for public safety, fostering national or international amateur sports competition, and preventing cruelty to children or animals. See discussion of these purposes under Part III, line 3 of these instructions.

If your purposes are limited by referring to section 501(c)(3), your organizing document also properly limits your purposes. For example, the phrase “relief of the elderly within the meaning of section 501(c)(3)” in your organizing document also properly limits your purposes.

However, if the purposes listed in your organizing document are broader than those listed in section 501(c)(3), you should amend your organizing document before applying for recognition of exemption. A reference to section 501(c)(3) will not ensure that your purposes are limited to those described in section 501(c)(3). All of the language in your organizing document must be considered. The following is an example of an acceptable purpose clause:

The organization is organized exclusively for charitable, religious, educational, and scientific purposes under section 501(c)(3) of the Internal Revenue Code, or corresponding section of any future federal tax code.

See Pub. 557 for further information and examples of how to limit your purposes.Line 6. Activities not in furtherance of tax-exempt purpo-ses. Your organizing document must not expressly empower you to engage, otherwise than as an insubstantial part of your activities, in activities that in themselves are not in furtherance of one or more exempt purposes described in section 501(c)(3). In other words, you are not organized exclusively for one or more exempt purposes if your organizing documents expressly empower you to carry on activities that further purposes outside the scope of section 501(c)(3), such as “to engage in the operation of a social club” or “to engage in a manufacturing business,” regardless of the fact that your organizing document may state that you are created for “charitable purposes within the meaning of section 501(c)(3) of the Code.”

Further, your net earnings must not inure to the benefit of private shareholders or individuals. You must establish that you will not be organized or operated for the benefit of private interests, such as the founder or the founder’s family, shareholders of the organization, other designated individuals, or persons controlled directly or indirectly by such private interests. Also, you must not, as a substantial part of your activities, attempt to influence legislation (however, eligible organizations may elect an expenditure limit instead of the “no substantial part” limit), and you are prohibited from participating to any extent in a political campaign for or against any candidate for public office.

The following is an example of an acceptable clause:No part of the net earnings of the corporation shall inure to

the benefit of, or be distributable to its members, trustees,





officers, or other private persons, except that the corporation shall be authorized and empowered to pay reasonable compensation for services rendered and to make payments and distributions in furtherance of the purposes described in section 501(c)(3). No substantial part of the activities of the corporation shall be the carrying on of propaganda, or otherwise attempting to influence legislation, and the corporation shall not participate in, or intervene in (including the publishing or distribution of statements) any political campaign on behalf of or in opposition to any candidate for public office. Notwithstanding any other provision of these articles, the corporation shall not carry on any other activities not permitted to be carried on (a) by a corporation exempt from federal income tax under section 501(c)(3) of the Internal Revenue Code, or the corresponding section of any future federal tax code, or (b) by a corporation, contributions to which are deductible under section 170(c)(2) of the Internal Revenue Code, or the corresponding section of any future federal tax code.

See Pub. 557 for further information and examples of acceptable language that expressly limits you to engage in activities in furtherance of one or more exempt purposes described in section 501(c)(3).

See the instructions for Part III, later, for more information on activities that exclusively further one or more exempt purposes, and certain activities that are

prohibited or restricted for organizations exempt from federal income tax under section 501(c)(3).Line 7. Dissolution clause. Your organizing document must permanently dedicate your assets for a section 501(c)(3) purpose. This means that if you dissolve your organization in the future, your assets must be distributed for an exempt purpose described in section 501(c)(3), or to the federal government, or to a state or local government, for a public purpose.

If your organizing document states that your assets would be distributed to members or private individuals or for any purpose other than those provided in section 501(c)(3), you must amend your organizing document to remove such statements before you apply for recognition of exemption.

The following is an example of an acceptable dissolution clause:

Upon the dissolution of this organization, assets shall be distributed for one or more exempt purposes within the meaning of section 501(c)(3) of the Internal Revenue Code, or corresponding section of any future federal tax code, or shall be distributed to the federal government, or to a state or local government, for a public purpose.

Naming a specific organization or organizations to receive your assets upon dissolution will be acceptable only if your articles state that the specific organization(s) must be exempt under section 501(c)(3) at the time your dissolution takes place and your organizing document provides for distribution for one or more exempt purposes within the meaning of section 501(c)(3) if the specific organization(s) are not exempt.

See Pub. 557 for further information and examples of acceptable language for dedication of assets upon dissolution in your organizing document.

Operation of state law. The laws of certain states provide for the distribution of assets upon dissolution. Therefore, specific written language regarding distribution of assets upon dissolution may not be needed in the organizing documents of exempt organizations organized in those states. Organizations that are organized in these cy pres states should be aware of their specific state requirements. Operation of state law is based on Rev. Proc. 82-2, 1982-1 C.B. 367.

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State law does not override an inappropriate dissolution clause. If you are organized in a cy pres state and do not have a dissolution clause, state law is sufficient to meet

the dissolution clause. However, if you have an inappropriate dissolution clause (for example, a clause specifying that assets will or may be distributed to officers and/or directors upon dissolution), state law will not override this inappropriate clause, and you will need to amend your organizing document to remove the inappropriate clause before you apply for recognition of exemption.

Part III. Your Specific ActivitiesConsider your past, present, and planned activities when responding to these questions.Line 1. Briefly describe your mission or most significant activities (limit 255 characters). Provide a brief summary of your tax-exempt 501(c)(3) purposes and the activities you engage in to further those purposes (see below for examples and a description of various 501(c)(3) purposes). Don’t refer to or repeat purposes in your organizing document or speculate about potential future programs. You should describe either actual or planned mission or activities. For example, an organization that plans to further educational purposes by operating an afterschool homework club would describe that activity. If the organization was also contemplating offering scholarships in the future but currently had no definitive plans to do so, then the scholarship activity would be speculative and should not be described.Examples of activities or missions that were determined to further tax-exempt 501(c)(3) purposes:

Example 1. In Rev. Rul. 69-161, 1969-1 C.B. 149, a nonprofit legal aid society that was organized and operated for the purpose of providing free legal services to indigent persons who were otherwise financially incapable of obtaining such services, qualified for exemption under section 501(c)(3) as a charitable organization providing relief to the poor and distressed.

Example 2. In Rev. Rul. 67-148, 1967-1 C.B. 132, an organization formed to increase the knowledge of its members and the public about historic events by researching, studying, and involving its members in historically accurate reenactments to which the public was invited, qualified for exemption under section 501(c)(3) as an educational organization.

Example 3. In Rev. Rul. 74-194, 1974-1 C.B. 129, an organization formed to prevent cruelty to animals by subsidizing spaying and neutering for pet owners who otherwise couldn’t afford the services, qualified for the exemption under section 501(c)(3) as an organization formed and operated exclusively for the prevention of cruelty to animals.Examples of activities or missions that were determined to not further tax-exempt 501(c)(3) purposes:

Example 1. In Wendy L. Parker Rehabilitation Foundation Inc. v. Commissioner, T.C. Memo. 1986-348, an organization created to aid an open-ended class of persons suffering from a disease or illness wasn’t described in section 501(c)(3) because it anticipated spending a portion of its income for the benefit of one specifically named individual. The specifically named individual’s family controlled the organization and made significant contributions to it. The distributions for her support relieved them of the economic burden of providing for her care and thus constituted prohibited inurement of the organization’s fund. The benefit didn’t flow primarily to the general public as required under Regulations section 1.501(c)(3)-1(d)(1)(ii) and instead provided an impermissible private benefit.

Example 2. In Rev. Rul. 71-395, 1971-2 C.B. 228, an organization created as a cooperative art gallery formed by

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artists to exhibit and sell their works, didn’t qualify for exemption under section 501(c)(3) because the gallery was a vehicle for advancing the careers of the artists and for promoting the sale of their works. The Revenue Ruling explains that “the gallery serves the private purposes of its members, even though the exhibition and sale of paintings may be an educational activity in other respects.” The organization failed to qualify for exemption because it was operated for the benefit of private individuals within the prohibition of Regulations section 1.501(c)(3)-1(d)(ii).

Example 3. In Rev. Rul. 67-367, 1967-2 C.B. 188, an organization was created to operate a scholarship fund plan for making payments to preselected, specifically named individuals. The subscribers deposited a certain amount of money with a designated bank. The subscribers also named a specific child to be the recipient of the scholarship money. The organization failed to qualify for exemption under section 501(c)(3) because it was operated for the benefit of private interests, the designated recipients, rather than to serve a public interest.Line 2. National Taxonomy of Exempt Entities (NTEE) code. An NTEE code is a three-character series of letters and numbers that generally summarize an organization’s purpose. Enter the code that best describes your organization from the list of NTEE codes, later. For more information and more detailed definitions of these codes developed by the National Center for Charitable Statistics (NCCS), visit the Urban Institute, NCCS website at nccs.urban.org.Note. NTEE codes are also used for purposes other than identification of organizations described in section 501(c)(3). Therefore, all codes in the list do not necessarily describe a 501(c)(3) purpose. Selecting the appropriate NTEE code is important as some donors use the codes to identify potential recipients of grants.Line 3. Exempt purposes. In order to qualify for exemption as an organization described in section 501(c)(3), you must be organized and operated exclusively for one or more of the following purposes: charitable, religious, educational, scientific, literary, testing for public safety, fostering national or international amateur sports competition, or preventing cruelty to children or animals. An organization is not regarded as being organized and operated exclusively for exempt purposes if more than an insubstantial part of its activities is not in furtherance of an exempt purpose. For more information, see Pub. 557.Note. An organization does not qualify for exemption as an organization described in section 501(c)(3) if its purposes are illegal or contrary to public policy. See Rev. Rul. 71-447, 1971-2 C.B. 230 (a private school that does not have a racially nondiscriminatory policy as to students does not qualify for exemption). Furthermore, an organization operated for the primary purpose of carrying on a trade or business for profit shall not be exempt from taxation under section 501(c)(3), even if all of its profits are payable to one or more organizations exempt from taxation under section 501.

Charitable. The generally accepted legal definition of “charitable” includes relief of the poor, the distressed, or the underprivileged; advancement of religion; advancement of education or science; erecting or maintaining public buildings, monuments, or works; lessening the burdens of government; lessening neighborhood tensions; eliminating prejudice and discrimination; defending human and civil rights secured by law; and combating community deterioration and juvenile delinquency.

Religious. To determine whether an organization meets the religious purposes test of section 501(c)(3), the IRS maintains two basic guidelines.

1. That the particular religious beliefs of the organization are truly and sincerely held. If there is a clear showing that the

beliefs (or doctrines) are sincerely held by those professing them, the IRS will not question the religious nature of those beliefs.

2. That the practices and rituals associated with the organization's religious belief or creed are not illegal or contrary to clearly defined public policy. Therefore, an organization may not qualify for treatment as an exempt religious organization for tax purposes if its actions are contrary to well established and clearly defined public policy.

Educational. The term “educational,” as used in section 501(c)(3), relates to:

The instruction or training of the individual for the purpose of improving or developing his or her capabilities, orThe instruction of the public on subjects useful to the individual and beneficial to the community.

An organization may be educational even though it advocates a particular position or viewpoint so long as it presents a sufficiently full and fair exposition of the pertinent facts as to permit an individual or the public to form an independent opinion or conclusion. An organization is not educational if its principal function is the mere presentation of unsupported opinion.

The term “educational” includes the provision of childcare away from the home if:

1. Substantially all of the care provided by the organization is to enable individuals (parents) to be gainfully employed, and

2. The services provided by the organization are available to the general public.

The following are examples of organizations which, if they otherwise meet the requirements of this section, are educational.

Example 1. An organization whose activities consist of presenting public discussion groups, forums, panels, lectures, or other similar programs. Such programs may be on radio or television.

Example 2. An organization which presents a course of instruction by means of correspondence or through the utilization of television or radio.

Example 3. Museums, zoos, planetariums, symphony orchestras, and other similar organizations.

Scientific. To be a scientific organization described in section 501(c)(3), an organization must be organized and operated in the public interest. Therefore, the term “scientific,” as used in section 501(c)(3), includes the carrying on of scientific research in the public interest. Scientific research does not include activities of a type ordinarily carried on as an incident to commercial or industrial operations, as, for example, the ordinary testing or inspection of materials or products, or the designing or construction of equipment or buildings.

Scientific research will be regarded as carried on in the public interest if:

1. The results of such research (including any patents, copyrights, processes, or formulas resulting from such research) are made available to the public on a nondiscriminatory basis;

2. Such research is performed for the United States, or any of its agencies or instrumentalities, or for a State or political subdivision thereof; or

3. Such research is directed toward benefiting the public.Testing for public safety. The term “testing for public

safety,” as used in section 501(c)(3), includes the testing of





consumer products, such as electrical products, to determine whether they are safe for use by the general public.

To foster national or international amateur sports competition. There are two types of amateur athletic organizations that can qualify for tax-exempt status. The first type is an organization that fosters national or international amateur sports competition, but only if none of its activities involve providing athletic facilities or equipment. The second type is a qualified amateur sports organization under section 501(j) (discussed below). The primary difference between the two is that a qualified amateur sports organization can provide athletic facilities and equipment.

An organization will be a qualified amateur sports organization under section 501(j) if it is organized and operated:

1. Exclusively to foster national or international amateur sports competition, and

2. Primarily to conduct national or international competition in sports or to support and develop amateur athletes for that competition.

The organization's membership can be local or regional in nature.

Prevention of cruelty to children or animals. Examples of activities that may qualify this type of organization for exempt status are:

1. Preventing children from working in hazardous trades or occupations,

2. Promoting high standards of care for laboratory animals, and

3. Providing funds to pet owners to have their pets spayed or neutered to prevent over-breeding.

Line 4. Prohibited or restricted activities. Certain activities are prohibited or restricted for organizations exempt from federal income tax under section 501(c)(3). Along with conducting activities that exclusively further one or more of the purposes listed in Part III, line 3, earlier, organizations exempt under section 501(c)(3) must:

a) Refrain from supporting or opposing candidates in political campaigns in any way.

An organization exempt under section 501(c)(3) is prohibited from directly or indirectly participating in, or intervening in, any political campaign on behalf of (or in opposition to) any candidate for elective public office. The prohibition applies to all campaigns, including campaigns at the federal, state, and local level.

Political campaign intervention includes any and all activities that favor or oppose one or more candidates for public office. The prohibition extends beyond candidate endorsements. Contributions to political campaign funds or public statements of position (verbal or written) made by or on behalf of an organization in favor of or in opposition to any candidate for public office clearly violate the prohibition on political campaign intervention. Distributing statements prepared by others that favor or oppose any candidate for public office will also violate the prohibition. Allowing a candidate to use an organization’s assets or facilities will also violate the prohibition if other candidates are not given an equivalent opportunity.

Certain activities will require an evaluation of all the facts and circumstances to determine whether they result in political campaign intervention. For example, section 501(c)(3) organizations are permitted to conduct certain voter education activities (including the presentation of public forums and the publication of voter education guides) if they are carried out in a non-partisan manner. In addition, section 501(c)(3) organizations may encourage people to participate in the

electoral process through voter registration and get-out-the-vote drives conducted in a non-partisan manner. However, voter education or registration activities conducted in a biased manner that favors (or opposes) one or more candidates is prohibited. For examples of relevant facts and circumstances, see Rev. Rul. 2007-41, 2007-1 C.B. 1421.

b) Ensure that net earnings do not inure in whole or in part to the benefit of private shareholders or individuals (that is, board members, officers, key management employees, or other insiders).

An organization is not operated exclusively for one or more exempt purposes if its net earnings inure in whole or in part to the benefit of private shareholders or individuals. The term “private shareholder or individual” refers to persons who have a personal and private interest in the organization, such as an officer, director, or a key employee. Any amount of inurement may be grounds for loss of tax-exempt status.Note. Examples of inurement include the payment of dividends and the payment of unreasonable compensation to private shareholders or individuals.

c) Not further non-exempt purposes (such as purposes that benefit private interests) more than insubstantially.

An organization cannot conduct activities that further any purposes other than those described in Part III, line 3 of these instructions more than insubstantially, including benefitting private interests rather than the public as a whole. For example, an organization whose sole activity is the operation of a scholarship program for making payments to pre-selected, specifically named individuals is serving private interests rather than public interests. See Rev. Rul. 67-367, 1967-2 C.B. 188.

d) Not be organized or operated for the primary purpose of conducting a trade or business that is unrelated to exempt purpose(s).

An activity is an unrelated trade or business (and subject to unrelated business income tax) if it meets three requirements.

1. It is a trade or business.2. It is regularly carried on.3. It is not substantially related to furthering the exempt

purpose(s) of the organization.Trade or business. The term “trade or business” generally

includes any activity conducted for the production of income from selling goods or performing services. An activity does not lose its identity as a trade or business merely because it is conducted within a larger group of similar activities that may or may not be related to the exempt purposes of the organization.

Regularly carried on. Business activities of an exempt organization ordinarily are considered regularly conducted if they show a frequency and continuity similar to, and are pursued in a manner similar to, comparable commercial activities of nonexempt organizations.

Not substantially related. A business activity is not substantially related to an organization’s exempt purpose if it does not contribute importantly to accomplishing that purpose (other than through the production of funds). Whether an activity contributes importantly depends in each case on the facts involved.

For more information, see Pub. 598.e) Not devote more than an insubstantial part of

activities to attempting to influence legislation.In general, if a substantial part of an organization's activities

consists of carrying on propaganda or otherwise attempting to influence legislation, it does not qualify for exemption under section 501(c)(3).





Legislation includes action by Congress, any state legislature, any local council, or similar governing body, with respect to acts, bills, resolutions, or similar items (such as legislative confirmation of appointive office), or by the public in referendum, ballot initiative, constitutional amendment, or similar procedure. It does not include actions by executive, judicial, or administrative bodies.

An organization will be regarded as attempting to influence legislation if it contacts, or urges the public to contact, members or employees of a legislative body for the purpose of proposing, supporting, or opposing legislation, or if the organization advocates the adoption or rejection of legislation.

Most public charities are eligible to elect under section 501(h) to have their legislative activities measured solely by an expenditure limit rather than by the “no substantial

amount” limit. An election is made by filing Form 5768, Election/Revocation of Election by an Eligible Section 501(c)(3) Organization To Make Expenditures To Influence Legislation. If you are eligible and would like to make the election, file Form 5768. Private foundations cannot make this election.

For additional information on the expenditure limit or the no substantial amount limit, see IRS.gov/Charities- &-Non-Profits/Lobbying.

f) Not provide commercial-type insurance as a substantial part of activities.

An organization described in section 501(c)(3) shall be exempt from tax only if no substantial part of its activities consists of providing commercial-type insurance. The term "commercial-type insurance" does not include:

Insurance provided at substantially below cost to a class of charitable recipients,Incidental health insurance provided by a health maintenance organization of a kind customarily provided by such organizations,Property or casualty insurance provided (directly or through an organization described in section 414(e)(3)(B)(ii)) by a church or convention or association of churches for such church or convention or association of churches,Providing retirement or welfare benefits (or both) by a church or a convention or association of churches (directly or through an organization described in section 414(e)(3)(A) or 414(e)(3)(B)(ii)) for the employees (including employees described in section 414(e)(3)(B)) of such church or convention or association of churches or the beneficiaries of such employees, andCharitable gift annuities.

Line 5. Attempting to influence legislation. Check “Yes” if you have attempted, or plan to attempt, to influence legislation. See the instructions for Part III, line 4, earlier, for a description of “attempting to influence legislation.”Line 6. Compensation to officers, directors, or trustees. Check “Yes” if you pay or plan to pay compensation to any of your officers, directors, or trustees.

Compensation includes salary or wages, deferred compensation, retirement benefits whether in the form of a qualified or non-qualified employee plan (pensions or annuities), fringe benefits (personal vehicle, meals, lodging, personal and family educational benefits, low interest loans, payment of personal travel, entertainment, or other expenses, athletic or country club membership, and personal use of your property), and bonuses.Line 7. Donation of funds or payment of expenses to indi-viduals. Check “Yes” if you have donated funds to or paid expenses for individual(s), or plan to donate funds to or pay expenses for individual(s) (other than paying for or reimbursing employees’ business expenses).

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An organization is not organized or operated exclusively for one or more exempt purposes unless it serves a public rather than a private interest. You do not qualify

as tax exempt if you are organized or operated for the benefit of private interests such as designated individuals, the creator or his or her family, or shareholders of the organization. For example, you may not set up a scholarship program to pay for the education expenses of a designated individual, such as a contributor’s family member. See Rev. Rul. 67-367, 1967-2 C.B. 188.Line 8. Conducting activities or providing grants outside the United States. Check “Yes” if you have conducted or plan to conduct activities outside the United States, or have provided or plan to provide grants or other assistance to individual(s) or organization(s) outside the United States. For purposes of this question, “outside the United States” means those locations other than the United States, its territories, and possessions.Line 9. Financial transactions with officers, directors, or trustees. Check “Yes” if you have engaged in or plan to engage in financial transactions (for example, loans, grants, or other assistance, payments for goods or services, rents, etc.) with any of your officers, directors, or trustees, or any entities they own or control. See the glossary in the Form 990 instructions for a definition of “control.”Line 10. Unrelated business gross income. Check “Yes” if you have received or plan to receive unrelated business gross income of $1,000 or more during a tax year. Exempt organizations that receive unrelated business gross income of $1,000 or more during a tax year must file Form 990-T, Exempt Organization Business Income Tax Return. For more information, see Pub. 598.Line 11. Gaming activities. Check “Yes” if you have conducted or plan to conduct bingo or other gaming activities. For more information, see Pub. 3079, Tax-Exempt Organizations and Gaming.Line 12. Disaster relief assistance. Check “Yes” if you have provided or plan to provide disaster relief. For more information, see Pub. 3833, Disaster Relief: Providing Assistance Through Charitable Organizations.

Because of the requirement that exempt organizations must serve a charitable class, you do not qualify as a tax-exempt disaster relief or emergency hardship

organization if you provide assistance only to specific individuals, such as a few persons injured in a particular natural disaster. Similarly, donors cannot earmark contributions to a charitable organization for a particular individual or family.

Part IV. Foundation ClassificationEvery organization described in section 501(c)(3) has a foundation classification. The two main classifications are public charity and private foundation. A public charity generally has a broad base of support, while a private foundation generally receives its support from a small number of donors. Your foundation classification is important because it determines which tax rules govern your operations and which limitations apply to your donors’ contributions. For example, deductibility of contributions to a private foundation is more limited than contributions to a public charity. In addition, private foundations are subject to excise taxes that are not imposed on public charities, discussed later.

Section 509(a) provides that every section 501(c)(3) organization is a private foundation unless it qualifies for one of the public charity exceptions under section 509(a)(1), 509(a)(2), 509(a)(3), or 509(a)(4). Section 509(a)(1) public charities have nine sub-classifications; however, only three of those

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subclasses (described in the first three bullets below) can apply for exemption on Form 1023-EZ. Private foundations have two main sub-classifications.Note. Private operating foundations can’t apply for exemption on Form 1023-EZ (see question 28 on the Form 1023-EZ Eligibility Worksheet).

You are solely responsible to check the line on Part IV of Form 1023-EZ that corresponds to your correct foundation classification. We will process your

application with the classification you indicate based upon your representations.Foundation classifications available to a Form 1023-EZ fil-er. An organization eligible to apply for exemption using Form 1023-EZ will have one of the following foundation classifications.

A section 509(a)(1) public charity described in section 170(b)(1)(A)(vi) that receives substantial support in the form of grants and contributions from governmental units, the general public, and other public charities. See the instructions for Line 2a, laterA section 509(a)(2) public charity that receives substantial revenues from a combination of contributions, membership fees, and gross receipts from activities that further its exempt purpose. See the instructions for Line 2b, later.A section 509(a)(1) public charity described in section 170(b)(1)(A)(iv) that operates for the benefit of a college or university that is owned or operated by a governmental unit. See the instructions for Line 2c, later.A private foundation (other than a private operating foundation). See the instructions for Line 3, later.

You can find a detailed description of the tax treatment of public charities and private foundations in chapter 3 of Pub. 557. Also see Pub. 526, which explains the limitations on deductibility of contributions for gifts to public charities and private foundations.Note. Your foundation classification can change if the types, sources, and amounts of your revenues change.Determining your correct foundation classification. In order to determine your correct foundation classification, you need to know the types, sources, and amounts of your revenues for the most recent 5-year period. If you are a new organization, base your determination on the types, sources, and amounts of revenue you actually received since your formation, together with the types, sources, and amounts of revenue you anticipate you will receive over the first 5 years of your existence.

Because of the low asset and revenue thresholds for Form 1023-EZ, the instructions later simplify the applicable tests for the types of public charity described in the instructions for Line 2a and Line 2b. You can obtain more detailed information about the public support tests for Line 2a and Line 2b in the Instructions for Schedule A (Form 990 or 990-EZ), Public Charity Status and Public Support. In addition, you can complete Schedule A (Form 990 or 990-EZ), Parts II and III as an alternative to the simplified calculation steps described later.Types of Revenue.

Gifts, grants, and contributions. Gifts, grants, and contributions are transfers of money or property you receive without providing goods or services in exchange. Include bequests and donations in this revenue type. Membership fees may also be treated as contributions when the member receives nothing of value in exchange for the membership fee. In addition, you can treat the value of services or facilities furnished by a governmental unit without charge, provided that the governmental unit would ordinarily charge for the use of its facilities. Treat contributions from members of a family as made by one person. Treat contributions by an individual and a

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business entity the individual controls as being made by the individual.

Exempt-activity revenues. Exempt-activity revenues include admissions fees, revenues from merchandise sold or services performed, or facilities furnished in any activity related to your tax-exempt purpose.

Revenues from unrelated activities. Revenues from activities unrelated to your exempt purpose don’t count as public support for section 509(a)(1) or 509(a)(2). Therefore, you need to identify these revenues and account for them separately from gifts, grants, contributions, exempt-activity revenues, and unusual grants. Revenues from activities unrelated to your exempt purpose include admissions fees, revenues from merchandise sold or services performed, or facilities furnished in any activity that is unrelated to your tax-exempt purpose. For the purposes of the Form 1023-EZ, we do not distinguish between revenues in this category that are taxable as unrelated business taxable income (UBTI) and revenues that are not UBTI because of an exception, nor do we factor in the deduction allowed on Schedule A (Form 990 and 990-EZ) for the tax on UBTI. See the Instructions for Schedule A (Form 990 and 990-EZ) and Pub. 598 for more information.

Investment income. Investment income includes interest, dividends, and similar items.

Unusual grants. “Unusual grants” are contributions from disinterested persons (that is, not your founder or members of your governing body) that are unusual (in terms of their size), that you do not anticipate will be recurring. For example, a one-time promise of “seed funding” to help you start operations and develop broad-based public support (whether received in a lump sum or over a period of years) could potentially be characterized as an unusual grant. Before you decide that a contribution is an “unusual grant,” see chapter 3 of Pub. 557 for more information.Sources of Revenue.

Disqualified persons. The term “disqualified person” has a specific meaning depending upon the circumstances. For the purposes of Form 1023-EZ and your foundation classification, the term “disqualified persons” includes any individual or organization that is any of the following.

1. A "substantial contributor" to you (defined below).2. An officer, director, trustee, or any other individual who has

similar powers or responsibilities.3. An individual who owns more than 20% of the total

combined voting power of a corporation that is a substantial contributor.

4. An individual who owns more than 20% of the profits interest of a partnership that is a substantial contributor.

5. An individual who owns more than 20% of the beneficial interest of a trust or estate that is a substantial contributor.

6. A member of the family of any individual described in 1, 2, 3, 4, or 5 above.

7. A corporation in which any individuals described in 1, 2, 3, 4, 5, or 6 above, hold more than 35% of the total combined voting power.

8. A trust or estate in which any individuals described in 1, 2, 3, 4, 5, or 6 above, hold more than 35% of the beneficial interests.

9. A partnership in which any individuals described in 1, 2, 3, 4, 5, or 6 above, hold more than 35% of the profits interest.

Substantial contributor. A “substantial contributor” is any individual or organization that gave more than $5,000 to you from the date you were formed or other date that your exemption would be effective, to the end of the year in which the





contributions were received. This total amount contributed must also be more than 2% of all the contributions you received. A creator of a trust is treated as a substantial contributor regardless of the amount contributed.

For more information regarding substantial contributors, go to IRS.gov/SubstantialContributor.

Family members. A “member of the family” includes the spouse, ancestors, children, grandchildren, great-grandchildren, and their spouses.

For additional information concerning members of the family, go to IRS.gov/FamilyMembers.

Further information about disqualified persons can be obtained at IRS.gov/DisqualifiedPerson.

General public. For the purposes of determining your foundation classification, the term “general public” includes any person who is not a disqualified person.

Governmental unit. Governmental unit means a state, a possession of the United States, or a political subdivision of a state or U.S. possession, the United States, or the District of Columbia. Treat taxes levied on your behalf that are paid to or spent on your behalf as being from a governmental unit. In addition, if a governmental unit provides services or facilities to you without charge, and it does not provide those services or facilities to the public without charge, you should treat the value of those services and facilities as being from a governmental unit.

Public charity. An organization described in section 501(c)(3) that makes a gift, grant or contribution to you, or pays exempt-service revenues to you, should inform you of its foundation classification.Foundation classification tests. Lines 2a, 2b, 2c, and 3 each uses a different test. The specific test for each line is explained below.

You may only check one box in Line 2.As an alternative to the tests described below, you can use

the more detailed support calculations in Schedule A (Form 990 or 990-EZ), Part II (for Line 2a, or Line 2c), or Part III (for Line 2b).

If the IRS approves your application and you are classified as a public charity, then any year that you must file Form 990 or Form 990-EZ, you will use

Schedule A (Form 990 or 990-EZ), to confirm that you continue to satisfy the section 509(a)(1) or 509(a)(2) public support test. See Annual Filing Requirements, earlier.Line 1. Check “Yes” if you are applying for recognition as a church, school, or hospital (as described in section 170(b)(1)(A)(i), (ii), or (iii)). Also see questions 12 through 14 on the Form 1023-EZ Eligibility Worksheet. If you are seeking recognition as a church, school, or hospital, you are not eligible to use Form 1023-EZ and should instead submit Form 1023 if you wish to obtain a determination letter from the IRS. However, churches (including synagogues, temples, and mosques) and integrated auxiliaries of churches and conventions or associations of churches may be considered tax exempt under section 501(c)(3) even if they do not file Form 1023.

Check “No” if you are not applying for recognition as a church, school, or hospital (as described in section 170(b)(1)(A)(i), (ii), or (iii)).Line 2a. Check this box if after completing Steps 1–7 below, you meet the requirements for the 509(a)(1) public support test.

Use the calculation below to determine whether you can check Line 2a. For the calculations below, combine revenues for the most recent 5-year period. If you are a new organization, base your calculation on revenues you have actually received since your formation as well as revenues you anticipate you will

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receive over the first 5 years of your existence. You can also use this support calculation for Line 2c.

Step 1. Total all gifts, grants, and contributions (including those from governmental units and public charities). Don’t include exempt-activity revenues and unusual grants.

Step 2. Multiply the amount from Step 1 by 2% (0.02). This is your 2% threshold amount. Gifts, grants, or contributions from persons other than governmental units and public charities can be treated as public support only up to the 2% threshold.

Step 3. Excluding gifts, grants, and contributions from governmental units and public charities, add together contributions of any person that exceed the 2% threshold amount calculated in Step 2.

Example. If the amount in Step 1 is $150,000, the 2% threshold is $3,000. If, over the 5-year period, one individual donor gave $4,000, another individual donor gave $3,250, and the rest of the donors gave $3,000 or less, the amount calculated for Step 3 will be $1,250, which is ($4,000 minus $3,000) plus ($3,250 minus $3,000).

Step 4. Subtract the amount calculated in Step 3 from the amount calculated in Step 1. This is your 509(a)(1) public support amount.

Step 5. Calculate the total of your unrelated trade or business revenues, and investment income. Don’t include exempt-activity revenues and unusual grants.

Step 6. Add the amount from Step 1 to the amount from Step 5. This is your 509(a)(1) total support amount.

Step 7. Divide your 509(a)(1) public support amount (calculated in Step 4) by your 509(a)(1) total support amount (calculated in Step 6).

If the result is at least 331 3%, you satisfy the 509(a)(1) public support test and should check the box on Line 2a.If the result is less than 331 3%, but is at least 10%, you might satisfy the public support test for Line 2a (or Line 2c) based upon a “facts and circumstances” test. An organization with public support between 10% and 331 3% must be organized and operated in a way that will attract new and additional public or governmental support on a continuous basis. The following factors are taken into account in determining whether an organization that meets the 10% public support requirement and is organized and operated to attract new and additional public support may qualify as publicly supported for the purposes of section 509(a)(1).

a. The percentage of financial support the organization receives from the general public, governmental units, or public charities (the higher the percentage, the lower the burden of meeting the other factors).

b. Whether the organization receives support from a representative number of persons.

c. All other facts and circumstances, including the public nature of the organization’s governing body, the extent to which its facilities or programs are publicly available, the extent to which its dues encourage membership, and whether its activities are likely to appeal to persons having a broad common interest or purpose.

For additional information about the “facts and circumstances” test, see Pub. 557 and Regulations section 1.170A-9(f)(3).Note. If you do not satisfy the section 509(a)(1) public support test, but you receive most of your support in the form of exempt-activity receipts, continue to the section 509(a)(2) public support test for Line 2b.Line 2b. Use the following public-support calculation if you did not satisfy the section 509(a)(1) public support test and you wish to determine whether you satisfy the section 509(a)(2) public support test.





Step 1. Add together amounts you received in the form of taxes levied on your behalf that are paid to or spent on your behalf and the value of services and facilities provided to you by a governmental unit without charge (see the description of this revenue source earlier). Do not include amounts a governmental unit pays to in the form of a grant, contribution, or exempt-activity revenues.

Step 2. Add together all gifts, grants, contributions, and exempt-activity revenues from all sources not included in the calculation for Step 1, excluding unusual grants.

Step 3. To the amount you calculated in Steps 1 and 2, add investment income and all revenues from unrelated activities. For the purposes of this simplified calculation, do not distinguish between unrelated activity revenues that generate UBTI and those that qualify for an exception from UBTI. This is your 509(a)(2) total support amount.

Step 4. Treating family members as one contributor, and any business entity and an individual who controls it as one contributor, identify the contributors who are disqualified persons. Then, calculate the total of contributions received from disqualified persons, regardless of amount.

Step 5. Identify any disqualified persons from whom you received exempt-activity revenues of any amount. Then, calculate the total of exempt-activity revenues received from disqualified persons.

Step 6. Identify the payers other than disqualified persons from whom you received exempt-activity revenues in any year that exceed the greater of 1% of your 509(a)(2) total support amount or $5,000 for that year. Total the amounts that exceed the greater of 1% or $5,000 threshold for each year. Make this calculation on a year-by-year basis, rather than on a 5-year aggregated basis.

Step 7. Subtract the total of the amounts calculated in Step 4, Step 5, and Step 6 from the amount you calculated in Step 2. Then, add that to the amount calculated in Step 1. This is your 509(a)(2) public support amount.

Step 8. Divide your 509(a)(2) public support amount (calculated in Step 7) by your 509(a)(2) total support amount (calculated in Step 3). If the result is less than 331 3%, this calculation indicates that you don’t satisfy the 509(a)(2) public support test. If the result is at least 331 3%, proceed to Step 9.

Step 9. In addition to the 509(a)(2) public support amount of at least 331 3%, you may not derive more than 331 3% of your total support from a combination of investment income and revenues from activities unrelated to your exempt purpose. Add together your investment income and revenues from unrelated activities. Then, divide that amount by the 509(a)(2) total support amount. If that amount is less than 331 3%, you satisfy the second part of the 509(a)(2) public support test.

If the result in Step 8 is at least 331 3% and the result in Step 9 is less than 331 3%, you satisfy the 509(a)(2) public support test. Check the box on Line 2b.Line 2c. In order to be able to check the box for Line 2c, you must satisfy the same public support test for Line 2a, earlier. See Rev. Rul. 82-132, 1982-2 C.B. 107. Check this box if, in addition to satisfying the support test described in Line 2a, earlier, you are organized and operated exclusively to receive, hold, invest, and administer property for and make expenditures to or for the benefit of a state or municipal college or university (see below).

The college or university you benefit must be: • An agency or instrumentality of a state or political

subdivision, • Owned and operated by a state or political subdivision, or • Owned and operated by an agency or instrumentality of

one or more states or political subdivisions.For this purpose, “support” doesn’t include income received

in the exercise or performance by the organization of its

charitable, educational, or other purpose or function constituting the basis for exemption. See Pub. 557 for additional information.Line 3. If you are eligible to apply for exemption using Form 1023-EZ, but you don’t satisfy one of the public charity tests listed in Lines 2a-2c, you are a private foundation and must confirm that you satisfy the organizing document requirements discussed below.Special organizing document requirement. Before you check Line 3, you need to ensure that your organizing document satisfies the special rule under section 508(e) applicable to private foundations.

As a private foundation you are not tax exempt unless your organizing document contains specific provisions required by section 508(e). These specific provisions

require that you operate to avoid liability for excise taxes under sections 4941(d) (acts of self-dealing), 4942 (undistributed income), 4943(c) (excess business holdings), 4944 (jeopardizing investments), and 4945(d) (taxable expenditures).

You can find sample provisions that satisfy the section 508(e) requirements in chapter 3 of Pub. 557.

You can include provisions that satisfy the requirement under section 508(e) even if you are not a private foundation, and even if state law provisions satisfy

section 508(e) requirements.Operation of state law. Some states have enacted statutory provisions that satisfy the requirements of section 508(e). See Appendix B in the Instructions for Form 1023. If you are organized in a state that has statutory provisions addressing the requirements of section 508(e), and if you wish to rely on your state law provisions instead of including the provisions in your organizing document, you should be certain that you know what the specific provisions are and where to find them. Reliance on state law to satisfy the rules under section 508(e) is explained in Rev. Rul. 75-38, 1975-1 C.B. 161.

Note. By checking Line 3, you are attesting that either your organizing document contains the appropriate provisions or that the requirement is satisfied by operation of state law.

As a private foundation you are subject to all of the private foundation rules, not just the specific provisions listed in section 508(e). You can find information about the private foundation rules and the excise taxes that may be imposed for violations of the rules in Pub. 4221-PF, Compliance Guide for 501(c)(3) Private Foundations, and at IRS.gov/Charities- &-Non-Profits/Private- Foundations/Private-Foundation-Excise-Taxes.Special foundations-rule procedure for grants to individu-als for travel or study. Private foundations are required to obtain advance approval from the IRS before making grants to individuals for travel, study, or similar purposes. Failure to do so will result in excise taxes under section 4945. Under section 4945, the excise tax does not apply to an individual grant awarded on an objective and nondiscriminatory basis pursuant to a procedure approved by the IRS in advance. Additional information regarding these rules is available at IRS.gov/Charities- &-Non-Profits/Private-Foundations/Grants-to-Individuals.

To request advance approval of grantmaking procedures under section 4945(g), you must complete and submit Form 8940. A user fee must accompany the form. The advance approval request should be sent to the address indicated on Form 8940. It cannot be submitted with Form 1023-EZ. Additional information about advance approval of individual grant procedures is available at IRS.gov/Charities- &-Non-Profits/Private-Foundations/Advance-Approval-of-Grant-Making- Procedures. Alternatively, if you do not wish to submit a Form

CAUTION!

TIP





1023-EZ and a Form 8940, private foundations required to obtain advance approval may complete Form 1023 instead.Part V. Reinstatement After Automatic RevocationYou should complete this section only if you have had your exempt status automatically revoked under section 6033(j)(1) for failure to file required annual returns or notices for three consecutive years, and you are applying for reinstatement under section 4 or 7 of Rev. Proc. 2014-11, 2014-3 I.R.B. 411.

Rev. Proc. 2014-11 establishes several different procedures for reinstating organizations depending upon their size, number of times they have been automatically revoked, and the timeliness of filing for reinstatement. Therefore, you should review the revenue procedure and determine which section applies to you.Note. You can apply using this form only if you are requesting reinstatement under section 4 or 7 of the revenue procedure. If you are applying for retroactive reinstatement under section 5 or 6 of Rev. Proc. 2014-11, you must submit the full Form 1023 along with the appropriate reasonable cause statement and a statement confirming you have filed the required annual returns as described in the revenue procedure.Line 1. Section 4 of Rev. Proc. 2014-11. Check this box if:

You were eligible to file either Form 990-EZ or Form 990-N for each of the three consecutive years that you failed to file,This is the first time you have been automatically revoked pursuant to section 6033(j), andYou are submitting this application not later than 15 months after the later of the date of your Revocation Letter or the date on which the IRS posted your name on the Revocation List at IRS.gov/Charities- &-Non-Profits/Exempt-Organizations-Select-Check.

By checking this box, you are also attesting that your failure to file was not intentional and you have put in place procedures to file required returns or notices in the future.

If you are requesting reinstatement under section 4 of Rev. Proc. 2014-11, the foundation classification that you request on Part IV. Foundation Classification of this

form must match the foundation classification you had at the time of your revocation. Otherwise, you must use Form 1023.

CAUTION!

Line 2. Section 7 of Rev. Proc. 2014-11. Check this box if you are seeking reinstatement under section 7 of Rev. Proc. 2014-11. By checking this box, you are agreeing to accept an effective date of reinstatement as of the date of filing this application.Part VI. SignatureAn officer, director, or trustee listed in Part I, line 8, who is authorized to sign for the organization must electronically sign Form 1023-EZ. To electronically sign Form 1023-EZ, the signer must check the "penalties of perjury" box in Part VI and type his or her name on the line provided. The signature must be accompanied by the title or authority of the signer and the date.

Paperwork Reduction Act Notice. The time needed to complete and file this form will vary depending on individual circumstances. The estimated average time is:Recordkeeping . . . . . . . . . . . . . . . . . . 10 hr., 02 min.

Learning about the law or the form . . . . 2 hr., 30 min.

Preparing the form . . . . . . . . . . . . . . . 5 hr., 33 min.

Copying, assembling, and sending the form to the IRS . . . . . . . . . . . . . . . . . . 48 min.

If you have comments concerning the accuracy of these time estimates or suggestions for making Form 1023-EZ simpler, we would be happy to hear from you. You can send us comments from IRS.gov/FormComments. Or you can write to the Internal Revenue Service, Tax Forms and Publications Division, 1111 Constitution Ave. NW, IR-6526, Washington, DC 20224. Don’t send Form 1023-EZ to this address. Instead, see How To File, earlier.





Form 1023-EZ Eligibility Worksheet(Must be completed prior to completing Form 1023-EZ)

If you answer “Yes” to any of the worksheet questions, you are not eligible to apply for exemption under section 501(c)(3) using Form 1023-EZ. You must apply on Form 1023. If you answer “No” to all of the worksheet questions, you may apply using Form 1023-EZ.

1. Do you project that your annual gross receipts will exceed $50,000 in any of the next 3 years?

Gross receipts are the total amounts the organization received from all sources during its annual accounting period, without subtracting any costs or expenses. You should consider this year and the next two years.

Yes No

2. Have your annual gross receipts exceeded $50,000 in any of the past 3 years? Yes No3. Do you have total assets the fair market value of which is in excess of $250,000?

Total assets includes cash, accounts receivable, inventories, bonds and notes

receivable, corporate stocks, loans receivable, other investments, depreciable and depletable assets, land, buildings, equipment, and any other assets.

Yes No

4. Were you formed under the laws of a foreign country (United States territories and possessions are not considered foreign countries)?

You are formed under the laws of a foreign country if you are not formed under the laws of (1) the United States, its states, territories, or possessions; (2) federally recognized Indian tribal or Alaskan native governments; or (3) the District of Columbia.

Yes No

5. Is your mailing address in a foreign country (United States territories and possessions are not considered foreign countries)? Your mailing address is the address where all correspondence will be sent.

Yes No

6. Are you a successor to, or controlled by, an entity suspended under section 501(p) (suspension of tax-exempt status of terrorist organizations)?

Section 501(p)(1) suspends the exemption from tax under section 501(a) of any organization described in section 501(p)(2). An organization is described in section 501(p)(2) if the organization is designated or otherwise individually identified (1) under certain provisions of the Immigration and Nationality Act as a terrorist organization or foreign terrorist organization; (2) in or pursuant to an Executive Order which is related to terrorism and issued under the authority of the International Emergency Economic Powers Act or section 5 of the United Nations Participation Act of 1945 for the purpose of imposing on such organization an economic or other sanction; or (3) in or pursuant to an Executive Order issued under the authority of any federal law, if the organization is designated or otherwise individually identified in or pursuant to the Executive Order as supporting or engaging in terrorist activity (as defined in the Immigration and Nationality Act) or supporting terrorism (as defined in the Foreign Relations Authorization Act) and the Executive Order refers to section 501(p)(2). Under section 501(p)(3) of the Code, suspension of an organization’s tax exemption begins on the date of the first publication of a designation or identification with respect to the organization, as described above, or the date on which section 501(p) was enacted, whichever is later. This suspension continues until all designations and identifications of the organization are rescinded under the law or Executive Order under which such designation or identification was made.

Yes No





7. Are you organized as an entity other than a corporation, unincorporated association, or trust?

Answer “Yes” if you are organized as an LLC under the laws of the state in which you were formed.

Yes No

8. Are you formed as a for-profit entity? Yes No9. Are you a successor to a for-profit entity?

You are a successor if you have:

1. Substantially taken over all of the assets or activities of a for-profit entity;2. Been converted or merged from a for-profit entity; or3. Installed the same officers, directors, or trustees as a for-profit entity that no longer

exists.

Yes No

10. Were you previously revoked or are you a successor to a previously revoked organization (other than an organization the tax-exempt status of which was automatically revoked for failure to file a Form 990-series return for three consecutive years)?

Do not check “Yes” if your previous revocation, or your predecessor’s revocation, was an automatic revocation (pursuant to section 6033(j)) for failing to satisfy Form 990-series filing requirements for three consecutive years.

Yes No

11. Are you currently recognized as tax exempt under another section of IRC 501(a) or were you previously exempt under another section of IRC 501(a)?

Yes No





12. Are you a church or a convention or association of churches described in section 170(b)(1)(A)(i)?

There is no single definition of the word “church” for tax purposes; however, the characteristics generally attributed to churches include:

A distinct legal existence,A recognized creed and form of worship,A definite and distinct ecclesiastical government, A formal code of doctrine and discipline,A distinct religious history, A membership not associated with any other church or denomination,Ordained ministers ministering to the congregation,Ordained ministers selected after completing prescribed courses of study,A literature of its own,Established places of worship,Regular congregations, Regular religious services,Sunday schools for the religious instruction of the young, andSchools for the preparation of ministers.

Although it is not necessary that each of the above characteristics be present, a congregation or other religious membership group that meets regularly for religious worship is generally required. A church includes mosques, temples, synagogues, and other forms of religious organizations. For more information, see Pub. 1828.

Yes No

13. Are you a school, college, or university described in section 170(b)(1)(A)(ii)?

An organization is a school if it:

1. Presents formal instruction as its primary function,2. Has a regularly scheduled curriculum,3. Has a regular faculty of qualified teachers,4. Has a regularly enrolled student body, and5. Has a place where educational activities are regularly carried on.

The term “school” includes primary, secondary, preparatory, high schools, colleges, and universities. It does not include organizations engaged in both educational and non-educational activities, unless the latter are merely incidental to the educational activities.

Yes No





14. Are you a hospital or medical research organization described in section 170(b)(1)(A)(iii) or a hospital organization described in section 501(r)(2)(A)(i)?

An organization is a hospital described in section 170(b)(1)(A)(iii) if its principal purpose or function is providing medical or hospital care, or medical education or research. Medical care includes treatment of any physical or mental disability or condition, on an inpatient or outpatient basis. Thus, if an organization is a rehabilitation institution, outpatient clinic, or community mental health or drug treatment center, it is a hospital if its principal function is providing treatment services as described above. A hospital does not include convalescent homes, homes for children or the aged, or institutions whose principal purpose or function is to train handicapped individuals to pursue a vocation. An organization is a medical research organization described in section 170(b)(1)(A)(iii) if its principal purpose or function is the direct, continuous, and active conduct of medical research in conjunction with a hospital. The hospital with which the organization is affiliated must be described in section 501(c)(3), a federal hospital, or an instrumentality of a governmental unit, such as a municipal hospital. An organization is a hospital organization described in section 501(r)(2)(A)(i) if the organization operates a facility which is required by a state to be licensed, registered, or similarly recognized as a hospital.

Yes No

15. Are you an agricultural research organization described in section 170(b)(1)(A)(ix)? An organization is an agricultural research organization described in section 170(b)(1)(A)(ix) if it is an agricultural research organization directly engaged in the continuous active conduct of agricultural research (as defined in section 1404 of the Agricultural Research, Extension, and Teaching Policy Act of 1977) in conjunction with a land grant college or university (as defined in such section) or a non-land grant college of agriculture (as defined in such section), and during the calendar year in which the contribution is made such organization is committed to spend such contribution for such research before January 1 of the fifth calendar year which begins after the date such contribution is made.

Yes No





16. Are you applying for exemption as a cooperative hospital service organization under section 501(e)?

A cooperative hospital service organization described in section 501(e) is organized and operated on a cooperative basis to provide its section 501(c)(3) hospital members one or more of the following activities.

Data processing. Purchasing (including purchasing insurance on a group basis).Warehousing.Billing and collection (including purchasing patron accounts receivable on a recourse basis).Food.Clinical.Industrial engineering.Laboratory.Printing.Communications.Record center.Personnel (including selecting, testing, training, and educating personnel) services.

A cooperative hospital service organization must also meet certain other requirements specified in section 501(e).

Yes No

17. Are you applying for exemption as a cooperative service organization of operating educational organizations under section 501(f)?

An organization is a cooperative service organization of operating educational organizations if it is organized and operated solely to provide investment services to its members. Those members must be organizations described in section 170(b)(1)(A)(ii) or (iv) that are tax exempt under section 501(a) or whose income is excluded from taxation under section 115.

Yes No





18. Are you applying for exemption as a qualified charitable risk pool under section 501(n)?

A qualified charitable risk pool is treated as organized and operated exclusively for charitable purposes. Check the appropriate box to indicate whether you are a charitable risk pool. A qualified charitable risk pool is an organization that:

1. Is organized and operated only to pool insurable risks of its members (not including risks related to medical malpractice) and to provide information to its members about loss control and risk management,

2. Consists only of members that are section 501(c)(3) organizations exempt from tax under section 501(a),

3. Is organized under state law authorizing this type of risk pooling,4. Is exempt from state income tax (or will be after qualifying as a section 501(c)(3)

organization),5. Has obtained at least $1,000,000 in startup capital from nonmember charitable

organizations,6. Is controlled by a board of directors elected by its members, and7. Is organized under documents requiring that:

a. Each member be a section 501(c)(3) organization exempt from tax under section 501(a),

b. Each member that receives a final determination that it no longer qualifies under section 501(c)(3) notify the pool immediately, and

c. Each insurance policy issued by the pool provide that it will not cover events occurring after a final determination described in (b).

Yes No





19. Are you requesting classification as a supporting organization under section 509(a)(3)?

A supporting organization (as defined in section 509(a)(3)) differs from the other types of public charities described in section 509. Instead of describing an organization that conducts a particular kind of activity or that receives financial support from the general public, section 509(a)(3) describes organizations that have established certain relationships in support of public charities described in section 509(a)(1) or 509(a)(2). Thus, an organization can qualify as a supporting organization (and not be classified as a private foundation) even though it may be funded by a single donor, family, or corporation. This kind of funding ordinarily would indicate private foundation status, but a section 509(a)(3) organization has limited purposes and activities, and gives up a significant degree of independence. A supporting organization is an organization that:

1. Is organized and operated exclusively for the benefit of, to perform the functions of, or to carry out the purposes of one or more specified organizations as described in section 509(a)(1) or 509(a)(2). These section 509(a)(1) and 509(a)(2) organizations are commonly called publicly supported organizations.

2. Has one of three types of relationships with one or more organizations described in section 509(a)(1) or 509(a)(2). It must be: a. Operated, supervised, or controlled by one or more section 509(a)(1) or 509(a)(2)

organizations (Type I supporting organization);b. Supervised or controlled in connection with one or more section 509(a)(1) or

509(a)(2) organizations (Type II supporting organization); or c. Operated in connection with one or more section 509(a)(1) or 509(a)(2)

organizations (Type III supporting organization).3. Is not controlled directly or indirectly by disqualified persons (as defined in section

4946) other than foundation managers and other than one or more organizations described in section 509(a)(1) or 509(a)(2).

See Pub. 557 for more information.

Yes No

20. Is a substantial purpose of your activities to provide assistance to individuals through credit counseling activities such as budgeting, personal finance, financial literacy, mortgage foreclosure assistance, or other consumer credit areas?

These activities involve the education of the consumer on budgeting, personal finance, financial literacy, mortgage foreclosure assistance, or other consumer credit areas. It may also involve assisting the consumer in consolidating debt and negotiating between debtors and creditors to lower interest rates and waive late and over-limit fees.

Yes No

21. Do you or will you invest 5% or more of your total assets in securities or funds that are not publicly traded?

Yes No

22. Do you participate, or intend to participate, in partnerships (including entities or arrangements treated as partnerships for federal tax purposes) in which you share losses with partners other than section 501(c)(3) organizations?

Yes No

23. Do you sell, or intend to sell carbon credits or carbon offsets? Yes No24. Are you a Health Maintenance Organization (HMO)? Yes No





25. Are you an Accountable Care Organization (ACO), or an organization that engages in, or intends to engage in, ACO activities (such as participation in the Medicare Shared Savings Program (MSSP) or in activities unrelated to the MSSP described in Notice 2011–20, 2011–16 I.R.B. 652)?

ACOs are entities formed by groups of physicians, hospitals, and other health care service providers and suppliers to manage and coordinate the care provided to patients. For a discussion of tax law issues relating to ACOs, see Notice 2011-20 and FS-2011-11, available at IRS.gov/uac/Tax-Exempt-Organizations-Participating-in-the-Medicare-Shared-Savings-Program-through-Accountable-Care-Organizations.

Yes No

26. Do you maintain or intend to maintain one or more donor advised funds?

In general, a donor advised fund is a fund or account that is owned and controlled by the organization but that is separately identified by reference to contributions of a donor or donors and with respect to which a donor (or any person appointed or designated by the donor) has or expects to have advisory privileges concerning the distribution or investment of amounts held in the fund or account by reason of the donor’s status as a donor. For additional information, see Pub. 557. Check “No” if you are a governmental unit referred to in section 170(c)(1) or a private foundation referred to in section 509(a).

Yes No

27. Are you organized and operated exclusively for testing for public safety and requesting a foundation classification under section 509(a)(4)?

Generally, these organizations test consumer products to determine their acceptability for use by the general public.

Yes No

28. Are you requesting classification as a private operating foundation?

Private foundations lack general public support. What distinguishes a private operating foundation from other private foundations is that it engages directly in the active conduct of charitable, religious, educational, and similar activities (as opposed to indirectly carrying out these activities by providing grants to individuals or other organizations). Private operating foundations are subject to more favorable rules than other private foundations in terms of charitable contribution deductions and attracting grants from private foundations. However, to be classified as a private operating foundation, an organization must meet certain tests. Additional information about private operating foundations is available at IRS.gov/Charities- &-Non-Profits/Private-Foundations/Private-Operating-Foundations.

Yes No

29. Are you applying for reinstatement under section 4 of Rev. Proc. 2014-11, and seeking to change your foundation classification from the classification you had at the time of your revocation?

Only organizations that are seeking the same foundation classification that they had at the time of revocation may use Form 1023-EZ to apply for reinstatement under section 4 of Rev. Proc. 2014-11. If you wish to change your foundation classification, you must use the full Form 1023.

Yes No

30. Are you applying for retroactive reinstatement of exemption under section 5 or 6 of Rev. Proc. 2014-11, after being automatically revoked?

Only organizations applying for reinstatement under section 4 or 7 of Rev. Proc. 2014-11 may use Form 1023-EZ. If you are applying for retroactive reinstatement under section 5 or 6 of Rev. Proc. 2014-11, you must submit the full Form 1023 along with the appropriate reasonable cause statement and a statement confirming you have filed the required annual returns as described in the revenue procedure.

Yes No





National Taxonomy of Exempt Entities (NTEE) Codes.Arts, Culture, and HumanitiesA01 Alliance/Advocacy OrganizationsA02 Management & Technical

AssistanceA03 Professional Societies,

AssociationsA05 Research Institutes and/or Public

Policy AnalysisA11 Single Organization SupportA12 Fund Raising and/or Fund

DistributionA19 Nonmonetary Support N.E.C.*A20 Arts, Cultural Organizations -

MultipurposeA23 Cultural, Ethnic AwarenessA25 Arts EducationA26 Arts Council/AgencyA30 Media, Communications

OrganizationsA31 Film, VideoA32 TelevisionA33 Printing, PublishingA34 RadioA40 Visual Arts OrganizationsA50 Museum, Museum ActivitiesA51 Art MuseumsA52 Children's MuseumsA54 History MuseumsA56 Natural History, Natural Science

MuseumsA57 Science and Technology

MuseumsA60 Performing Arts OrganizationsA61 Performing Arts CentersA62 DanceA63 BalletA65 TheaterA68 MusicA69 Symphony OrchestrasA6A OperaA6B Singing, ChoralA6C Music Groups, Bands,

EnsemblesA6E Performing Arts SchoolsA70 Humanities OrganizationsA80 Historical Societies, Related

Historical ActivitiesA84 Commemorative EventsA90 Arts Service Organizations and

ActivitiesA99 Arts, Culture, and Humanities

N.E.C.EducationB01 Alliance/Advocacy OrganizationsB02 Management & Technical

AssistanceB03 Professional Societies,

AssociationsB05 Research Institutes and/or Public

Policy AnalysisB11 Single Organization SupportB12 Fund Raising and/or Fund

DistributionB19 Nonmonetary Support N.E.C.B20 Elementary, Secondary

Education, K - 12B21 Kindergarten, Preschool,

Nursery School, Early Admissions

B24 Primary, Elementary SchoolsB25 Secondary, High SchoolB28 Specialized Education

InstitutionsB30 Vocational, Technical SchoolsB40 Higher Education InstitutionsB41 Community or Junior CollegesB42 Undergraduate College (4-year)B43 University or Technological

InstituteB50 Graduate, Professional Schools

(Separate Entities)B60 Adult, Continuing EducationB70 LibrariesB80 Student Services, Organizations

of Students

B82 Scholarships, Student Financial Aid Services, Awards

B83 Student Sororities, FraternitiesB84 Alumni AssociationsB90 Educational Services and

Schools - OtherB92 Remedial Reading, Reading

EncouragementB94 Parent/Teacher GroupB99 Education N.E.C.Environmental Quality, Protection, and BeautificationC01 Alliance/Advocacy OrganizationsC02 Management & Technical

AssistanceC03 Professional Societies,

AssociationsC05 Research Institutes and/or Public

Policy AnalysisC11 Single Organization SupportC12 Fund Raising and/or Fund

DistributionC19 Nonmonetary Support N.E.C.C20 Pollution Abatement and Control

ServicesC27 Recycling ProgramsC30 Natural Resources Conservation

and ProtectionC32 Water Resource, Wetlands

Conservation and ManagementC34 Land Resources ConservationC35 Energy Resources Conservation

and DevelopmentC36 Forest ConservationC40 Botanical, Horticultural, and

Landscape ServicesC41 Botanical Gardens, Arboreta and

Botanical OrganizationsC42 Garden Club, Horticultural

ProgramC50 Environmental Beautification and

AestheticsC60 Environmental Education and

Outdoor Survival ProgramsC99 Environmental Quality,

Protection, and Beautification N.E.C.

Animal-RelatedD01 Alliance/Advocacy OrganizationsD02 Management & Technical

AssistanceD03 Professional Societies,

AssociationsD05 Research Institutes and/or Public

Policy AnalysisD11 Single Organization SupportD12 Fund Raising and/or Fund

DistributionD19 Nonmonetary Support N.E.C.D20 Animal Protection and WelfareD30 Wildlife Preservation, ProtectionD31 Protection of Endangered

SpeciesD32 Bird Sanctuary, PreserveD33 Fisheries ResourcesD34 Wildlife Sanctuary, RefugeD40 Veterinary ServicesD50 Zoo, Zoological SocietyD60 Other Services - Specialty

AnimalsD61 Animal Training, BehaviorD99 Animal-Related N.E.C.Health - General and RehabilitativeE01 Alliance/Advocacy OrganizationsE02 Management & Technical

AssistanceE03 Professional Societies,

AssociationsE05 Research Institutes and/or Public

Policy AnalysisE11 Single Organization SupportE12 Fund Raising and/or Fund

DistributionE19 Nonmonetary Support N.E.C.

E20 Hospitals and Related Primary Medical Care Facilities

E21 Community Health SystemsE22 Hospital, GeneralE24 Hospital, SpecialtyE30 Health Treatment Facilities,

Primarily OutpatientE31 Group Health Practice (Health

Maintenance Organizations)E32 Ambulatory Health Center,

Community ClinicE40 Reproductive Health Care

Facilities and Allied ServicesE42 Family Planning CentersE50 Rehabilitative Medical ServicesE60 Health Support ServicesE61 Blood Supply RelatedE62 Ambulance, Emergency Medical

Transport ServicesE65 Organ and Tissue BanksE70 Public Health Program (Includes

General Health and Wellness Promotion Services)

E80 Health, General and FinancingE86 Patient Services - Entertainment,

RecreationE90 Nursing Services (General)E91 Nursing, Convalescent FacilitiesE92 Home Health CareE99 Health - General and

Rehabilitative N.E.C.Mental Health, Crisis InterventionF01 Alliance/Advocacy OrganizationsF02 Management & Technical

AssistanceF03 Professional Societies,

AssociationsF05 Research Institutes and/or Public

Policy AnalysisF11 Single Organization SupportF12 Fund Raising and/or Fund

DistributionF19 Nonmonetary Support N.E.C.F20 Alcohol, Drug and Substance

Abuse, Dependency Prevention and Treatment

F21 Alcohol, Drug Abuse, Prevention Only

F22 Alcohol, Drug Abuse, Treatment Only

F30 Mental Health Treatment - Multipurpose and N.E.C.

F31 Psychiatric, Mental Health Hospital

F32 Community Mental Health Center

F33 Group Home, Residential Treatment Facility - Mental Health Related

F40 Hot Line, Crisis Intervention Services

F42 Rape Victim ServicesF50 Addictive Disorders N.E.C.F52 Smoking AddictionF53 Eating Disorder, AddictionF54 Gambling AddictionF60 Counseling, Support GroupsF70 Mental Health DisordersF80 Mental Health Association,

MultipurposeF99 Mental Health, Crisis Intervention

N.E.C.Diseases, Disorders, Medical DisciplinesG01 Alliance/Advocacy OrganizationsG02 Management & Technical

AssistanceG03 Professional Societies,

AssociationsG05 Research Institutes and/or Public

Policy AnalysisG11 Single Organization SupportG12 Fund Raising and/or Fund

DistributionG19 Nonmonetary Support N.E.C.

G20 Birth Defects and Genetic Diseases

G25 Down SyndromeG30 CancerG40 Diseases of Specific OrgansG41 Eye Diseases, Blindness and

Vision ImpairmentsG42 Ear and Throat DiseasesG43 Heart and Circulatory System

Diseases, DisordersG44 Kidney DiseaseG45 Lung DiseaseG48 Brain DisordersG50 Nerve, Muscle and Bone

DiseasesG51 ArthritisG54 EpilepsyG60 Allergy Related Diseases G61

AsthmaG70 Digestive Diseases, DisordersG80 Specifically Named DiseasesG81 AIDSG83 Alzheimer's DiseaseG84 AutismG90 Medical DisciplinesG92 Biomedicine, BioengineeringG94 GeriatricsG96 Neurology, NeuroscienceG98 PediatricsG9B SurgeryG99 Diseases, Disorders, Medical

Disciplines N.E.C.Medical ResearchH01 Alliance/Advocacy OrganizationsH02 Management & Technical

AssistanceH03 Professional Societies,

AssociationsH05 Research Institutes and/or Public

Policy AnalysisH11 Single Organization SupportH12 Fund Raising and/or Fund

DistributionH19 Nonmonetary Support N.E.C.H20 Birth Defects, Genetic Diseases

ResearchH25 Down Syndrome ResearchH30 Cancer ResearchH40 Specific Organ ResearchH41 Eye ResearchH42 Ear and Throat ResearchH43 Heart, Circulatory ResearchH44 Kidney ResearchH45 Lung ResearchH48 Brain Disorders ResearchH50 Nerve, Muscle, Bone ResearchH51 Arthritis ResearchH54 Epilepsy ResearchH60 Allergy Related Disease

ResearchH61 Asthma ResearchH70 Digestive Disease, Disorder

ResearchH80 Specifically Named Diseases

ResearchH81 AIDS ResearchH83 Alzheimer's Disease ResearchH84 Autism ResearchH90 Medical Specialty ResearchH92 Biomedicine, Bioengineering

ResearchH94 Geriatrics ResearchH96 Neurology, Neuroscience

ResearchH98 Pediatrics ResearchH9B Surgery ResearchH99 Medical Research N.E.C.Crime, Legal RelatedI01 Alliance/Advocacy OrganizationsI02 Management & Technical

AssistanceI03 Professional Societies,

AssociationsI05 Research Institutes and/or Public

Policy Analysis

-21-




National Taxonomy of Exempt Entities (NTEE) Codes. (Continued)I11 Single Organization SupportI12 Fund Raising and/or Fund

DistributionI19 Nonmonetary Support N.E.C.I20 Crime Prevention N.E.C.I21 Delinquency PreventionI23 Drunk Driving RelatedI30 Correctional Facilities N.E.C.I31 Transitional Care, Half-Way

House for Offenders, Ex-Offenders

I40 Rehabilitation Services for Offenders

I43 Services to Prisoners and Families - Multipurpose

I44 Prison AlternativesI50 Administration of Justice, CourtsI51 Dispute Resolution, Mediation

ServicesI60 Law Enforcement Agencies

(Police Departments)I70 Protection Against, Prevention of

Neglect, Abuse, ExploitationI71 Spouse Abuse, Prevention ofI72 Child Abuse, Prevention ofI73 Sexual Abuse, Prevention ofI80 Legal ServicesI83 Public Interest Law, LitigationI99 Crime, Legal Related N.E.C.Employment, Job RelatedJ01 Alliance/Advocacy OrganizationsJ02 Management & Technical

AssistanceJ03 Professional Societies,

AssociationsJ05 Research Institutes and/or Public

Policy AnalysisJ11 Single Organization SupportJ12 Fund Raising and/or Fund

DistributionJ19 Nonmonetary Support N.E.C.J20 Employment Procurement

Assistance, Job TrainingJ21 Vocational Counseling,

Guidance and TestingJ22 Vocational TrainingJ30 Vocational RehabilitationJ32 Goodwill IndustriesJ33 Sheltered Remunerative

Employment, Work Activity Center N.E.C.

J40 Labor Unions, OrganizationsJ99 Employment, Job Related N.E.C.Food, Agriculture, and NutritionK01 Alliance/Advocacy OrganizationsK02 Management & Technical

AssistanceK03 Professional Societies,

AssociationsK05 Research Institutes and/or Public

Policy AnalysisK11 Single Organization SupportK12 Fund Raising and/or Fund

DistributionK19 Nonmonetary Support N.E.C.K20 Agricultural ProgramsK25 Farmland PreservationK26 Livestock Breeding,

Development, ManagementK28 Farm Bureau, GrangeK30 Food Service, Free Food

Distribution ProgramsK31 Food Banks, Food PantriesK34 Congregate MealsK35 Eatery, Agency, Organization

SponsoredK36 Meals on WheelsK40 Nutrition ProgramsK50 Home EconomicsK99 Food, Agriculture, and Nutrition

N.E.C.Housing, ShelterL01 Alliance/Advocacy OrganizationsL02 Management & Technical

AssistanceL03 Professional Societies,

AssociationsL05 Research Institutes and/or Public

Policy AnalysisL11 Single Organization Support

L12 Fund Raising and/or Fund Distribution

L19 Nonmonetary Support N.E.C.L20 Housing Development,

Construction, ManagementL21 Public Housing FacilitiesL22 Senior Citizens' Housing/

Retirement CommunitiesL25 Housing RehabilitationL30 Housing Search AssistanceL40 Low-Cost Temporary HousingL41 Homeless, Temporary Shelter

ForL50 Housing Owners, Renters

OrganizationsL80 Housing Support Services --

OtherL81 Home Improvement and RepairsL82 Housing Expense Reduction

SupportL99 Housing, Shelter N.E.C.Public Safety, Disaster Preparedness, and ReliefM01 Alliance/Advocacy OrganizationsM02 Management & Technical

AssistanceM03 Professional Societies,

AssociationsM05 Research Institutes and/or Public

Policy AnalysisM11 Single Organization SupportM12 Fund Raising and/or Fund

DistributionM19 Nonmonetary Support N.E.C.M20 Disaster Preparedness and

Relief ServicesM23 Search and Rescue Squads,

ServicesM24 Fire Prevention, Protection,

ControlM40 Safety EducationM41 First Aid Training, ServicesM42 Automotive SafetyM99 Public Safety, Disaster

Preparedness, and Relief N.E.C.Recreation, Sports, Leisure, AthleticsN01 Alliance/Advocacy OrganizationsN02 Management & Technical

AssistanceN03 Professional Societies,

AssociationsN05 Research Institutes and/or Public

Policy AnalysisN11 Single Organization SupportN12 Fund Raising and/or Fund

DistributionN19 Nonmonetary Support N.E.C.N20 Recreational and Sporting

CampsN30 Physical Fitness and Community

Recreational FacilitiesN31 Community Recreational CentersN32 Parks and PlaygroundsN40 Sports Training Facilities,

AgenciesN50 Recreational, Pleasure, or Social

ClubN52 Fairs, County and OtherN60 Amateur Sports Clubs, Leagues,

N.E.C.N61 Fishing, Hunting ClubsN62 BasketballN63 Baseball, SoftballN64 Soccer Clubs, LeaguesN65 Football Clubs, LeaguesN66 Tennis, Racquet Sports Clubs,

LeaguesN67 Swimming, Water RecreationN68 Winter Sports (Snow and Ice)N69 Equestrian, RidingN6A GolfN70 Amateur Sports CompetitionsN71 Olympics Committees and

Related International Competitions

N72 Special OlympicsN80 Professional Athletic LeaguesN99 Recreation, Sports, Leisure,

Athletics N.E.C.

Youth DevelopmentO01 Alliance/Advocacy OrganizationsO02 Management & Technical

AssistanceO03 Professional Societies,

AssociationsO05 Research Institutes and/or Public

Policy AnalysisO11 Single Organization SupportO12 Fund Raising and/or Fund

DistributionO19 Nonmonetary Support N.E.C.O20 Youth Centers, Clubs,

MultipurposeO21 Boys ClubsO22 Girls Clubs O23 Boys and Girls

Clubs (Combined)O30 Adult, Child Matching ProgramsO31 Big Brothers, Big SistersO40 Scouting OrganizationsO41 Boy Scouts of AmericaO42 Girl Scouts of the U.S.A.O43 Camp FireO50 Youth Development Programs,

OtherO51 Youth Community Service ClubsO52 Youth Development - AgriculturalO53 Youth Development - BusinessO54 Youth Development - Citizenship

ProgramsO55 Youth Development - Religious

LeadershipO99 Youth Development N.E.C.Human Services - Multipurpose and OtherP01 Alliance/Advocacy OrganizationsP02 Management & Technical

AssistanceP03 Professional Societies,

AssociationsP05 Research Institutes and/or Public

Policy AnalysisP11 Single Organization SupportP12 Fund Raising and/or Fund

DistributionP19 Nonmonetary Support N.E.C.P20 Human Service Organizations -

MultipurposeP21 American Red CrossP22 Urban LeagueP24 Salvation ArmyP26 Volunteers of AmericaP27 Young Men's or Women's

Associations (YMCA, YWCA, YWHA, YMHA)

P28 Neighborhood Centers, Settlement Houses

P29 Thrift ShopsP30 Children's, Youth ServicesP31 AdoptionP32 Foster CareP33 Child Day CareP40 Family ServicesP42 Single Parent Agencies,

ServicesP43 Family Violence Shelters,

ServicesP44 Homemaker, Home Health AideP45 Family Services, Adolescent

ParentsP46 Family CounselingP50 Personal Social ServicesP51 Financial Counseling, Money

ManagementP52 Transportation, Free or

SubsidizedP58 Gift DistributionP60 Emergency Assistance (Food,

Clothing, Cash)P61 Travelers' AidP62 Victims' ServicesP70 Residential, Custodial CareP72 Half-Way House (Short-Term

Residential Care)P73 Group Home (Long Term)P74 HospiceP75 Senior Continuing Care

Communities

P80 Services to Promote the Independence of Specific Populations

P81 Senior Centers, ServicesP82 Developmentally Disabled

Centers, ServicesP84 Ethnic, Immigrant Centers,

ServicesP85 Homeless Persons Centers,

ServicesP86 Blind/Visually Impaired Centers,

ServicesP87 Deaf/Hearing Impaired Centers,

ServicesP99 Human Services - Multipurpose

and Other N.E.C.International, Foreign Affairs, and National SecurityQ01 Alliance/Advocacy OrganizationsQ02 Management & Technical

AssistanceQ03 Professional Societies,

AssociationsQ05 Research Institutes and/or Public

Policy AnalysisQ11 Single Organization SupportQ12 Fund Raising and/or Fund

DistributionQ19 Nonmonetary Support N.E.C.Q20 Promotion of International

UnderstandingQ21 International Cultural ExchangeQ22 International Student Exchange

and AidQ23 International Exchanges, N.E.C.Q30 International Development,

Relief ServicesQ31 International Agricultural

DevelopmentQ32 International Economic

DevelopmentQ33 International ReliefQ40 International Peace and SecurityQ41 Arms Control, Peace

OrganizationsQ42 United Nations AssociationQ43 National Security, DomesticQ70 International Human RightsQ71 International Migration, Refugee

IssuesQ99 International, Foreign Affairs, and

National Security N.E.C.Civil Rights, Social Action, AdvocacyR01 Alliance/Advocacy OrganizationsR02 Management & Technical

AssistanceR03 Professional Societies,

AssociationsR05 Research Institutes and/or Public

Policy AnalysisR11 Single Organization SupportR12 Fund Raising and/or Fund

DistributionR19 Nonmonetary Support N.E.C.R20 Civil Rights, Advocacy for

Specific GroupsR22 Minority RightsR23 Disabled Persons' RightsR24 Women's RightsR25 Seniors' RightsR26 Lesbian, Gay RightsR30 Intergroup, Race RelationsR40 Voter Education, RegistrationR60 Civil Liberties AdvocacyR61 Reproductive RightsR62 Right to LifeR63 Censorship, Freedom of Speech

and Press IssuesR67 Right to Die, Euthanasia IssuesR99 Civil Rights, Social Action,

Advocacy N.E.C.Community Improvement, Capacity BuildingS01 Alliance/Advocacy OrganizationsS02 Management & Technical

AssistanceS03 Professional Societies,

Associations

-22-




National Taxonomy of Exempt Entities (NTEE) Codes. (Continued)S05 Research Institutes and/or Public

Policy AnalysisS11 Single Organization SupportS12 Fund Raising and/or Fund

DistributionS19 Nonmonetary Support N.E.C.S20 Community, Neighborhood

Development, Improvement (General)

S21 Community CoalitionsS22 Neighborhood, Block

AssociationsS30 Economic DevelopmentS31 Urban, Community Economic

DevelopmentS32 Rural DevelopmentS40 Business and IndustryS41 Promotion of BusinessS43 Management Services for Small

Business, EntrepreneursS46 Boards of TradeS47 Real Estate OrganizationsS50 Nonprofit ManagementS80 Community Service ClubsS81 Women's Service ClubsS82 Men's Service ClubsS99 Community Improvement,

Capacity Building N.E.C.Philanthropy, Voluntarism, and Grantmaking FoundationsT01 Alliance/Advocacy OrganizationsT02 Management & Technical

AssistanceT03 Professional Societies,

AssociationsT05 Research Institutes and/or Public

Policy AnalysisT11 Single Organization SupportT12 Fund Raising and/or Fund

DistributionT19 Nonmonetary Support N.E.C.T20 Private Grantmaking

FoundationsT21 Corporate FoundationsT22 Private Independent FoundationsT23 Private Operating FoundationsT30 Public FoundationsT31 Community FoundationsT40 Voluntarism PromotionT50 Philanthropy, Charity,

Voluntarism Promotion, GeneralT70 Fund Raising Organizations That

Cross CategoriesT90 Named Trusts/Foundations

N.E.C.T99 Philanthropy, Voluntarism, and

Grantmaking Foundations N.E.C.

Science and Technology Research Institutes, ServicesU01 Alliance/Advocacy OrganizationsU02 Management & Technical

AssistanceU03 Professional Societies,

AssociationsU05 Research Institutes and/or Public

Policy AnalysisU11 Single Organization SupportU12 Fund Raising and/or Fund

DistributionU19 Nonmonetary Support N.E.C.U20 Science, GeneralU21 Marine Science and

OceanographyU30 Physical Sciences, Earth

Sciences Research and Promotion

U31 AstronomyU33 Chemistry, Chemical

EngineeringU34 MathematicsU36 GeologyU40 Engineering and Technology

Research, ServicesU41 Computer ScienceU42 EngineeringU50 Biological, Life Science

ResearchU99 Science and Technology

Research Institutes, Services N.E.C.

Social Science Research Institutes, ServicesV01 Alliance/Advocacy OrganizationsV02 Management & Technical

AssistanceV03 Professional Societies,

AssociationsV05 Research Institutes and/or Public

Policy AnalysisV11 Single Organization SupportV12 Fund Raising and/or Fund

DistributionV19 Nonmonetary Support N.E.C.V20 Social Science Institutes,

ServicesV21 Anthropology, SociologyV22 Economics (as a social science)V23 Behavioral ScienceV24 Political ScienceV25 Population StudiesV26 Law, International Law,

JurisprudenceV30 Interdisciplinary Research

V31 Black StudiesV32 Women's StudiesV33 Ethnic StudiesV34 Urban StudiesV35 International StudiesV36 Gerontology (as a social

science)V37 Labor Studies V99 Social

Science Research Institutes, Services N.E.C.

Public, Society Benefit - Multipurpose and OtherW01 Alliance/Advocacy OrganizationsW02 Management & Technical

AssistanceW03 Professional Societies,

AssociationsW05 Research Institutes and/or Public

Policy AnalysisW11 Single Organization SupportW12 Fund Raising and/or Fund

DistributionW19 Nonmonetary Support N.E.C.W20 Government and Public

AdministrationW22 Public Finance, Taxation,

Monetary PolicyW24 Citizen ParticipationW30 Military, Veterans' OrganizationsW40 Public Transportation Systems,

ServicesW50 Telephone, Telegraph and

Telecommunication ServicesW60 Financial Institutions, Services

(Non-Government Related)W61 Credit UnionsW70 Leadership DevelopmentW80 Public UtilitiesW90 Consumer Protection, SafetyW99 Public, Society Benefit -

Multipurpose and Other N.E.C.Religion Related, Spiritual DevelopmentX01 Alliance/Advocacy OrganizationsX02 Management & Technical

AssistanceX03 Professional Societies,

AssociationsX05 Research Institutes and/or Public

Policy AnalysisX11 Single Organization SupportX12 Fund Raising and/or Fund

DistributionX19 Nonmonetary Support N.E.C.X20 ChristianX21 Protestant

X22 Roman CatholicX30 JewishX40 IslamicX50 BuddhistX70 HinduX80 Religious Media,

Communications OrganizationsX81 Religious Film, VideoX82 Religious TelevisionX83 Religious Printing, PublishingX84 Religious RadioX90 Interfaith IssuesX99 Religion Related, Spiritual

Development N.E.C.Mutual/Membership Benefit Organizations, OtherY01 Alliance/Advocacy OrganizationsY02 Management & Technical

AssistanceY03 Professional Societies,

AssociationsY05 Research Institutes and/or Public

Policy AnalysisY11 Single Organization SupportY12 Fund Raising and/or Fund

DistributionY19 Nonmonetary Support N.E.C.Y20 Insurance Providers, ServicesY22 Local Benevolent Life Insurance

Associations, Mutual Irrigation and Telephone Companies, and Like Organizations

Y23 Mutual Insurance Company or Association

Y24 Supplemental Unemployment Compensation

Y25 State-Sponsored Worker's Compensation Reinsurance Organizations

Y30 Pension and Retirement FundsY33 Teachers Retirement Fund

AssociationY34 Employee Funded Pension TrustY35 Multi-Employer Pension PlansY40 Fraternal Beneficiary SocietiesY42 Domestic Fraternal SocietiesY43 Voluntary Employees Beneficiary

Associations (Non-Government)Y44 Voluntary Employees Beneficiary

Associations (Government)Y50 Cemeteries, Burial ServicesY99 Mutual/Membership Benefit

Organizations, Other N.E.C.UnknownZ99 Unknown

-23-



4. Form 1023, Application for Recognition of Exemption

Form 1023(Rev. December 2017) Department of the Treasury Internal Revenue Service

Application for Recognition of Exemption Under Section 501(c)(3) of the Internal Revenue Code ▶ Do not enter social security numbers on this form as it may be made public.

▶ Go to www.irs.gov/Form1023 for instructions and the latest information.

OMB No. 1545-0056 Note: If exempt status is approved, this application will be open for public inspection.

Use the instructions to complete this application and for a definition of all bold items. For additional help, call IRS Exempt Organizations Customer Account Services toll-free at 1-877-829-5500. Visit our website at www.irs.gov for forms and publications. If the required information and documents are not submitted with payment of the appropriate user fee, the application may be returned to you.

Attach additional sheets to this application if you need more space to answer fully. Put your name and EIN on each sheet and identify each answer by Part and line number. Complete Parts I – XI of Form 1023 and submit only those Schedules (A through H) that apply to you.

Part I Identification of Applicant

1 Full name of organization (exactly as it appears in your organizing document) 2 c/o Name (if applicable)

3 Mailing address (Number and street) (see instructions) Room/Suite 4 Employer Identification Number (EIN)

City or town, state or country, and ZIP + 4 5 Month the annual accounting period ends (01 – 12)

6 Primary contact (officer, director, trustee, or authorized representative) a Name:

b Phone: c Fax: (optional)

7 Are you represented by an authorized representative, such as an attorney or accountant? If “Yes,” provide the authorized representative’s name, and the name and address of the authorized representative’s firm. Include a completed Form 2848, Power of Attorney and Declaration of Representative, with your application if you would like us to communicate with your representative.

Yes No

8 Was a person who is not one of your officers, directors, trustees, employees, or an authorized representative listed in line 7, paid, or promised payment, to help plan, manage, or advise you about the structure or activities of your organization, or about your financial or tax matters? If “Yes,” providethe person’s name, the name and address of the person’s firm, the amounts paid or promised to bepaid, and describe that person’s role.

Yes No

9a Organization’s website:

b Organization’s email: (optional)

10 Certain organizations are not required to file an information return (Form 990 or Form 990-EZ). If you are granted tax-exemption, are you claiming to be excused from filing Form 990 or Form 990-EZ? If “Yes,” explain. See the instructions for a description of organizations not required to file Form 990 or Form 990-EZ.

Yes No

11 Date incorporated if a corporation, or formed, if other than a corporation. (MM/DD/YYYY) / /

12 Were you formed under the laws of a foreign country? Yes NoIf “Yes,” state the country.

For Paperwork Reduction Act Notice, see instructions. Cat. No. 17133K Form 1023 (Rev. 12-2017)



Form 1023 (Rev. 12-2017) Name: EIN: Page 2Part II Organizational Structure

You must be a corporation (including a limited liability company), an unincorporated association, or a trust to be tax exempt. See instructions. DO NOT file this form unless you can check “Yes” on lines 1, 2, 3, or 4.

1 Are you a corporation? If “Yes,” attach a copy of your articles of incorporation showing certification of filing with the appropriate state agency. Include copies of any amendments to your articles and be sure they also show state filing certification.

Yes No

2 Are you a limited liability company (LLC)? If “Yes,” attach a copy of your articles of organization showing certification of filing with the appropriate state agency. Also, if you adopted an operating agreement, attach a copy. Include copies of any amendments to your articles and be sure they show state filing certification. Refer to the instructions for circumstances when an LLC should not file its own exemption application.

Yes No

3 Are you an unincorporated association? If “Yes,” attach a copy of your articles of association, constitution, or other similar organizing document that is dated and includes at least two signatures. Include signed and dated copies of any amendments.

Yes No

4a Are you a trust? If “Yes,” attach a signed and dated copy of your trust agreement. Include signed and dated copies of any amendments.

Yes No

b Have you been funded? If “No,” explain how you are formed without anything of value placed in trust. Yes No5 Have you adopted bylaws? If “Yes,” attach a current copy showing date of adoption. If “No,” explain

how your officers, directors, or trustees are selected. Yes No

Part III Required Provisions in Your Organizing Document The following questions are designed to ensure that when you file this application, your organizing document contains the required provisions to meet the organizational test under section 501(c)(3). Unless you can check the boxes in both lines 1 and 2, your organizing document does not meet the organizational test. DO NOT file this application until you have amended your organizing document. Submit your original and amended organizing documents (showing state filing certification if you are a corporation or an LLC) with your application.

1 Section 501(c)(3) requires that your organizing document state your exempt purpose(s), such as charitable, religious, educational, and/or scientific purposes. Check the box to confirm that your organizing document meets this requirement. Describe specifically where your organizing document meets this requirement, such as a referenceto a particular article or section in your organizing document. Refer to the instructions for exempt purpose language.

Location of Purpose Clause (Page, Article, and Paragraph): 2 a Section 501(c)(3) requires that upon dissolution of your organization, your remaining assets must be used exclusively

for exempt purposes, such as charitable, religious, educational, and/or scientific purposes. Check the box on line 2a to confirm that your organizing document meets this requirement by express provision for the distribution of assets upon dissolution. If you rely on state law for your dissolution provision, do not check the box on line 2a and go to line 2c.

b If you checked the box on line 2a, specify the location of your dissolution clause (Page, Article, and Paragraph). Do not complete line 2c if you checked box 2a.

c See the instructions for information about the operation of state law in your particular state. Check this box if you rely on operation of state law for your dissolution provision and indicate the state:

Part IV Narrative Description of Your Activities Using an attachment, describe your past, present, and planned activities in a narrative. If you believe that you have already provided some of this information in response to other parts of this application, you may summarize that information here and refer to the specific parts of the application for supporting details. You may also attach representative copies of newsletters, brochures, or similar documents for supporting details to this narrative. Remember that if this application is approved, it will be open for public inspection. Therefore, your narrative description of activities should be thorough and accurate. Refer to the instructions for information that must be included in your description.

Part V Compensation and Other Financial Arrangements With Your Officers, Directors, Trustees, Employees, and Independent Contractors

1a List the names, titles, and mailing addresses of all of your officers, directors, and trustees. For each person listed, state their total annual compensation, or proposed compensation, for all services to the organization, whether as an officer, employee, or other position. Use actual figures, if available. Enter “none” if no compensation is or will be paid. If additional space is needed, attach a separate sheet. Refer to the instructions for information on what to include as compensation.

Name Title Mailing address Compensation amount (annual actual or estimated)

Form 1023 (Rev. 12-2017)



Form 1023 (Rev. 12-2017) Name: EIN: Page 3 Part V Compensation and Other Financial Arrangements With Your Officers, Directors, Trustees, Employees,

and Independent Contractors (Continued) b List the names, titles, and mailing addresses of each of your five highest compensated employees who receive or will receive

compensation of more than $50,000 per year. Use the actual figure, if available. Refer to the instructions for information onwhat to include as compensation. Do not include officers, directors, or trustees listed in line 1a.


c List the names, names of businesses, and mailing addresses of your five highest compensated independent contractors that receive or will receive compensation of more than $50,000 per year. Use the actual figure, if available. Refer to the instructionsfor information on what to include as compensation.


The following “Yes” or “No” questions relate to past, present, or planned relationships, transactions, or agreements with your officers, directors, trustees, highest compensated employees, and highest compensated independent contractors listed in lines 1a, 1b, and 1c.

2a Are any of your officers, directors, or trustees related to each other through family or business relationships? If “Yes,” identify the individuals and explain the relationship.

Yes No

b Do you have a business relationship with any of your officers, directors, or trustees other than throughtheir position as an officer, director, or trustee? If “Yes,” identify the individuals and describe the businessrelationship with each of your officers, directors, or trustees.

Yes No

c Are any of your officers, directors, or trustees related to your highest compensated employees or highest compensated independent contractors listed on lines 1b or 1c through family or business relationships? If“Yes,” identify the individuals and explain the relationship.

Yes No

3 a For each of your officers, directors, trustees, highest compensated employees, and highest compensated independent contractors listed on lines 1a, 1b, or 1c, attach a list showing their name, qualifications, average hours worked, and duties.

b Do any of your officers, directors, trustees, highest compensated employees, and highest compensatedindependent contractors listed on lines 1a, 1b, or 1c receive compensation from any other organizations, whether tax exempt or taxable, that are related to you through common control? If “Yes,” identify theindividuals, explain the relationship between you and the other organization, and describe thecompensation arrangement.

Yes No

4 In establishing the compensation for your officers, directors, trustees, highest compensated employees, and highest compensated independent contractors listed on lines 1a, 1b, and 1c, the following practices are recommended, although they are not required to obtain exemption. Answer “Yes” to all the practices you use.

a Do you or will the individuals that approve compensation arrangements follow a conflict of interest policy? Yes Nob Do you or will you approve compensation arrangements in advance of paying compensation? Yes Noc Do you or will you document in writing the date and terms of approved compensation arrangements? Yes No

Form 1023 (Rev. 12-2017)



Form 1023 (Rev. 12-2017) Name: EIN: Page 4 Part V Compensation and Other Financial Arrangements With Your Officers, Directors, Trustees, Employees,

and Independent Contractors (Continued) d Do you or will you record in writing the decision made by each individual who decided or voted on

compensation arrangements? Yes No

e Do you or will you approve compensation arrangements based on information about compensation paid by similarly situated taxable or tax-exempt organizations for similar services, current compensation surveys compiled by independent firms, or actual written offers from similarly situated organizations? Refer to the instructions for Part V, lines 1a, 1b, and 1c, for information on what to include as compensation.

Yes No

f Do you or will you record in writing both the information on which you relied to base your decision and its source?

Yes No

g If you answered “No” to any item on lines 4a through 4f, describe how you set compensation that is reasonable for your officers, directors, trustees, highest compensated employees, and highest compensated independent contractors listed in Part V, lines 1a, 1b, and 1c.

5a Have you adopted a conflict of interest policy consistent with the sample conflict of interest policy inAppendix A to the instructions? If “Yes,” provide a copy of the policy and explain how the policy hasbeen adopted, such as by resolution of your governing board. If “No,” answer lines 5b and 5c.

Yes No

b What procedures will you follow to assure that persons who have a conflict of interest will not have influence over you for setting their own compensation?

c What procedures will you follow to assure that persons who have a conflict of interest will not have influence over you regarding business deals with themselves? Note: A conflict of interest policy is recommended though it is not required to obtain exemption. Hospitals, see Schedule C, Section I, line 14.

6a Do you or will you compensate any of your officers, directors, trustees, highest compensated employees, and highest compensated independent contractors listed in lines 1a, 1b, or 1c through non-fixed payments, such as discretionary bonuses or revenue-based payments? If “Yes,” describe all non-fixed compensation arrangements, including how the amounts are determined, who is eligible for such arrangements, whether you place a limitation on total compensation, and how you determine or will determine that you pay no more than reasonable compensation for services. Refer to the instructions for Part V, lines 1a, 1b, and 1c, for information on what to include as compensation.

Yes No

b Do you or will you compensate any of your employees, other than your officers, directors, trustees, or your five highest compensated employees who receive or will receive compensation of more than $50,000 per year, through non-fixed payments, such as discretionary bonuses or revenue-based payments? If “Yes,” describe all non-fixed compensation arrangements, including how the amounts are or will be determined, who is or will be eligible for such arrangements, whether you place or will place a limitation on total compensation, and how you determine or will determine that you pay no more than reasonable compensation for services. Refer to the instructions for Part V, lines 1a, 1b, and 1c, for information on what to include as compensation.

Yes No

7a Do you or will you purchase any goods, services, or assets from any of your officers, directors, trustees, highest compensated employees, or highest compensated independent contractors listed in lines 1a, 1b, or 1c? If “Yes,” describe any such purchase that you made or intend to make, from whom you make or will make such purchases, how the terms are or will be negotiated at arm’s length, and explain how you determine or will determine that you pay no more than fair market value. Attach copies of any written contracts or other agreements relating to such purchases.

Yes No

b Do you or will you sell any goods, services, or assets to any of your officers, directors, trustees, highest compensated employees, or highest compensated independent contractors listed in lines 1a, 1b, or 1c? If “Yes,” describe any such sales that you made or intend to make, to whom you make or will make such sales, how the terms are or will be negotiated at arm’s length, and explain how you determine or will determine you are or will be paid at least fair market value. Attach copies of any written contracts or other agreements relating to such sales.

Yes No

8a Do you or will you have any leases, contracts, loans, or other agreements with your officers, directors, trustees, highest compensated employees, or highest compensated independent contractors listed in lines 1a, 1b, or 1c? If “Yes,” provide the information requested in lines 8b through 8f.

Yes No

b Describe any written or oral arrangements that you made or intend to make. c Identify with whom you have or will have such arrangements. d Explain how the terms are or will be negotiated at arm’s length. e Explain how you determine you pay no more than fair market value or you are paid at least fair market value. f Attach copies of any signed leases, contracts, loans, or other agreements relating to such arrangements.

9a Do you or will you have any leases, contracts, loans, or other agreements with any organization in which any of your officers, directors, or trustees are also officers, directors, or trustees, or in which anyindividual officer, director, or trustee owns more than a 35% interest? If “Yes,” provide the informationrequested in lines 9b through 9f.

Yes No

Form 1023 (Rev. 12-2017)



Form 1023 (Rev. 12-2017) Name: EIN: Page 5 Part V Compensation and Other Financial Arrangements With Your Officers, Directors, Trustees,

Employees, and Independent Contractors (Continued) b Describe any written or oral arrangements you made or intend to make. c Identify with whom you have or will have such arrangements. d Explain how the terms are or will be negotiated at arm’s length. e Explain how you determine or will determine you pay no more than fair market value or that you are paid

at least fair market value.

f Attach a copy of any signed leases, contracts, loans, or other agreements relating to such arrangements.

Part VI Your Members and Other Individuals and Organizations That Receive Benefits From You The following “Yes” or “No” questions relate to goods, services, and funds you provide to individuals and organizations as part of your activities. Your answers should pertain to past, present, and planned activities. See instructions.

1 a In carrying out your exempt purposes, do you provide goods, services, or funds to individuals? If “Yes,”describe each program that provides goods, services, or funds to individuals.

Yes No

b In carrying out your exempt purposes, do you provide goods, services, or funds to organizations? If “Yes,” describe each program that provides goods, services, or funds to organizations.

Yes No

2 Do any of your programs limit the provision of goods, services, or funds to a specific individual or group of specific individuals? For example, answer “Yes,” if goods, services, or funds are provided only for a particular individual, your members, individuals who work for a particular employer, or graduates of a particular school. If “Yes,” explain the limitation and how recipients are selected for each program.

Yes No

3 Do any individuals who receive goods, services, or funds through your programs have a family or business relationship with any officer, director, trustee, or with any of your highest compensated employees or highest compensated independent contractors listed in Part V, lines 1a, 1b, and 1c? If “Yes,” explain how these related individuals are eligible for goods, services, or funds.

Yes No

Part VII Your History The following “Yes” or “No” questions relate to your history. See instructions.

1 Are you a successor to another organization? Answer “Yes,” if you have taken or will take over the activities of another organization; you took over 25% or more of the fair market value of the net assets ofanother organization; or you were established upon the conversion of an organization from for-profit to nonprofit status. If “Yes,” complete Schedule G.

Yes No

2 Are you submitting this application more than 27 months after the end of the month in which you were legally formed? If “Yes,” complete Schedule E.

Yes No

Part VIII Your Specific Activities The following “Yes” or “No” questions relate to specific activities that you may conduct. Check the appropriate box. Your answers should pertain to past, present, and planned activities. See instructions.

1 Do you support or oppose candidates in political campaigns in any way? If “Yes,” explain. Yes No2 a Do you attempt to influence legislation? If “Yes,” explain how you attempt to influence legislation and

complete line 2b. If “No,” go to line 3a. Yes No

b Have you made or are you making an election to have your legislative activities measured by expenditures by filing Form 5768? If “Yes,” attach a copy of the Form 5768 that was already filed or attach a completed Form 5768 that you are filing with this application. If “No,” describe whether your attempts to influence legislation are a substantial part of your activities. Include the time and money spent on your attempts to influence legislation as compared to your total activities.

Yes No

3a Do you or will you operate bingo or gaming activities? If “Yes,” describe who conducts them, and list all revenue received or expected to be received and expenses paid or expected to be paid in operating these activities. Revenue and expenses should be provided for the time periods specified in Part IX, Financial Data.

Yes No

b Do you or will you enter into contracts or other agreements with individuals or organizations to conduct bingo or gaming for you? If “Yes,” describe any written or oral arrangements that you made or intend to make, identify with whom you have or will have such arrangements, explain how the terms are or will benegotiated at arm’s length, and explain how you determine or will determine you pay no more than fair market value or you will be paid at least fair market value. Attach copies or any written contracts or other agreements relating to such arrangements.

Yes No

c List the states and local jurisdictions, including Indian Reservations, in which you conduct or will conduct gaming or bingo.

Form 1023 (Rev. 12-2017)



Form 1023 (Rev. 12-2017) Name: EIN: Page 6 Part VIII Your Specific Activities (Continued)

4 a Do you or will you undertake fundraising? If “Yes,” check all the fundraising programs you do or will conduct. See instructions.

Yes No

mail solicitations phone solicitations email solicitations accept donations on your website personal solicitations receive donations from another organization’s website vehicle, boat, plane, or similar donations government grant solicitations foundation grant solicitations Other

Attach a description of each fundraising program.

b Do you or will you have written or oral contracts with any individuals or organizations to raise funds for you? If “Yes,” describe these activities. Include all revenue and expenses from these activities and state who conducts them. Revenue and expenses should be provided for the time periods specified in Part IX, Financial Data. Also, attach a copy of any contracts or agreements.

Yes No

c Do you or will you engage in fundraising activities for other organizations? If “Yes,” describe these arrangements. Include a description of the organizations for which you raise funds and attach copies ofall contracts or agreements.

Yes No

d List all states and local jurisdictions in which you conduct fundraising. For each state or local jurisdictionlisted, specify whether you fundraise for your own organization, you fundraise for another organization, or another organization fundraises for you.

e Do you or will you maintain separate accounts for any contributor under which the contributor has theright to advise on the use or distribution of funds? Answer “Yes” if the donor may provide advice on thetypes of investments, distributions from the types of investments, or the distribution from the donor’s contribution account. If “Yes,” describe this program, including the type of advice that may be provided and submit copies of any written materials provided to donors.

Yes No

5 Are you affiliated with a governmental unit? If “Yes,” explain. Yes No6a Do you or will you engage in economic development? If “Yes,” describe your program. Yes No

b Describe in full who benefits from your economic development activities and how the activities promote exempt purposes.

7a Do or will persons other than your employees or volunteers develop your facilities? If “Yes,” describe each facility, the role of the developer, and any business or family relationship(s) between the developer and your officers, directors, or trustees.

Yes No

b Do or will persons other than your employees or volunteers manage your activities or facilities? If “Yes,”describe each activity and facility, the role of the manager, and any business or family relationship(s) between the manager and your officers, directors, or trustees.

Yes No

c If there is a business or family relationship between any manager or developer and your officers, directors, or trustees, identify the individuals, explain the relationship, describe how contracts are negotiated at arm’s length so that you pay no more than fair market value, and submit a copy of any contracts or other agreements.

8 Do you or will you enter into joint ventures, including partnerships or limited liability companies treated as partnerships, in which you share profits and losses with partners other than section 501(c)(3) organizations? If “Yes,” describe the activities of these joint ventures in which you participate.

Yes No

9a Are you applying for exemption as a childcare organization under section 501(k)? If “Yes,” answer lines9b through 9d. If “No,” go to line 10.

Yes No

b Do you provide childcare so that parents or caretakers of children you care for can be gainfully employed (see instructions)? If “No,” explain how you qualify as a childcare organization described insection 501(k).

Yes No

c Of the children for whom you provide childcare, are 85% or more of them cared for by you to enable their parents or caretakers to be gainfully employed (see instructions)? If “No,” explain how you qualify as a childcare organization described in section 501(k).

Yes No

d Are your services available to the general public? If “No,” describe the specific group of people for whomyour activities are available. Also, see the instructions and explain how you qualify as a childcare organization described in section 501(k).

Yes No

10 Do you or will you publish, own, or have rights in music, literature, tapes, artworks, choreography, scientific discoveries, or other intellectual property? If “Yes,” explain. Describe who owns or will ownany copyrights, patents, or trademarks, whether fees are or will be charged, how the fees are determined, and how any items are or will be produced, distributed, and marketed.

Yes No

Form 1023 (Rev. 12-2017)



Form 1023 (Rev. 12-2017) Name: EIN: Page 7 Part VIII Your Specific Activities (Continued) 11 Do you or will you accept contributions of: real property; conservation easements; closely held

securities; intellectual property such as patents, trademarks, and copyrights; works of music or art; licenses; royalties; automobiles, boats, planes, or other vehicles; or collectibles of any type? If “Yes,” describe each type of contribution, any conditions imposed by the donor on the contribution, and anyagreements with the donor regarding the contribution.

Yes No

12 a Do you or will you operate in a foreign country or countries? If “Yes,” answer lines 12b through 12d. If“No,” go to line 13a.

Yes No

b Name the foreign countries and regions within the countries in which you operate. c Describe your operations in each country and region in which you operate. d Describe how your operations in each country and region further your exempt purposes.

13a Do you or will you make grants, loans, or other distributions to organization(s)? If “Yes,” answer lines 13bthrough 13g. If “No,” go to line 14a.

Yes No

b Describe how your grants, loans, or other distributions to organizations further your exempt purposes. c Do you have written contracts with each of these organizations? If “Yes,” attach a copy of each contract. Yes Nod Identify each recipient organization and any relationship between you and the recipient organization. e Describe the records you keep with respect to the grants, loans, or other distributions you make. f Describe your selection process, including whether you do any of the following.

(i) Do you require an application form? If “Yes,” attach a copy of the form. Yes No(ii) Do you require a grant proposal? If “Yes,” describe whether the grant proposal specifies your

responsibilities and those of the grantee, obligates the grantee to use the grant funds only for the purposes for which the grant was made, provides for periodic written reports concerning the use ofgrant funds, requires a final written report and an accounting of how grant funds were used, and acknowledges your authority to withhold and/or recover grant funds in case such funds are, or appear to be, misused.

Yes No

g Describe your procedures for oversight of distributions that assure you the resources are used to further your exempt purposes, including whether you require periodic and final reports on the use of resources.

14 a Do you or will you make grants, loans, or other distributions to foreign organizations? If “Yes,” answer lines 14b through 14f. If “No,” go to line 15.

Yes No

b Provide the name of each foreign organization, the country and regions within a country in which eachforeign organization operates, and describe any relationship you have with each foreign organization.

c Does any foreign organization listed in line 14b accept contributions earmarked for a specific country or specific organization? If “Yes,” list all earmarked organizations or countries.

Yes No

d Do your contributors know that you have ultimate authority to use contributions made to you at your discretion for purposes consistent with your exempt purposes? If “Yes,” describe how you relay this information to contributors.

Yes No

e Do you or will you make pre-grant inquiries about the recipient organization? If “Yes,” describe these inquiries, including whether you inquire about the recipient’s financial status, its tax-exempt status under the Internal Revenue Code, its ability to accomplish the purpose for which the resources are provided, and other relevant information.

Yes No

f Do you or will you use any additional procedures to ensure that your distributions to foreign organizations are used in furtherance of your exempt purposes? If “Yes,” describe these procedures, including site visits by your employees or compliance checks by impartial experts, to verify that grant funds are being used appropriately.

Yes No

Form 1023 (Rev. 12-2017)



Form 1023 (Rev. 12-2017) Name: EIN: Page 8 Part VIII Your Specific Activities (Continued) 15 Do you have a close connection with any organizations? If “Yes,” explain. Yes No16 Are you applying for exemption as a cooperative hospital service organization under section 501(e)? If

“Yes,” explain. Yes No

17 Are you applying for exemption as a cooperative service organization of operating educational organizations under section 501(f)? If “Yes,” explain.

Yes No

18 Are you applying for exemption as a charitable risk pool under section 501(n)? If “Yes,” explain. Yes No19 Do you or will you operate a school? If “Yes,” complete Schedule B. Answer “Yes,” whether you operate

a school as your main function or as a secondary activity. Yes No

20 Is your main function to provide hospital or medical care? If “Yes,” complete Schedule C. Yes No21 Do you or will you provide low-income housing or housing for the elderly or handicapped? If “Yes,”

complete Schedule F. Yes No

22 Do you or will you provide scholarships, fellowships, educational loans, or other educational grants to individuals, including grants for travel, study, or other similar purposes? If “Yes,” complete Schedule H.

Yes No

Note: Private foundations may use Schedule H to request advance approval of individual grant procedures.

Form 1023 (Rev. 12-2017)



Form 1023 (Rev. 12-2017) Name: EIN: Page 9 Part IX Financial Data

For purposes of this schedule, years in existence refer to completed tax years.

1. If in existence less than 5 years, complete the statement for each year in existence and provide projections of your likely revenues and expenses based on a reasonable and good faith estimate of your future finances for a total of:

a. Three years of financial information if you have not completed one tax year, orb. Four years of financial information if you have completed one tax year. See instructions.

2. If in existence 5 or more years, complete the schedule for the most recent 5 tax years. You will need to provide a separate statement that includes information about the most recent 5 tax years because the data table in Part IX has not been updated to provide for a 5th year. See instructions.

A. Statement of Revenues and Expenses Type of revenue or expense Current tax year

(a) From To

3 prior tax years or 2 succeeding tax years

(b) From To

(c) From To

(d) From To

(e) Provide Total for (a) through (d)

Rev

enue

s

1 Gifts, grants, and contributions received (do not include unusual grants)

2 Membership fees received 3 Gross investment income 4 Net unrelated business

income 5 Taxes levied for your benefit 6 Value of services or facilities

furnished by a governmental unit without charge (not including the value of services generally furnished to the public without charge)

7 Any revenue not otherwise listed above or in lines 9–12 below (attach an itemized list)

8 Total of lines 1 through 7 9 Gross receipts from admissions,

merchandise sold or services performed, or furnishing of facilities in any activity that is related to your exempt purposes (attach itemized list)

10 Total of lines 8 and 9

11 Net gain or loss on sale of capital assets (attach schedule and see instructions)

12 Unusual grants 13 Total Revenue

Add lines 10 through 12

Exp

ense

s

14 Fundraising expenses

15 Contributions, gifts, grants, and similar amounts paid out (attach an itemized list)

16 Disbursements to or for the benefit of members (attach an itemized list)

17 Compensation of officers, directors, and trustees

18 Other salaries and wages 19 Interest expense 20 Occupancy (rent, utilities, etc.) 21 Depreciation and depletion 22 Professional fees

23 Any expense not otherwise classified, such as program services (attach itemized list)

24 Total Expenses Add lines 14 through 23

Form 1023 (Rev. 12-2017)



Form 1023 (Rev. 12-2017) Name: EIN: Page 10 Part IX Financial Data (Continued)

B. Balance Sheet (for your most recently completed tax year) Year End:Assets

1 Cash . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1

(Whole dollars)

2 Accounts receivable, net . . . . . . . . . . . . . . . . . . . . . . . . . . 2 3 Inventories . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 3 4 Bonds and notes receivable (attach an itemized list) . . . . . . . . . . . . . . . . . 4 5 Corporate stocks (attach an itemized list) . . . . . . . . . . . . . . . . . . . . 5 6 Loans receivable (attach an itemized list) . . . . . . . . . . . . . . . . . . . . 6 7 Other investments (attach an itemized list) . . . . . . . . . . . . . . . . . . . . 7 8 Depreciable and depletable assets (attach an itemized list) . . . . . . . . . . . . . . 8 9 Land . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 9

10 Other assets (attach an itemized list) . . . . . . . . . . . . . . . . . . . . . . 10 11 Total Assets (add lines 1 through 10) . . . . . . . . . . . . . . . . . . . . . . 11

Liabilities 12 Accounts payable . . . . . . . . . . . . . . . . . . . . . . . . . . . . 12 13 Contributions, gifts, grants, etc. payable . . . . . . . . . . . . . . . . . . . . 13 14 Mortgages and notes payable (attach an itemized list) . . . . . . . . . . . . . . . . 14 15 Other liabilities (attach an itemized list) . . . . . . . . . . . . . . . . . . . . . 15 16 Total Liabilities (add lines 12 through 15) . . . . . . . . . . . . . . . . . . . . 16

Fund Balances or Net Assets 17 Total fund balances or net assets . . . . . . . . . . . . . . . . . . . . . . . 17 18 Total Liabilities and Fund Balances or Net Assets (add lines 16 and 17) . . . . . . . . . . 18 19 Have there been any substantial changes in your assets or liabilities since the end of the period

shown above? If “Yes,” explain. Yes No

Part X Public Charity Status Part X is designed to classify you as an organization that is either a private foundation or a public charity. Public charity status is a more favorable tax status than private foundation status. If you are a private foundation, Part X is designed to further determine whether you are a private operating foundation. See instructions.

1 a Are you a private foundation? If “Yes,” go to line 1b. If “No,” go to line 5 and proceed as instructed. If youare unsure, see the instructions.

Yes No

b As a private foundation, section 508(e) requires special provisions in your organizing document in addition to those that apply to all organizations described in section 501(c)(3). Check the box to confirmthat your organizing document meets this requirement, whether by express provision or by reliance onoperation of state law. Attach a statement that describes specifically where your organizing document meets this requirement, such as a reference to a particular article or section in your organizing document or by operation of state law. See the instructions, including Appendix B, for information about the specialprovisions that need to be contained in your organizing document. Go to line 2.

2 Are you a private operating foundation? To be a private operating foundation you must engage directly inthe active conduct of charitable, religious, educational, and similar activities, as opposed to indirectly carrying out these activities by providing grants to individuals or other organizations. If “Yes,” go to line 3. If “No,” go to the signature section of Part XI.

Yes No

3 Have you existed for one or more years? If “Yes,” attach financial information showing that you are a private operating foundation; go to the signature section of Part XI. If “No,” continue to line 4.

Yes No

4 Have you attached either (1) an affidavit or opinion of counsel, (including a written affidavit or opinion from a certified public accountant or accounting firm with expertise regarding this tax law matter), that sets forth facts concerning your operations and support to demonstrate that you are likely to satisfy therequirements to be classified as a private operating foundation; or (2) a statement describing your proposed operations as a private operating foundation?

Yes No

5 If you answered “No” to line 1a, indicate the type of public charity status you are requesting by checking one of the choices below. You may check only one box.

The organization is not a private foundation because it is: a 509(a)(1) and 170(b)(1)(A)(i)—a church or a convention or association of churches. Complete and attach Schedule A. b 509(a)(1) and 170(b)(1)(A)(ii)—a school. Complete and attach Schedule B. c 509(a)(1) and 170(b)(1)(A)(iii)—a hospital, a cooperative hospital service organization, or a medical research

organization operated in conjunction with a hospital. Complete and attach Schedule C. d 509(a)(3)—an organization supporting either one or more organizations described in line 5a through c, f, h, or i or a

publicly supported section 501(c)(4), (5), or (6) organization. Complete and attach Schedule D.

Form 1023 (Rev. 12-2017)



Form 1023 (Rev. 12-2017) Name: EIN: Page 11 Part X Public Charity Status (Continued)

e 509(a)(4) – an organization organized and operated exclusively for testing for public safety. f 509(a)(1) and 170(b)(1)(A)(iv) – an organization operated for the benefit of a college or university that is owned or

operated by a governmental unit.g 509(a)(1) and 170(b)(1)(A)(ix) – an agricultural research organization directly engaged in the continuous active

conduct of agricultural research in conjunction with a college or university.

h 509(a)(1) and 170(b)(1)(A)(vi) – an organization that receives a substantial part of its financial support in the formof contributions from publicly supported organizations, from a governmental unit, or from the general public.

i 509(a)(2) – an organization that normally receives not more than one-third of its financial support from gross investment income and receives more than one-third of its financial support from contributions, membership fees, and gross receipts from activities related to its exempt functions (subject to certain exceptions).

j A publicly supported organization, but unsure if it is described in 5h or 5i. You would like the IRS to decide thecorrect status.

6 If you checked box h, i, or j in question 5 above, and you have been in existence more than 5 years, you must confirm your public support status. Answer line 6a if you checked box h in line 5 above. Answer line 6b if you checked box i in line 5 above. If you checked box j in line 5 above, answer both lines 6a and 6b.

a (i) Enter 2% of line 8, column (e) on Part IX-A Statement of Revenues and Expenses(ii) Attach a list showing the name and amount contributed by each person, company, or organization whose gifts

totaled more than the 2% amount. If the answer is “None,” state this.

b (i) For each year amounts are included on lines 1, 2, and 9 of Part IX-A Statement of Revenues and Expenses, attacha list showing the name and amount received from each disqualified person. If the answer is “None,” state this.

(ii) For each year amounts were included on line 9 of Part IX-A Statement of Revenues and Expenses, attach a list showing the name of and amount received from each payer, other than a disqualified person, whose payments were more than the larger of (1) 1% of Line 10, Part IX-A Statement of Revenues and Expenses, or (2) $5,000. Ifthe answer is “None,” state this.

7 Did you receive any unusual grants during any of the years shown on Part IX-A Statement ofRevenues and Expenses? If “Yes,” attach a list including the name of the contributor, the date and amount of the grant, a brief description of the grant, and explain why it is unusual.

Yes No

Part XI User Fee Information and Signature

You must include the correct user fee payment with this application. If you do not submit the correct user fee, we will not process the application and we will return it to you. Your check or money order must be made payable to the United States Treasury. User fees are subject to change. Check our website at www.irs.gov and type “Exempt Organizations User Fee” in the search box, or call Customer Account Services at 1-877-829-5500 for current information.

Enter the amount of the user fee paid:

I declare under the penalties of perjury that I am authorized to sign this application on behalf of the above organization and that I have examined this application, including the accompanying schedules and attachments, and to the best of my knowledge it is true, correct, and complete.

Please Sign Here

▲

(Signature of Officer, Director, Trustee, or other authorized official)

(Type or print name of signer) (Date)

(Type or print title or authority of signer)

Form 1023 (Rev. 12-2017)



[This page left blank intentionally]



Form 1023 (Rev. 12-2017) Name: EIN: Page 13 Schedule A. Churches

1 a Do you have a written creed, statement of faith, or summary of beliefs? If “Yes,” attach copies of relevant documents.

Yes No

b Do you have a form of worship? If “Yes,” describe your form of worship. Yes No2 a Do you have a formal code of doctrine and discipline? If “Yes,” describe your code of doctrine and

discipline. Yes No

b Do you have a distinct religious history? If “Yes,” describe your religious history. Yes No

c Do you have a literature of your own? If “Yes,” describe your literature. Yes No

3 Describe the organization’s religious hierarchy or ecclesiastical government.

4a Do you have regularly scheduled religious services? If “Yes,” describe the nature of the services and provide representative copies of relevant literature such as church bulletins.

Yes No

b What is the average attendance at your regularly scheduled religious services? 5a Do you have an established place of worship? If “Yes,” refer to the instructions for the information

required. Yes No

b Do you own the property where you have an established place of worship? Yes No6 Do you have an established congregation or other regular membership group? If “No,” refer to the

instructions. Yes No

7 How many members do you have? 8 a Do you have a process by which an individual becomes a member? If “Yes,” describe the process and

complete lines 8b–8d, below. Yes No

b If you have members, do your members have voting rights, rights to participate in religious functions, or other rights? If “Yes,” describe the rights your members have.

Yes No

c May your members be associated with another denomination or church? Yes No

d Are all of your members part of the same family? Yes No

9 Do you conduct baptisms, weddings, funerals, etc.? Yes No

10 Do you have a school for the religious instruction of the young? Yes No11a Do you have a minister or religious leader? If “Yes,” describe this person’s role and explain whether the

minister or religious leader was ordained, commissioned, or licensed after a prescribed course of study. Yes No

b Do you have schools for the preparation of your ordained ministers or religious leaders? Yes No

12 Is your minister or religious leader also one of your officers, directors, or trustees? Yes No13 Do you ordain, commission, or license ministers or religious leaders? If “Yes,” describe the requirements

for ordination, commission, or licensure. Yes No

14 Are you part of a group of churches with similar beliefs and structures? If “Yes,” explain. Include the name of the group of churches.

Yes No

15 Do you issue church charters? If “Yes,” describe the requirements for issuing a charter. Yes No

16 Did you pay a fee for a church charter? If “Yes,” attach a copy of the charter. Yes No17 Do you have other information you believe should be considered regarding your status as a church?

If “Yes,” explain. Yes No

Form 1023 (Rev. 12-2017)



Form 1023 (Rev. 12-2017) Name: EIN: Page 14 Schedule B. Schools, Colleges, and Universities

If you operate a school as an activity, complete Schedule B

Section I Operational Information 1a Do you normally have a regularly scheduled curriculum, a regular faculty of qualified teachers, a regularly

enrolled student body, and facilities where your educational activities are regularly carried on? If “No,” do not complete the remainder of Schedule B.

Yes No

b Is the primary function of your school the presentation of formal instruction? If “Yes,” describe your school in terms of whether it is an elementary, secondary, college, technical, or other type of school. If“No,” do not complete the remainder of Schedule B.

Yes No

2 a Are you a public school because you are operated by a state or subdivision of a state? If “Yes,” explain how you are operated by a state or subdivision of a state. Do not complete the remainder of Schedule B.

Yes No

b Are you a public school because you are operated wholly or predominantly from government funds or property? If “Yes,” explain how you are operated wholly or predominantly from government funds or property. Submit a copy of your funding agreement regarding government funding. Do not complete theremainder of Schedule B.

Yes No

3 In what public school district, county, and state are you located?

4 Were you formed or substantially expanded at the time of public school desegregation in the above school district or county?

Yes No

5 Has a state or federal administrative agency or judicial body ever determined that you are racially discriminatory? If “Yes,” explain.

Yes No

6 Has your right to receive financial aid or assistance from a governmental agency ever been revoked or suspended? If “Yes,” explain.

Yes No

7 Do you or will you contract with another organization to develop, build, market, or finance your facilities?If “Yes,” explain how that entity is selected, explain how the terms of any contracts or other agreements are negotiated at arm’s length, and explain how you determine that you will pay no more than fair market value for services.

Yes No

Note: Make sure your answer is consistent with the information provided in Part VIII, line 7a.

8 Do you or will you manage your activities or facilities through your own employees or volunteers? If “No,”attach a statement describing the activities that will be managed by others, the names of the persons or organizations that manage or will manage your activities or facilities, and how these managers were or will be selected. Also, submit copies of any contracts, proposed contracts, or other agreements regarding the provision of management services for your activities or facilities. Explain how the terms ofany contracts or other agreements were or will be negotiated, and explain how you determine you will pay no more than fair market value for services.

Yes No

Note: Answer “Yes” if you manage or intend to manage your programs through your own employees or by using volunteers. Answer “No” if you engage or intend to engage a separate organization or independent contractor. Make sure your answer is consistent with the information provided in Part VIII, line 7b.

Section II Establishment of Racially Nondiscriminatory Policy Information required by Revenue Procedure 75-50.

1 Have you adopted a racially nondiscriminatory policy as to students in your organizing document, bylaws, or by resolution of your governing body? If “Yes,” state where the policy can be found or supplya copy of the policy. If “No,” you must adopt a nondiscriminatory policy as to students before submitting this application. See Pub. 557.

Yes No

2 Do your brochures, application forms, advertisements, and catalogues dealing with student admissions, programs, and scholarships contain a statement of your racially nondiscriminatory policy?

Yes No

a If “Yes,” attach a representative sample of each document. b If “No,” by checking the box to the right you agree that all future printed materials, including website

content, will contain the required nondiscriminatory policy statement. ▶

3 Have you published a notice of your nondiscriminatory policy in a newspaper of general circulation that serves all racial segments of the community? See the instructions for specific requirements. If “No,”explain.

Yes No

4 Does or will the organization (or any department or division within it) discriminate in any way on the basisof race with respect to admissions; use of facilities or exercise of student privileges; faculty or administrative staff; or scholarship or loan programs? If “Yes,” for any of the above, explain fully.

Yes No

Form 1023 (Rev. 12-2017)



Form 1023 (Rev. 12-2017) Name: EIN: Page 15 Schedule B. Schools, Colleges, and Universities (Continued)

5 Complete the table below to show the racial composition for the current academic year and projected for the next academic year, of: (a) the student body, (b) the faculty, and (c) the administrative staff. Provide actual numbers rather than percentages for each racial category. If you are not operational, submit an estimate based on the best information available (such as the racial composition of thecommunity served).

Racial Category (a) Student Body (b) Faculty (c) Administrative Staff Current Year Next Year Current Year Next Year Current Year Next Year

Total

6 In the table below, provide the number and amount of loans and scholarships awarded to students enrolled by racial categories.

Racial Category Number of Loans Amount of Loans Number of Scholarships Amount of Scholarships Current Year Next Year Current Year Next Year Current Year Next Year Current Year Next Year

Total

7 a Attach a list of your incorporators, founders, board members, and donors of land or buildings, whether individuals or organizations.

b Do any of these individuals or organizations have an objective to maintain segregated public or private school education? If “Yes,” explain.

Yes No

8 Will you maintain records according to the nondiscrimination provisions contained in Revenue Procedure 75-50? If “No,” explain. See instructions.

Yes No

Form 1023 (Rev. 12-2017)



Form 1023 (Rev. 12-2017) Name: EIN: Page 16 Schedule C. Hospitals and Medical Research Organizations

Check the box if you are a hospital. See the instructions for a definition of the term “hospital,” which includes an organization whose principal purpose or function is providing hospital or medical care. Complete Section I below.

Check the box if you are a medical research organization operated in conjunction with a hospital. See the instructions for a definition of the term “medical research organization,” which refers to an organization whose principal purpose or function is medical research and which is directly engaged in the continuous active conduct of medical research in conjunction with a hospital. Complete Section II.

Section I Hospitals 1 a Are all the doctors in the community eligible for staff privileges? If “No,” give the reasons why and

explain how the medical staff is selected. Yes No

2 a Do you or will you provide medical services to all individuals in your community who can pay for themselves or have private health insurance? If “No,” explain.

Yes No

b Do you or will you provide medical services to all individuals in your community who participate in Medicare? If “No,” explain.

Yes No

c Do you or will you provide medical services to all individuals in your community who participate in Medicaid? If “No,” explain.

Yes No

3a Do you or will you require persons covered by Medicare or Medicaid to pay a deposit before receiving services? If “Yes,” explain.

Yes No

b Does the same deposit requirement, if any, apply to all other patients? If “No,” explain. Yes No4 a Do you or will you maintain a full-time emergency room? If “No,” explain why you do not maintain a

full-time emergency room. Also, describe any emergency services that you provide. Yes No

b Do you have a policy on providing emergency services to persons without apparent means to pay? If “Yes,” provide a copy of the policy.

Yes No

c Do you have any arrangements with police, fire, and voluntary ambulance services for the delivery or admission of emergency cases? If “Yes,” describe the arrangements, including whether they are writtenor oral agreements. If written, submit copies of all such agreements.

Yes No

5 a Do you provide for a portion of your services and facilities to be used for charity patients? If “Yes,” answer 5b through 5e.

Yes No

b Explain your policy regarding charity cases, including how you distinguish between charity care and bad debts. Submit a copy of your written policy.

c Provide data on your past experience in admitting charity patients, including amounts you expend for treating charity care patients and types of services you provide to charity care patients.

d Describe any arrangements you have with federal, state, or local governments or government agenciesfor paying for the cost of treating charity care patients. Submit copies of any written agreements.

e Do you provide services on a sliding fee schedule depending on financial ability to pay? If “Yes,” submit your sliding fee schedule.

Yes No

6 a Do you or will you carry on a formal program of medical training or medical research? If “Yes,” describesuch programs, including the type of programs offered, the scope of such programs, and affiliations withother hospitals or medical care providers with which you carry on the medical training or researchprograms.

Yes No

b Do you or will you carry on a formal program of community education? If “Yes,” describe such programs, including the type of programs offered, the scope of such programs, and affiliation with other hospitals or medical care providers with which you offer community education programs.

Yes No

7 Do you or will you provide office space to physicians carrying on their own medical practices? If “Yes,”describe the criteria for who may use the space, explain the means used to determine that you are paid at least fair market value, and submit representative lease agreements.

Yes No

8 Is your board of directors comprised of a majority of individuals who are representative of the community you serve? Include a list of each board member’s name and business, financial, or professionalrelationship with the hospital. Also, identify each board member who is representative of the community and describe how that individual is a community representative.

Yes No

9 Do you participate in any joint ventures? If “Yes,” state your ownership percentage in each joint venture, list your investment in each joint venture, describe the tax status of other participants in each joint venture (including whether they are section 501(c)(3) organizations), describe the activities of each joint venture, describe how you exercise control over the activities of each joint venture, and describe how each joint venture furthers your exempt purposes. Also, submit copies of all agreements.

Yes No

Note: Make sure your answer is consistent with the information provided in Part VIII, line 8.

Form 1023 (Rev. 12-2017)



Form 1023 (Rev. 12-2017) Name: EIN: Page 17 Schedule C. Hospitals and Medical Research Organizations (Continued)

Section I Hospitals (Continued) 10 Do you or will you manage your activities or facilities through your own employees or volunteers? If “No,”

attach a statement describing the activities that will be managed by others, the names of the persons or organizations that manage or will manage your activities or facilities, and how these managers were or will be selected. Also, submit copies of any contracts, proposed contracts, or other agreements regarding the provision of management services for your activities or facilities. Explain how the terms ofany contracts or other agreements were or will be negotiated, and explain how you determine you will pay no more than fair market value for services.

Yes No

Note: Answer “Yes” if you do manage or intend to manage your programs through your own employees or by using volunteers. Answer “No” if you engage or intend to engage a separate organization or independent contractor. Make sure your answer is consistent with the information provided in Part VIII, line 7b.

11 Do you or will you offer recruitment incentives to physicians? If “Yes,” describe your recruitment incentives and attach copies of all written recruitment incentive policies.

Yes No

12 Do you or will you lease equipment, assets, or office space from physicians who have a financial or professional relationship with you? If “Yes,” explain how you establish a fair market value for the lease.

Yes No

13 Have you purchased medical practices, ambulatory surgery centers, or other business assets from physicians or other persons with whom you have a business relationship, aside from the purchase? If “Yes,” submit a copy of each purchase and sales contract and describe how you arrived at fair market value, including copies of appraisals.

Yes No

14 Have you adopted a conflict of interest policy consistent with the sample health care organization conflict of interest policy in Appendix A of the instructions? If “Yes,” submit a copy of the policy and explain how the policy has been adopted, such as by resolution of your governing board. If “No,” explain how you will avoid any conflicts of interest in your business dealings.

Yes No

Section II Medical Research Organizations 1 Name the hospitals with which you have a relationship and describe the relationship. Attach copies of

written agreements with each hospital that demonstrate continuing relationships between you and thehospital(s).

2 Attach a schedule describing your present and proposed activities for the direct conduct of medical research; describe the nature of the activities, and the amount of money that has been or will be spent incarrying them out.

3 Attach a schedule of assets showing their fair market value and the portion of your assets directly devoted to medical research.

Form 1023 (Rev. 12-2017)



Form 1023 (Rev. 12-2017) Name: EIN: Page 18 Schedule D. Section 509(a)(3) Supporting Organizations

Section I Identifying Information About the Supported Organization(s) 1 State the names, addresses, and EINs of the supported organizations. If additional space is needed, attach a separate sheet.

Name Address EIN

2 Are all supported organizations listed in line 1 public charities under section 509(a)(1) or (2)? If “Yes,” go to Section II. If “No,” go to line 3.

Yes No

3 Do the supported organizations have tax-exempt status under section 501(c)(4), 501(c)(5), or 501(c)(6)? Yes NoIf “Yes,” for each 501(c)(4), (5), or (6) organization supported, provide the following financial information. • Part IX-A. Statement of Revenues and Expenses, lines 1–13, and • Part X, lines 6b(i), 6b(ii), and 7. If “No,” attach a statement describing how each organization you support is a public charity under section 509(a)(1) or (2).

Section II Relationship with Supported Organization(s)—Three Tests To be classified as a supporting organization, an organization must meet one of three relationship tests.

Test 1: “Operated, supervised, or controlled by” one or more publicly supported organizations, or Test 2: “Supervised or controlled in connection with” one or more publicly supported organizations, or Test 3: “Operated in connection with” one or more publicly supported organizations.

1 Information to establish the “operated, supervised, or controlled by” relationship (Test 1) Is a majority of your governing board or officers elected or appointed by the supported organization(s)? If “Yes,” describe the process by which your governing board is appointed and elected; go to Section III. If “No,” continue to line 2.

Yes No

2 Information to establish the “supervised or controlled in connection with” relationship (Test 2) Does a majority of your governing board consist of individuals who also serve on the governing board ofthe supported organization(s)? If “Yes,” describe the process by which your governing board is appointedand elected; go to Section III. If “No,” go to line 3.

Yes No

3 Information to establish the “operated in connection with” responsiveness test (Test 3) Are you a trust from which the named supported organization(s) can enforce and compel an accounting under state law? If “Yes,” explain whether you advised the supported organization(s) in writing of theserights and provide a copy of the written communication documenting this; go to Section II, line 5. If “No,”go to line 4a.

Yes No

4 Information to establish the alternative “operated in connection with” responsiveness test (Test 3) a Do the officers, directors, trustees, or members of the supported organization(s) elect or appoint one or

more of your officers, directors, or trustees? If “Yes,” explain and provide documentation; go to line 4d, below. If “No,” go to line 4b.

Yes No

b Do one or more members of the governing body of the supported organization(s) also serve as your officers, directors, or trustees or hold other important offices with respect to you? If “Yes,” explain and provide documentation; go to line 4d, below. If “No,” go to line 4c.

Yes No

c Do your officers, directors, or trustees maintain a close and continuous working relationship with the officers, directors, or trustees of the supported organization(s)? If “Yes,” explain and provide documentation.

Yes No

d Do the supported organization(s) have a significant voice in your investment policies, in the making and timing of grants, and in otherwise directing the use of your income or assets? If “Yes,” explain and provide documentation.

Yes No

e Describe and provide copies of written communications documenting how you made the supported organization(s) aware of your supporting activities.

5 Information to establish the “operated in connection with” integral part test (Test 3) Do you conduct activities that would otherwise be carried out by the supported organization(s)? If “Yes,”explain and go to Section III. If “No,” continue to line 6a.

Yes No

Form 1023 (Rev. 12-2017)



Form 1023 (Rev. 12-2017) Name: EIN: Page 19 Schedule D. Section 509(a)(3) Supporting Organizations (Continued)

Section II Relationship with Supported Organization(s)—Three Tests (Continued) 6 Information to establish the alternative “operated in connection with” integral part test (Test 3)

a Do you distribute at least 85% of your annual net income to the supported organization(s)? If “Yes,” go to line 6b. See instructions.

Yes No

If “No,” state the percentage of your income that you distribute to each supported organization. Also explain how you ensure that the supported organization(s) are attentive to your operations.

b How much do you contribute annually to each supported organization? Attach a schedule. c What is the total annual revenue of each supported organization? If you need additional space, attach a

list.

d Do you or the supported organization(s) earmark your funds for support of a particular program or activity? If “Yes,” explain.

Yes No

7 a Does your organizing document specify the supported organization(s) by name? If “Yes,” state the article and paragraph number and go to Section III. If “No,” answer line 7b.

Yes No

b Attach a statement describing whether there has been an historic and continuing relationship betweenyou and the supported organization(s).

Section III Organizational Test 1a If you met relationship Test 1 or Test 2 in Section II, your organizing document must specify the

supported organization(s) by name, or by naming a similar purpose or charitable class of beneficiaries. Ifyour organizing document complies with this requirement, answer “Yes.” If your organizing document does not comply with this requirement, answer “No,” and see the instructions.

Yes No

b If you met relationship Test 3 in Section II, your organizing document must generally specify the supported organization(s) by name. If your organizing document complies with this requirement, answer “Yes,” and go to Section IV. If your organizing document does not comply with this requirement, answer “No,” and see the instructions.

Yes No

Section IV Disqualified Person Test You do not qualify as a supporting organization if you are controlled directly or indirectly by one or more disqualified persons (as defined in section 4946) other than foundation managers or one or more organizations that you support. Foundation managers who are also disqualified persons for another reason are disqualified persons with respect to you.

1a Do any persons who are disqualified persons with respect to you, (except individuals who are disqualified persons only because they are foundation managers), appoint any of your foundation managers? If “Yes,” (1) describe the process by which disqualified persons appoint any of your foundation managers, (2) provide the names of these disqualified persons and the foundation managers they appoint, and (3) explain how control is vested over your operations (including assets and activities) by persons other than disqualified persons.

Yes No

b Do any persons who have a family or business relationship with any disqualified persons with respect to you, (except individuals who are disqualified persons only because they are foundation managers), appoint any of your foundation managers? If “Yes,” (1) describe the process by which individuals with a family or business relationship with disqualified persons appoint any of your foundation managers, (2) provide the names of these disqualified persons, the individuals with a family or business relationshipwith disqualified persons, and the foundation managers appointed, and (3) explain how control is vestedover your operations (including assets and activities) in individuals other than disqualified persons.

Yes No

c Do any persons who are disqualified persons, (except individuals who are disqualified persons only because they are foundation managers), have any influence regarding your operations, including your assets or activities? If “Yes,” (1) provide the names of these disqualified persons, (2) explain how influence is exerted over your operations (including assets and activities), and (3) explain how control is vested over your operations (including assets and activities) by individuals other than disqualified persons.

Yes No

Form 1023 (Rev. 12-2017)



Form 1023 (Rev. 12-2017) Name: EIN: Page 20 Schedule E. Organizations Not Filing Form 1023 Within 27 Months of Formation

Schedule E is intended to determine whether you are eligible for tax exemption under section 501(c)(3) from the postmark date of your application or from your date of incorporation or formation, whichever is earlier.

1 Are you a church, association of churches, or integrated auxiliary of a church? If “Yes,” complete Schedule A and stop here. Do not complete the remainder of Schedule E.

Yes No

2 a Are you a public charity with annual gross receipts that are normally $5,000 or less? If “Yes,” stop here. Answer “No” if you are a private foundation, regardless of your gross receipts.

Yes No

b If your gross receipts were normally more than $5,000, are you filing this application within 90 days fromthe end of the tax year in which your gross receipts were normally more than $5,000? If “Yes,” stop here.

Yes No

3a Were you included as a subordinate in a group exemption application or letter? If “No,” go to line 4. Yes No

b If you were included as a subordinate in a group exemption letter, are you filing this application within 27 months from the date you were notified by the organization holding the group exemption letter or theInternal Revenue Service that you cease to be covered by the group exemption letter? If “Yes,” stop here.

Yes No

c If you were included as a subordinate in a timely filed group exemption request that was denied, are youfiling this application within 27 months from the postmark date of the Internal Revenue Service final adverse ruling letter? If “Yes,” stop here.

Yes No

4 Were you created on or before October 9, 1969? If “Yes,” stop here. Do not complete the remainder ofthis schedule.

Yes No

5 If you answered “No” to lines 1 through 4, we cannot recognize you as tax exempt from your date of formation unless you qualify for an extension of time to apply for exemption. Do you wish to request anextension of time to apply to be recognized as exempt from the date you were formed? If “Yes,” attach a statement explaining why you did not file this application within the 27-month period. Do not answer lines6 or 7. If “No,” go to line 6a.

Yes No

6 a If you answered “No” to line 5, you can only be exempt under section 501(c)(3) from the postmark date ofthis application. Therefore, do you want us to treat this application as a request for tax exemption fromthe postmark date?

Yes No

Note: Be sure your ruling eligibility agrees with your answer to Part X, line 6. b Do you anticipate significant changes in your sources of support in the future? If “Yes,” complete line 7

below. Yes No

Form 1023 (Rev. 12-2017)



Form 1023 (Rev. 12-2017) Name: EIN: Page 21 Schedule E. Organizations Not Filing Form 1023 Within 27 Months of Formation (Continued)

7 Complete this item only if you answered “Yes” to line 6b. Include projected revenue for the first two full years following the current tax year.

Type of Revenue Projected revenue for 2 years following current tax year (a) From

To (b) From

To (c) Total

1 Gifts, grants, and contributions received (do not include unusual grants)

2 Membership fees received

3 Gross investment income

4 Net unrelated business income

5 Taxes levied for your benefit

6 Value of services or facilities furnished by a governmental unit without charge (not including the value of services generally furnished to the public without charge)

7 Any revenue not otherwise listed above or in lines 9–12 below (attach an itemized list)

8 Total of lines 1 through 7

9 Gross receipts from admissions, merchandise sold, or services performed, or furnishing of facilities in any activity that is related to your exempt purposes (attach itemized list)

10 Total of lines 8 and 9

11 Net gain or loss on sale of capital assets (attach an itemized list)

12 Unusual grants

13 Total revenue. Add lines 10 through 12

Form 1023 (Rev. 12-2017)



Form 1023 (Rev. 12-2017) Name: EIN: Page 22 Schedule F. Homes for the Elderly or Handicapped and Low-Income Housing

Section I General Information About Your Housing

1 Describe the type of housing you provide.

2 Provide copies of any application forms you use for admission.

3 Explain how the public is made aware of your facility.

4 a Provide a description of each facility. b What is the total number of residents each facility can accommodate? c What is your current number of residents in each facility? d Describe each facility in terms of whether residents rent or purchase housing from you.

5 Attach a sample copy of your residency or homeownership contract or agreement.

6 Do you participate in any joint ventures? If “Yes,” state your ownership percentage in each joint venture, list your investment in each joint venture, describe the tax status of other participants in each joint venture (including whether they are section 501(c)(3) organizations), describe the activities of each joint venture, describe how you exercise control over the activities of each joint venture, and describe how each joint venture furthers your exempt purposes. Also, submit copies of all joint venture agreements.

Yes No

Note: Make sure your answer is consistent with the information provided in Part VIII, line 8.

7 Do you or will you contract with another organization to develop, build, market, or finance your housing?If “Yes,” explain how that entity is selected, explain how the terms of any contract(s) are negotiated at arm’s length, and explain how you determine you will pay no more than fair market value for services.

Yes No

Note: Make sure your answer is consistent with the information provided in Part VIII, line 7a.

8 Do you or will you manage your activities or facilities through your own employees or volunteers? If “No,”attach a statement describing the activities that will be managed by others, the names of the persons or organizations that manage or will manage your activities or facilities, and how these managers were or will be selected. Also, submit copies of any contracts, proposed contracts, or other agreements regarding the provision of management services for your activities or facilities. Explain how the terms ofany contracts or other agreements were or will be negotiated, and explain how you determine you will pay no more than fair market value for services.

Yes No

Note: Answer “Yes” if you do manage or intend to manage your programs through your own employees or by using volunteers. Answer “No” if you engage or intend to engage a separate organization or independent contractor. Make sure your answer is consistent with the information provided in Part VIII, line 7b.

9 Do you participate in any government housing programs? If “Yes,” describe these programs. Yes No10 a Do you own the facility? If “No,” describe any enforceable rights you possess to purchase the facility in

the future; go to line 10c. If “Yes,” answer line 10b. Yes No

b How did you acquire the facility? For example, did you develop it yourself, purchase a project, etc. Attach all contracts, transfer agreements, or other documents connected with the acquisition of the facility.

c Do you lease the facility or the land on which it is located? If “Yes,” describe the parties to the lease(s) and provide copies of all leases.

Yes No

Form 1023 (Rev. 12-2017)



Form 1023 (Rev. 12-2017) Name: EIN: Page 23 Schedule F. Homes for the Elderly or Handicapped and Low-Income Housing (Continued)

Section II Homes for the Elderly or Handicapped 1a Do you provide housing for the elderly? If “Yes,” describe who qualifies for your housing in terms of age,

infirmity, or other criteria and explain how you select persons for your housing. Yes No

b Do you provide housing for the handicapped? If “Yes,” describe who qualifies for your housing in termsof disability, income levels, or other criteria and explain how you select persons for your housing.

Yes No

2 a Do you charge an entrance or founder’s fee? If “Yes,” describe what this charge covers, whether it is a one-time fee, how the fee is determined, whether it is payable in a lump sum or on an installment basis, whether it is refundable, and the circumstances, if any, under which it may be waived.

Yes No

b Do you charge periodic fees or maintenance charges? If “Yes,” describe what these charges cover and how they are determined.

Yes No

c Is your housing affordable to a significant segment of the elderly or handicapped persons in the community? Identify your community. Also, if “Yes,” explain how you determine your housing is affordable.

Yes No

3 a Do you have an established policy concerning residents who become unable to pay their regular charges? If “Yes,” describe your established policy.

Yes No

b Do you have any arrangements with government welfare agencies or others to absorb all or part of thecost of maintaining residents who become unable to pay their regular charges? If “Yes,” describe thesearrangements.

Yes No

4 Do you have arrangements for the healthcare needs of your residents? If “Yes,” describe these arrangements.

Yes No

5 Are your facilities designed to meet the physical, emotional, recreational, social, religious, and/or other similar needs of the elderly or handicapped? If “Yes,” describe these design features.

Yes No

Section III Low-Income Housing

1 Do you provide low-income housing? If “Yes,” describe who qualifies for your housing in terms of income levels or other criteria, and describe how you select persons for your housing.

Yes No

2 In addition to rent or mortgage payments, do residents pay periodic fees or maintenance charges? If “Yes,” describe what these charges cover and how they are determined.

Yes No

3 a Is your housing affordable to low income residents? If “Yes,” describe how your housing is made affordable to low-income residents.

Yes No

Note: Revenue Procedure 96-32, 1996-1 C.B. 717, provides guidelines for providing low-income housing that will be treated as charitable. (At least 75% of the units are occupied by low-income tenants or 40% are occupied by tenants earning not more than 120% of the very low-income levels for the area.)

b Do you impose any restrictions to make sure that your housing remains affordable to low-income residents? If “Yes,” describe these restrictions.

Yes No

4 Do you provide social services to residents? If “Yes,” describe these services. Yes No

Form 1023 (Rev. 12-2017)



Form 1023 (Rev. 12-2017) Name: EIN: Page 24 Schedule G. Successors to Other Organizations

1 a Are you a successor to a for-profit organization? If “Yes,” explain the relationship with the predecessor organization that resulted in your creation and complete line 1b.

Yes No

b Explain why you took over the activities or assets of a for-profit organization or converted from for-profit to nonprofit status.

2a Are you a successor to an organization other than a for-profit organization? Answer “Yes” if you have taken or will take over the activities of another organization; or you have taken or will take over 25% or more of the fair market value of the net assets of another organization. If “Yes,” explain the relationshipwith the other organization that resulted in your creation.

Yes No

b Provide the tax status of the predecessor organization. c Did you or did an organization to which you are a successor previously apply for tax exemption under

section 501(c)(3) or any other section of the Code? If “Yes,” explain how the application was resolved. Yes No

d Was your prior tax exemption or the tax exemption of an organization to which you are a successor revoked or suspended? If “Yes,” explain. Include a description of the corrections you made to re-establish tax exemption.

Yes No

e Explain why you took over the activities or assets of another organization.

3 Provide the name, last address, and EIN of the predecessor organization and describe its activities. Name: EIN: Address:

4 List the owners, partners, principal stockholders, officers, and governing board members of the predecessor organization. Attach a separate sheet if additional space is needed.

Name Address Share/Interest (If a for-profit)

5 Do or will any of the persons listed in line 4, maintain a working relationship with you? If “Yes,” describethe relationship in detail and include copies of any agreements with any of these persons or with any for-profit organizations in which these persons own more than a 35% interest.

Yes No

6a Were any assets transferred, whether by gift or sale, from the predecessor organization to you? If “Yes,”provide a list of assets, indicate the value of each asset, explain how the value was determined, and attach an appraisal, if available. For each asset listed, also explain if the transfer was by gift, sale, or combination thereof.

Yes No

b Were any restrictions placed on the use or sale of the assets? If “Yes,” explain the restrictions. Yes No

c Provide a copy of the agreement(s) of sale or transfer.

7 Were any debts or liabilities transferred from the predecessor for-profit organization to you? Yes NoIf “Yes,” provide a list of the debts or liabilities that were transferred to you, indicating the amount of each, how the amount was determined, and the name of the person to whom the debt or liability is owed.

8 Will you lease or rent any property or equipment previously owned or used by the predecessor for-profit organization, or from persons listed in line 4, or from for-profit organizations in which these persons ownmore than a 35% interest? If “Yes,” submit a copy of the lease or rental agreement(s). Indicate how thelease or rental value of the property or equipment was determined.

Yes No

9 Will you lease or rent property or equipment to persons listed in line 4, or to for-profit organizations inwhich these persons own more than a 35% interest? If “Yes,” attach a list of the property or equipment, provide a copy of the lease or rental agreement(s), and indicate how the lease or rental value of theproperty or equipment was determined.

Yes No

Form 1023 (Rev. 12-2017)



Form 1023 (Rev. 12-2017) Name: EIN: Page 25 Schedule H. Organizations Providing Scholarships, Fellowships, Educational Loans, or Other Educational Grants to Individuals and Private Foundations Requesting Advance Approval of Individual Grant Procedures Section I Names of individual recipients are not required to be listed in Schedule H.

Public charities and private foundations complete lines 1a through 7 of this section. See the instructions to Part X if you are not sure whether you are a public charity or a private foundation.

1 a Describe the types of educational grants you provide to individuals, such as scholarships, fellowships, loans, etc. b Describe the purpose and amount of your scholarships, fellowships, and other educational grants and loans that

you award.

c If you award educational loans, explain the terms of the loans (interest rate, length, forgiveness, etc.). d Specify how your program is publicized. e Provide copies of any solicitation or announcement materials. f Provide a sample copy of the application used.

2 Do you maintain case histories showing recipients of your scholarships, fellowships, educational loans, or other educational grants, including names, addresses, purposes of awards, amount of each grant, manner of selection, and relationship (if any) to officers, trustees, or donors of funds to you? If “No,” refer to the instructions.

Yes No

3 Describe the specific criteria you use to determine who is eligible for your program. (For example, eligibility selection criteria could consist of graduating high school students from a particular high school who will attend college, writers of scholarly works about American history, etc.)

4 a Describe the specific criteria you use to select recipients. (For example, specific selection criteria could consist ofprior academic performance, financial need, etc.)

b Describe how you determine the number of grants that will be made annually. c Describe how you determine the amount of each of your grants. d Describe any requirement or condition that you impose on recipients to obtain, maintain, or qualify for renewal of a

grant. (For example, specific requirements or conditions could consist of attendance at a four-year college, maintaining a certain grade point average, teaching in public school after graduation from college, etc.)

5 Describe your procedures for supervising the scholarships, fellowships, educational loans, or other educationalgrants. Describe whether you obtain reports and grade transcripts from recipients, or you pay grants directly to a school under an arrangement whereby the school will apply the grant funds only for enrolled students who are ingood standing. Also, describe your procedures for taking action if the terms of the award are violated.

6 Who is on the selection committee for the awards made under your program, including names of current committee members, criteria for committee membership, and the method of replacing committee members?

7 Are relatives of members of the selection committee, or of your officers, directors, or substantial contributors eligible for awards made under your program? If “Yes,” what measures are taken to ensure unbiased selections?

Yes No

Note: If you are a private foundation, you are not permitted to provide educational grants to disqualified persons. Disqualified persons include your substantial contributors and foundation managers and certain family members of disqualified persons.

Section II Private foundations complete lines 1a through 4f of this section. Public charities do not complete this section.

1 a If we determine that you are a private foundation, do you want this application to be considered as a request for advance approval of grant making procedures?

Yes No N/A

b For which section(s) do you wish to be considered? • 4945(g)(1)—Scholarship or fellowship grant to an individual for study at an educational institution • 4945(g)(3)—Other grants, including loans, to an individual for travel, study, or other similar

purposes, to enhance a particular skill of the grantee or to produce a specific product

2 Do you represent that you will (1) arrange to receive and review grantee reports annually and upon completion of the purpose for which the grant was awarded, (2) investigate diversions offunds from their intended purposes, and (3) take all reasonable and appropriate steps to recover diverted funds, ensure other grant funds held by a grantee are used for their intendedpurposes, and withhold further payments to grantees until you obtain grantees’ assurancesthat future diversions will not occur and that grantees will take extraordinary precautions to prevent future diversions from occurring?

Yes No

3 Do you represent that you will maintain all records relating to individual grants, including information obtained to evaluate grantees, identify whether a grantee is a disqualified person, establish the amount and purpose of each grant, and establish that you undertook thesupervision and investigation of grants described in line 2?

Yes No

Form 1023 (Rev. 12-2017)



Form 1023 (Rev. 12-2017) Name: EIN: Page 26 Schedule H. Organizations Providing Scholarships, Fellowships, Educational Loans, or Other Educational Grants to Individuals and Private Foundations Requesting Advance Approval of Individual Grant Procedures (Continued) Section II Private foundations complete lines 1a through 4f of this section. Public charities do not complete

this section. (Continued) 4 a Do you or will you award scholarships, fellowships, and educational loans to attend an

educational institution based on the status of an individual being an employee of a particular employer? If “Yes,” complete lines 4b through 4f.

Yes No

b Will you comply with the seven conditions and either the percentage tests or facts and circumstances test for scholarships, fellowships, and educational loans to attend an educational institution as set forth in Revenue Procedures 76-47, 1976-2 C.B. 670, and 80-39, 1980-2 C.B. 772, which apply to inducement, selection committee, eligibility requirements, objective basis of selection, employment, course of study, and other objectives? (See lines 4c, 4d, and 4e, regarding the percentage tests.)

Yes No

c Do you or will you provide scholarships, fellowships, or educational loans to attend an educational institution to employees of a particular employer?

Yes No N/A

If “Yes,” will you award grants to 10% or fewer of the eligible applicants who were actuallyconsidered by the selection committee in selecting recipients of grants in that year as provided by Revenue Procedures 76-47 and 80-39?

Yes No

d Do you provide scholarships, fellowships, or educational loans to attend an educational institution to children of employees of a particular employer?

Yes No N/A

If “Yes,” will you award grants to 25% or fewer of the eligible applicants who were actuallyconsidered by the selection committee in selecting recipients of grants in that year as provided by Revenue Procedures 76-47 and 80-39? If “No,” go to line 4e.

Yes No

e If you provide scholarships, fellowships, or educational loans to attend an educational institution to children of employees of a particular employer, will you award grants to 10% or fewer of the number of employees’ children who can be shown to be eligible for grants (whether or not they submitted an application) in that year, as provided by Revenue Procedures 76-47 and 80-39?

Yes No N/A

If “Yes,” describe how you will determine who can be shown to be eligible for grants without submitting an application, such as by obtaining written statements or other information about the expectations of employees’ children to attend an educational institution. If “No,” go to line4f. Note: Statistical or sampling techniques are not acceptable. See Revenue Procedure 85-51, 1985-2 C.B. 717, for additional information.

f If you provide scholarships, fellowships, or educational loans to attend an educational institution to children of employees of a particular employer without regard to either the 25% limitation described in line 4d, or the 10% limitation described in line 4e, will you award grants based on facts and circumstances that demonstrate that the grants will not be consideredcompensation for past, present, or future services or otherwise provide a significant benefit to the particular employer? If “Yes,” describe the facts and circumstances that you believe will demonstrate that the grants are neither compensatory nor a significant benefit to the particular employer. In your explanation, describe why you cannot satisfy either the 25% test described in line 4d or the 10% test described in line 4e.

Yes No

Form 1023 (Rev. 12-2017)



Form 1023 Checklist (Revised December 2017) Application for Recognition of Exemption under Section 501(c)(3) of the Internal Revenue Code

Note: Retain a copy of the completed Form 1023 in your permanent records. Refer to the General Instructions regarding Public Inspection of approved applications.

Check each box to finish your application (Form 1023). Send this completed Checklist with your filled-in application. If you have not answered all the items below, your application may be returned to you as incomplete.

Assemble the application and materials in this order.• Form 1023 Checklist • Form 2848, Power of Attorney and Declaration of Representative (if filing) • Form 8821, Tax Information Authorization (if filing) • Expedite request (if requesting) • Application (Form 1023 and Schedules A through H, as required) • Articles of organization • Amendments to articles of organization in chronological order • Bylaws or other rules of operation and amendments • Documentation of nondiscriminatory policy for schools, as required by Schedule B • Form 5768, Election/Revocation of Election by an Eligible Section 501(c)(3) Organization To Make

Expenditures To Influence Legislation (if filing) • All other attachments, including explanations, financial data, and printed materials or publications.

Label each page with name and EIN.

User fee payment placed in envelope on top of checklist. DO NOT STAPLE or otherwise attach your check or money order to your application. Instead, just place it in the envelope.

Employer Identification Number (EIN)

Completed Parts I through XI of the application, including any requested information and any required Schedules A through H. • You must provide specific details about your past, present, and planned activities. • Generalizations or failure to answer questions in the Form 1023 application will prevent us from

recognizing you as tax exempt. • Describe your purposes and proposed activities in specific easily understood terms. • Financial information should correspond with proposed activities.

Schedules. Submit only those schedules that apply to you and check either “Yes” or “No” below.

Schedule A Yes No

Schedule B Yes No

Schedule C Yes No

Schedule D Yes No

Schedule E Yes No

Schedule F Yes No

Schedule G Yes No

Schedule H Yes No



An exact copy of your complete articles of organization (creating document). Absence of the proper purpose and dissolution clauses is the number one reason for delays in the issuance of determination letters. • Location of Purpose Clause from Part III, line 1 (Page, Article and Paragraph Number) • Location of Dissolution Clause from Part III, line 2b or 2c (Page, Article and Paragraph Number) or by operation of state law

Signature of an officer, director, trustee, or other official who is authorized to sign the application. • Signature at Part XI of Form 1023.

Your name on the application must be the same as your legal name as it appears in your articles of organization.

Send completed Form 1023, user fee payment, and all other required information, to:

Internal Revenue Service Attention: EO Determination Letters Stop 31 P.O. Box 12192 Covington, KY 41012-0192

If you are using express mail or a delivery service, send Form 1023, user fee payment, and attachments to:

Internal Revenue Service Attention: EO Determination Letters Stop 31 201 West Rivercenter Boulevard Covington, KY 41011



5. Form 1024-A, Application for Recognition of Exemption

Form 1024-A(January 2018)


Application for Recognition of Exemption Under Section 501(c)(4) of the Internal Revenue Code ▶ Go to www.irs.gov/Form1024A for instructions and the latest information.

OMB No.1545-0057

Note: If exempt status is approved, this application will be open for public inspection.

Complete Parts I–IX and submit Form 8718 (with payment of the appropriate user fee). Attach additional sheets if you need more space to answer fully. Use the instructions to complete this application and for definitions of terms used in this form. For additional help, call IRS Exempt Organizations Customer Account Services toll-free at 877-829-5500, or visit our website at www.irs.gov. If you don’t submit the required information, we may return the application to you. A request for a determination under section 501(c)(4) is optional. See instructions for additional information.

Don't include social security numbers on this form as it may be made public.

Part I Identification of Applicant 1 Full name of organization (exactly as it appears in your organizing document) 2 c/o Name (if applicable)

3 Mailing address (Number and street) (see instructions)

City or town, state or country, and ZIP + 4

4 Employer Identification Number (EIN)

5 Month the annual accounting period ends

6 Primary contact (officer, director, trustee, or authorized representative) a Name:

b Phone:

c Fax: (optional)

7 Organization’s website:

Part II Organizational Structure You must be a corporation (including a limited liability company), an unincorporated association, or a trust to be tax exempt. See instructions. Don't file this form unless you can check “Yes” on lines 1, 2, 3, or 4.

1

Are you a corporation? If “Yes,” attach a copy of your articles of incorporation showing certification of filing with the appropriate state agency. Include copies of any amendments to your articles and be sure they also show state filing certification.

Yes No

2

Are you a limited liability company (LLC)? If “Yes,” attach a copy of your articles of organizationshowing certification of filing with the appropriate state agency. Include copies of any amendments to your articles and be sure they show state filing certification. Also, if you adopted an operating agreement, attach a copy, along with any amendments.

Yes No

3

Are you an unincorporated association? If “Yes,” attach a copy of your articles of association, constitution, or other similar organizing document that is dated and includes at least two signatures. Include signed and dated copies of any amendments.

Yes No

4 Are you a trust? If “Yes,” attach a signed and dated copy of your trust agreement. Include signed and dated copies of any amendments. If you are a trust, enter the date the trust was funded. (MM/DD/YYYY)

Yes No

5 Have you adopted bylaws? If “Yes,” attach a current copy showing date of adoption. If “No,” explain inan attachment how your officers, directors, or trustees are selected.

Yes No / /

Part III Narrative Description of Your Activities Use an attachment to describe all of your past, present, and planned activities in a narrative (including the percentage of time and funds spent on these activities). You may attach representative copies of newsletters, brochures, or similar documents for supporting details to this narrative. Refer to the instructions for information that must be included in your description. Check this box to confirm that you submitted a narrative attachment describing your activities.

For Paperwork Reduction Act Notice, see instructions. Cat. No. 69155Y Form 1024-A (1-2018)



Form 1024-A (1-2018) Name: EIN: Page 2Part IV Officers, Directors, Trustees, Employees, and Independent Contractors

1 List the names, titles, and mailing addresses for all of your officers, directors, and trustees. If additional space is needed, attach a separate sheet.

Name Title Mailing address

The following “Yes” or “No” questions relate to all past, present, or planned relationships, transactions, or agreements with your officers, directors, trustees, employees, members, and independent contractors.

2

Do you have a family or business relationship or agreement with any of your officers, directors, trustees, employees, members, or independent contractors, or any entity they own or control, other than throughtheir position as your officer, director, trustee, employee, member, or independent contractor? If “Yes,”identify in an attachment the individual and describe the relationship or agreement.

Yes No

3 a Do or will you pay any compensation to your officers, directors, trustees, employees, members, or independent contractors? If “Yes,” answer lines 3b and 3c.

Yes No

b Do or will the individuals that approve compensation arrangements follow a conflict of interest policy?If “No,” describe in an attachment how you set compensation that is reasonable.

Yes No

c

Do or will you compensate any of your officers, directors, trustees, employees, members, or independent contractors through nonfixed payments, such as discretionary bonuses or revenue-based payments?If “Yes,” describe in an attachment all nonfixed compensation agreements.

Yes No

Part V Your Specific Activities The following “Yes” or “No” questions relate to all past, present, and planned activities you may conduct. See instructions.

1

Has the organization spent, or does it plan to spend, any money attempting to influence the selection, nomination, election, or appointment of any person to any federal, state, or local public office or to an office in a political organization? If “Yes,” explain in detail and list the amounts spent or to be spent in each case in an attachment.

Yes No

2

Have you previously received a ruling or determination letter recognizing you (or any predecessor organization) as exempt under section 501(c)(3) and later revoked that recognition of exemption on thebasis that you (or your predecessor) were carrying on propaganda or otherwise attempting to influence legislation or on the basis that it engaged in political activity? If “Yes,” explain in an attachment.

Yes No

3

Are you a successor to another organization? Answer “Yes” if you have taken or will take over theactivities of another organization, you took over 25% or more of the fair market value of the net assets ofanother organization, or you were established upon the conversion of an organization from for-profit to nonprofit status. If “Yes,” explain in an attachment.

Yes No

4 Are you connected in any way with any other organization (for example, financial support on a continuing basis; shared facilities or employees; same officers, directors, or trustees)? If “Yes,” explain in an attachment.

Yes No

5 Do you have members? If “Yes,” state in an attachment the qualifications necessary for membership, the classes of membership and number of members in each class, and the voting rights or privileges received.

Yes No

6 Have you made, or do you plan on making, any distribution of property or surplus funds to shareholders or members? If "Yes," explain in an attachment.

Yes No

7

Do you receive payments for services performed? If “Yes,” explain in an attachment the services performed, income realized and expenses incurred, and the nature of benefits to the general public fromthese activities.

Yes No

8 Do you lease property? If “Yes,” explain in an attachment. Include a description of the property, anyrelationship between the applicant and the other party, and a copy of the lease agreement.

Yes No

9 Are you a homeowner’s association? If “Yes,” explain in an attachment whether access to any property or facility you own or maintain is restricted in any way.

Yes No

10 Are you a local association of employees? If “Yes,” state in an attachment the name and address of eachemployer whose employees are eligible for membership in the organization.

Yes No

11 Do you or will you make foreign grants or conduct activities in any foreign country or countries? If “Yes,”describe those grants or activities in an attachment.

Yes No

Form 1024-A (1-2018)



Form 1024-A (1-2018) Name: EIN: Page 3 Part VI Financial Data (see instructions for information you must provide) (attach statement regarding accounting

method, if necessary) A. Statement of Revenues and Expenses

Rev

enue

s

Type of revenue or expense Year: Year: Year:

1 Gifts, grants, and contributions received . . . . . . . . .2 Membership fees received . . . . . . . . . . . . . .3 Gross investment income . . . . . . . . . . . . . .4 Net unrelated business income . . . . . . . . . . . .5 Taxes levied for your benefit . . . . . . . . . . . . .6 Value of services or facilities furnished by a governmental unit

without charge . . . . . . . . . . . . . . . . . .

7 Any revenue not otherwise listed above or in lines 9–11 below (attach statement) . . . . . . . . . . . . . . . . .

8 Total of lines 1 through 7 . . . . . . . . . . . . . .9 Gross receipts from any activity that is related to your exempt

purposes . . . . . . . . . . . . . . . . . . .10 Total of lines 8 and 9 . . . . . . . . . . . . . . . .11 Net gain or loss on sale of capital assets (attach statement) . . .12 Total Revenue

Combine lines 10 and 11 . . . . . . . . . . . . . .

Exp

ense

s

13 Fundraising expenses (attach statement) . . . . . . . . .14 Contributions, gifts, grants, and similar amounts paid out (attach

statement) . . . . . . . . . . . . . . . . . . .15 Disbursements to or for the benefit of members (attach statement) .16 Compensation of officers, directors, and trustees . . . . . .17 Other salaries and wages . . . . . . . . . . . . . .18 Occupancy . . . . . . . . . . . . . . . . . . .19 Any expense not otherwise classified, such as program services

(attach statement) . . . . . . . . . . . . . . . . .

20

Total Expenses Add lines 13 through 19 . . . . . . . . . . . . . . .

B. Balance Sheet (for your most recently completed tax year) Year EndAssets

1 Cash . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1 2 Accounts receivable, net . . . . . . . . . . . . . . . . . . . . . . . . . . 2 3 Inventories . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 3 4 Bonds and notes receivable (attach statement) . . . . . . . . . . . . . . . . . . 4 5 Corporate stocks (attach statement) . . . . . . . . . . . . . . . . . . . . . . 5 6 Loans receivable (attach statement) . . . . . . . . . . . . . . . . . . . . . . 6 7 Other investments (attach statement) . . . . . . . . . . . . . . . . . . . . . . 7 8 Depreciable and depletable assets (attach statement) . . . . . . . . . . . . . . . . 8 9 Land . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 9

10 Other assets (attach statement) . . . . . . . . . . . . . . . . . . . . . . . 10 11 Total assets (add lines 1 through 10) . . . . . . . . . . . . . . . . . . . . . . 11

Liabilities 12 Accounts payable . . . . . . . . . . . . . . . . . . . . . . . . . . . . 12 13 Contributions, gifts, grants, etc., payable . . . . . . . . . . . . . . . . . . . . 13 14 Mortgages and notes payable (attach statement) . . . . . . . . . . . . . . . . . . 14 15 Other liabilities (attach statement) . . . . . . . . . . . . . . . . . . . . . . . 15 16 Total liabilities (add lines 12 through 15) . . . . . . . . . . . . . . . . . . . . . 16

Fund Balances or Net Assets17 Total fund balances or net assets . . . . . . . . . . . . . . . . . . . . . . . 1718 Total liabilities and fund balances or net assets (add lines 16 and 17) . . . . . . . . . . 18

Form 1024-A (1-2018)



Form 1024-A (1-2018) Name: EIN: Page 4 Part VII Annual Filing Requirements (see instructions)

Certain organizations aren't required to file an information return. If you are granted tax-exemption, are youclaiming to be excused from filing an information return? If “Yes,” explain in an attachment.

Yes No

If you fail to file a required information return for three consecutive years, your exempt status will be revoked.

Part VIII Information Regarding Notification Requirement Under Section 506Most organizations operating under section 501(c)(4) are required to notify the IRS that they are operating under section 501(c)(4) within 60 days of formation by filing Form 8976, Notice of Intent to Operate Under Section 501(c)(4). If an organization doesn't submit a timely notification, a penalty will be assessed. Submission of Form 1024-A doesn't satisfy the requirement to provide notice to the IRS. See instructions for additional information regarding the notification requirement.

Part IX User Fee Information and SignatureYou must include Form 8718 and the correct user fee payment with this application. If you don't submit the correct user fee, we won't process the application and we will return it to you. Your check or money order must be made payable to the United States Treasury. User fees are subject to change. Check our website at www.irs.gov and type “User Fee” in the keyword box, or call Customer Account Services at 877-829-5500 for current information. Also, attach Form 2848, if the application is signed by a person authorized by power of attorney.

I declare under the penalties of perjury that I am authorized to sign this application on behalf of the above organization and that I have examined this application, including the accompanying schedules and attachments, and to the best of my knowledge it is true, correct, and complete.

Please Sign Here

▲

(Signature of Officer, Director, Trustee, or other authorized individual)

(Type or print name of signer) (Date)

(Type or print title or authority of signer)

Form 1024-A (1-2018)



6. Sample Conflict of Interest Policy



7. Sample Article of Incorporation



8. Form 990, Return of Organization Exempt From Income Tax

© 2016 BOARDSOURCE.ORG

All tax-exempt organizations must report annually to the IRS on their financial and other activities — including their governance activities. They do this by filing a Form 990, Return of Organization Exempt from Income Tax.

Many organizations provide a CPA or legal counsel with the pertinent information and then rely on him or her to complete the form. Regardless of who completes the form, however, all organizations should ensure that the chief executive and either the board chair or the chair of the audit (or finance/audit committee) committee examines it closely prior to filing. As fiduciaries, all board members also should be familiar with it. In Part VI, Section A of the form, the IRS asks whether the board receives a copy and what its review process is.

To help your board review the completed form, BoardSource provides the following checklist pertaining to governance. If your board members flag any of the items on the checklist, address them before filing the form with the IRS. When reviewing the form, keep the following in mind:

• Is it accurate? Form 990 serves as introduction to your organization and is reviewed by the IRS, your constituents, donors, and the media. You do not want to share inaccurate information.

• Are you meeting legal requirements? The IRS recognizes your tax-exempt status. Form 990 allows the IRS to verify that your organization meets the expectations and deserves its special status.

• “No” answers may raise red or yellow flags in the eyes of the IRS. They may lead to a heightened audit profile. Are there justified reasons for your “no” answers? Have you explained the reasons sufficiently in Schedule O?

• Have you done your due diligence in justifying various interdependencies and relationships among your insiders or individuals or entities with which your organization does business?

• Are those who are compensated for services truly earning their compensation? Familiarize yourself with the IRS’s intermediate sanctions and safe harbor clauses and follow them to protect yourself and your organization.

REVIEWING FORM 990A Checklist

The Board’s Role in

LIST OF BOARD MEMBERSThe IRS requires you to list the names and titles of all board members and officers, whether or not compensation is provided. Have you done so and is the information correct?

NUMBER OF VOTING MEMBERSThe IRS wants to know the size of your decision-making body/board. Do not include ex-officio non-voting members in this number. If your chief executive is a voting member, you must add him or her to this number. Is this number correct?

INDEPENDENCE OF BOARD MEMBERSThe IRS wants to ensure that your voting board members are independent as it pertains to three conditions: 1) No compensation as an officer or employee of the organization; 2) No (or less than $10,000) compensation as a contractor to the organization or a related organization; 3) No other financial transactions directly with the organization or a related organization or to a family member with the organization or a related organization. Are your board members independent?

YES NO






COMPENSATION OF BOARD MEMBERS, OFFICERS, AND KEY EMPLOYEESCompensation is of primary concern to the IRS. Above all, it wants to ensure that no tax-exempt organization is involved in private inurement, undue or excessive remuneration for services not provided, or that decisions related to financial transactions are made by insiders who have a conflict of interest in the outcome.

Do your board members serve as volunteers without compensation? If they are compensated, is it reported? If you compensated any former board members more than $10,000, did you report it? After five years, one is no longer a “former board member.”

Have you reported any “key” employees* earning more than $150,000? (Your CEO and COO are not key employees; they are considered officers of the organization.)

Have you reported any non-key employees earning more than $100,000?

If you compensated any independent contractors more than $100,000, have you reported it?

If you compensated any former officers or any former key employees more than $100,000, did you report it?

COMPENSATION PROCESSThe IRS focuses on the process of determining compensation for the chief executive and other key individuals.

Is your board adhering to the intermediate sanctions’ safe harbor clauses?

Do you rely on comparable data when setting compensation?

Do independent individuals approve the compensation for top management?

Does the board keep accurate and contemporaneous records of how it makes compensation decisions?

LOANSThe IRS wants to ensure that the board is an independent body that makes decisions for the good of the organization without weighing in personal benefits.

Did the organization refrain from providing loans, grants, or other financial assistance to board members, officers, or key employees?

YES NO






DELEGATION OF AUTHORITYIf your board delegates part of its authority to an executive or similar committee, have you described the composition of this group and the scope of its authority in Schedule O?

If any board decisions are subject to approval by members, stockholders, or other persons, have you reported this?

BOARD PRACTICESDid your board members refrain from engaging in direct or indirect campaign activities on behalf of or in opposition to candidates for public office or engage in lobbying?

Did the board and each committee with authority to act on behalf of the board contemporaneously document the meetings held or written actions undertaken during the year?

Does the organization have members, stockholders, or other persons who may elect one or more members of the board, and if so, is it reported?

BOARD POLICIESDo you have a written conflict-of interest (COI) policy, are board members and key staff required to disclose interests that could lead to conflict, and are these situations monitored and enforced? Do you share your COI policy (as well as your governing and financial statements and Form 990) with the public?

Does the organization have a written whistleblower policy and document retention and destruction policy?

Did the organization make any significant changes to its articles of incorporation or bylaws since the prior Form 990 was filed and, if so, are they explained in Schedule O?

Does the organization have a gift acceptance policy that requires the review of any non-standard contributions?

FINANCESAre any assets held in term, permanent, or quasi-endowments reported?

Did the organization receive an audited financial statement for the year for which it is completing this return that was prepared in accordance with GAAP?

YES NO






Were the organization’s financial statements compiled or reviewed by an independent accountant? If “Yes,” does the organization have a committee that assumes responsibility for oversight of the audit, review, or compilation of its financial statements and selection of an independent accountant?

Are any non-cash contributions to the organization valued more than $25,000 — or any contributions of art, historical treasures, or other similar assets, or qualified conservation contributions — reported?

Is any unrelated business income of $1,000 or more reported?

If the organization invested in, contributed to, or participated in a joint venture or similar arrangement with a taxable entity during the year, has the organization adopted a written policy or procedure requiring the organization to evaluate its participation under applicable federal tax law, and taken steps to safeguard the organization’s exempt status with respect to such an arrangement?

MISSION AND PROGRAMSHave you accurately and succinctly described your mission?

If you made any significant changes to your programs — adding, ending, or altering how you deliver your programs — have you explained them in Schedule O?

Have you accurately described the achievements for your three largest program services by revenue?

If you have chapters, branches, or affiliates, do you have written policies and procedures governing their activities to ensure consistency with the organization?

YES NO

*Who is a key employee? A key employee meets the following tests:• Received annual compensation in excess of $150,000.• Has responsibilities, powers, or influences over the organization that are similar to that held by an officer (e.g.,

CEO, CFO, COO) or a board member.• Manages a discrete segment or activity that represents 10 percent or more of the organization’s activities, assets,

income, or expenses.• Has or shares the authority to control or determine 10 percent of the organization’s capital expenditures, operating

budget, or compensation for employees. • Is one of the top 20 employees who pass the $150,000 and responsibility tests.



9. Form 990-EZ, Short Form Return of Organization Exempt From

Income TaxClick on the question-mark icons to display help windows. The information provided will enable you to file a more complete return and reduce the chances the IRS has to contact you.

Form 990-EZ


Short Form Return of Organization Exempt From Income Tax

Under section 501(c), 527, or 4947(a)(1) of the Internal Revenue Code (except private foundations)

▶ Do not enter social security numbers on this form as it may be made public.

▶ Go to www.irs.gov/Form990EZ for instructions and the latest information.

OMB No. 1545-1150

2017Open to Public

Inspection

A For the 2017 calendar year, or tax year beginning , 2017, and ending , 20 B Check if applicable:

Address change

Name change

Initial return

Final return/terminated

Amended return

Application pending

C Name of organization

Number and street (or P.O. box, if mail is not delivered to street address) Room/suite

City or town, state or province, country, and ZIP or foreign postal code

D Employer identification number

E Telephone number

F Group Exemption Number ▶

G Accounting Method: Cash Accrual Other (specify) ▶ H Check ▶ if the organization is not required to attach Schedule B (Form 990, 990-EZ, or 990-PF).

I Website: ▶

J Tax-exempt status (check only one) — 501(c)(3) 501(c) ( ) ◀ (insert no.) 4947(a)(1) or 527

K Form of organization: Corporation Trust Association OtherL Add lines 5b, 6c, and 7b to line 9 to determine gross receipts. If gross receipts are $200,000 or more, or if total assets (Part II, column (B) below) are $500,000 or more, file Form 990 instead of Form 990-EZ . . . . . . . . . . ▶ $ Part I Revenue, Expenses, and Changes in Net Assets or Fund Balances (see the instructions for Part I)

Check if the organization used Schedule O to respond to any question in this Part I . . . . . . . . . .

Rev

enue

1 Contributions, gifts, grants, and similar amounts received . . . . . . . . . . . . . 1 2 Program service revenue including government fees and contracts . . . . . . . . . 2 3 Membership dues and assessments . . . . . . . . . . . . . . . . . . . . 3 4 Investment income . . . . . . . . . . . . . . . . . . . . . . . . . 4 5 a Gross amount from sale of assets other than inventory . . . . 5a b Less: cost or other basis and sales expenses . . . . . . . . 5b c Gain or (loss) from sale of assets other than inventory (Subtract line 5b from line 5a) . . . . 5c

6 Gaming and fundraising events a Gross income from gaming (attach Schedule G if greater than

$15,000) . . . . . . . . . . . . . . . . . . . . 6a b Gross income from fundraising events (not including $ of contributions

from fundraising events reported on line 1) (attach Schedule G if thesum of such gross income and contributions exceeds $15,000) . . 6b

c Less: direct expenses from gaming and fundraising events . . . 6c d Net income or (loss) from gaming and fundraising events (add lines 6a and 6b and subtract

line 6c) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 6d7 a Gross sales of inventory, less returns and allowances . . . . . 7a b Less: cost of goods sold . . . . . . . . . . . . . . 7b c Gross profit or (loss) from sales of inventory (Subtract line 7b from line 7a) . . . . . . . 7c

8 Other revenue (describe in Schedule O) . . . . . . . . . . . . . . . . . . . 8 9 Total revenue. Add lines 1, 2, 3, 4, 5c, 6d, 7c, and 8 . . . . . . . . . . . . . ▶ 9

Exp

ense

s

10 Grants and similar amounts paid (list in Schedule O) . . . . . . . . . . . . . . 10 11 Benefits paid to or for members . . . . . . . . . . . . . . . . . . . . . 11 12 Salaries, other compensation, and employee benefits . . . . . . . . . . . . . . 12 13 Professional fees and other payments to independent contractors . . . . . . . . . . 13 14 Occupancy, rent, utilities, and maintenance . . . . . . . . . . . . . . . . . 14 15 Printing, publications, postage, and shipping . . . . . . . . . . . . . . . . . 15 16 Other expenses (describe in Schedule O) . . . . . . . . . . . . . . . . . . 16 17 Total expenses. Add lines 10 through 16 . . . . . . . . . . . . . . . . . ▶ 17

Net

Ass

ets 18 Excess or (deficit) for the year (Subtract line 17 from line 9) . . . . . . . . . . . . 18

19 Net assets or fund balances at beginning of year (from line 27, column (A)) (must agree with end-of-year figure reported on prior year’s return) . . . . . . . . . . . . . . . 19

20 Other changes in net assets or fund balances (explain in Schedule O) . . . . . . . . . 20 21 Net assets or fund balances at end of year. Combine lines 18 through 20 . . . . . . ▶ 21

For Paperwork Reduction Act Notice, see the separate instructions. Cat. No. 10642I Form 990-EZ (2017)

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Form 990-EZ (2017) Page 2 Part II Balance Sheets (see the instructions for Part II)

Check if the organization used Schedule O to respond to any question in this Part II . . . . . . . . . .(A) Beginning of year (B) End of year

22 Cash, savings, and investments . . . . . . . . . . . . . . . . . 22 23 Land and buildings . . . . . . . . . . . . . . . . . . . . . . 23 24 Other assets (describe in Schedule O) . . . . . . . . . . . . . . . 24 25 Total assets . . . . . . . . . . . . . . . . . . . . . . . . 25 26 Total liabilities (describe in Schedule O) . . . . . . . . . . . . . . 26 27 Net assets or fund balances (line 27 of column (B) must agree with line 21) . . 27 Part III Statement of Program Service Accomplishments (see the instructions for Part III)

Check if the organization used Schedule O to respond to any question in this Part III . . What is the organization’s primary exempt purpose?

Describe the organization’s program service accomplishments for each of its three largest program services, as measured by expenses. In a clear and concise manner, describe the services provided, the number of persons benefited, and other relevant information for each program title.

Expenses (Required for section 501(c)(3) and 501(c)(4) organizations; optional for others.)

28

(Grants $ ) If this amount includes foreign grants, check here . . . . ▶ 28a 29

(Grants $ ) If this amount includes foreign grants, check here . . . . ▶ 29a 30

(Grants $ ) If this amount includes foreign grants, check here . . . . ▶ 30a 31 Other program services (describe in Schedule O) . . . . . . . . . . . . . . . . . .

(Grants $ ) If this amount includes foreign grants, check here . . . . ▶ 31a 32 Total program service expenses (add lines 28a through 31a) . . . . . . . . . . . . . ▶ 32 Part IV List of Officers, Directors, Trustees, and Key Employees (list each one even if not compensated—see the instructions for Part IV)

Check if the organization used Schedule O to respond to any question in this Part IV . . . . . . . . .

(a) Name and title(b) Average

hours per week devoted to position

(c) Reportable compensation

(Forms W-2/1099-MISC) (if not paid, enter -0-)

(d) Health benefits, contributions to employee

benefit plans, and deferred compensation

(e) Estimated amount of other compensation

Form 990-EZ (2017)

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Form 990-EZ (2017) Page 3 Part V Other Information (Note the Schedule A and personal benefit contract statement requirements in the

instructions for Part V.) Check if the organization used Schedule O to respond to any question in this Part V .Yes No

33 Did the organization engage in any significant activity not previously reported to the IRS? If “Yes,” provide a detailed description of each activity in Schedule O . . . . . . . . . . . . . . . . . . . 33

34 Were any significant changes made to the organizing or governing documents? If “Yes,” attach a conformed copy of the amended documents if they reflect a change to the organization's name. Otherwise, explain thechange on Schedule O (see instructions) . . . . . . . . . . . . . . . . . . . . . . 34

35 a Did the organization have unrelated business gross income of $1,000 or more during the year from businessactivities (such as those reported on lines 2, 6a, and 7a, among others)? . . . . . . . . . . . . 35a

b If “Yes” to line 35a, has the organization filed a Form 990-T for the year? If “No,” provide an explanation in Schedule O 35b c Was the organization a section 501(c)(4), 501(c)(5), or 501(c)(6) organization subject to section 6033(e) notice,

reporting, and proxy tax requirements during the year? If “Yes,” complete Schedule C, Part III . . . . . 35c 36 Did the organization undergo a liquidation, dissolution, termination, or significant disposition of net assets

during the year? If “Yes,” complete applicable parts of Schedule N . . . . . . . . . . . . . 36 37 a Enter amount of political expenditures, direct or indirect, as described in the instructions ▶ 37a

b Did the organization file Form 1120-POL for this year? . . . . . . . . . . . . . . . . . . 37b 38a Did the organization borrow from, or make any loans to, any officer, director, trustee, or key employee or were

any such loans made in a prior year and still outstanding at the end of the tax year covered by this return? . 38a b If “Yes,” complete Schedule L, Part II and enter the total amount involved . . . . 38b

39 Section 501(c)(7) organizations. Enter: a Initiation fees and capital contributions included on line 9 . . . . . . . . . . 39a b Gross receipts, included on line 9, for public use of club facilities . . . . . . . 39b

40 a Section 501(c)(3) organizations. Enter amount of tax imposed on the organization during the year under: section 4911 ▶ ; section 4912 ▶ ; section 4955 ▶

b Section 501(c)(3), 501(c)(4), and 501(c)(29) organizations. Did the organization engage in any section 4958 excess benefit transaction during the year, or did it engage in an excess benefit transaction in a prior year that has not been reported on any of its prior Forms 990 or 990-EZ? If “Yes,” complete Schedule L, Part I 40b

c Section 501(c)(3), 501(c)(4), and 501(c)(29) organizations. Enter amount of tax imposed on organization managers or disqualified persons during the year under sections 4912, 4955, and 4958 . . . . . . . . . . . . . . . . . . . . . . . ▶

d Section 501(c)(3), 501(c)(4), and 501(c)(29) organizations. Enter amount of tax on line 40c reimbursed by the organization . . . . . . . . . . . . . . . . ▶

e All organizations. At any time during the tax year, was the organization a party to a prohibited tax shelter transaction? If “Yes,” complete Form 8886-T . . . . . . . . . . . . . . . . . . . . . 40e

41 List the states with which a copy of this return is filed ▶

42a The organization's books are in care of ▶ Telephone no. ▶

Located at ▶ ZIP + 4 ▶b 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)? Yes No

42b If “Yes,” enter the name of the foreign country: ▶

See the instructions for exceptions and filing requirements for FinCEN Form 114, Report of Foreign Bank and Financial Accounts (FBAR).

c At any time during the calendar year, did the organization maintain an office outside the United States? . 42c If “Yes,” enter the name of the foreign country: ▶

43 Section 4947(a)(1) nonexempt charitable trusts filing Form 990-EZ in lieu of Form 1041—Check here . . . . . . ▶

and enter the amount of tax-exempt interest received or accrued during the tax year . . . . . ▶ 43 Yes No

44 a Did the organization maintain any donor advised funds during the year? If “Yes,” Form 990 must becompleted instead of Form 990-EZ . . . . . . . . . . . . . . . . . . . . . . . . 44a

b Did the organization operate one or more hospital facilities during the year? If "Yes," Form 990 must becompleted instead of Form 990-EZ . . . . . . . . . . . . . . . . . . . . . . . . 44b

c Did the organization receive any payments for indoor tanning services during the year? . . . . . . . 44c d If "Yes" to line 44c, has the organization filed a Form 720 to report these payments? If "No," provide an

explanation in Schedule O . . . . . . . . . . . . . . . . . . . . . . . . . . . 44d 45 Did the organization have a controlled entity within the meaning of section 512(b)(13)? . . . . . . . 45a a

b Did the organization receive any payment from or engage in any transaction with a controlled entity within themeaning of section 512(b)(13)? If “Yes,” Form 990 and Schedule R may need to be completed instead ofForm 990-EZ (see instructions) . . . . . . . . . . . . . . . . . . . . . . . . . . 45b

Form 990-EZ (2017)

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Form 990-EZ (2017) Page 4 Yes No

46 Did the organization engage, directly or indirectly, in political campaign activities on behalf of or in oppositionto candidates for public office? If “Yes,” complete Schedule C, Part I . . . . . . . . . . . . . 46

Part VI Section 501(c)(3) organizations only All section 501(c)(3) organizations must answer questions 47–49b and 52, and complete the tables for lines 50 and 51.Check if the organization used Schedule O to respond to any question in this Part VI . . . . . . . . .

Yes No47 Did the organization engage in lobbying activities or have a section 501(h) election in effect during the tax

year? If “Yes,” complete Schedule C, Part II . . . . . . . . . . . . . . . . . . . . . 47 48 Is the organization a school as described in section 170(b)(1)(A)(ii)? If “Yes,” complete Schedule E . . . . 48 49 a Did the organization make any transfers to an exempt non-charitable related organization? . . . . . . 49a

b If “Yes,” was the related organization a section 527 organization? . . . . . . . . . . . . . . 49b 50 Complete this table for the organization's five highest compensated employees (other than officers, directors, trustees, and key

employees) who each received more than $100,000 of compensation from the organization. If there is none, enter “None.”

(a) Name and title of each employee (b) Average

hours per week devoted to position

(c) Reportable compensation

(Forms W-2/1099-MISC)

(d) Health benefits, contributions to employee benefit plans, and deferred

compensation

(e) Estimated amount of other compensation

f Total number of other employees paid over $100,000 . . . . ▶

51 Complete this table for the organization's five highest compensated independent contractors who each received more than $100,000 of compensation from the organization. If there is none, enter “None.”

(a) Name and business address of each independent contractor (b) Type of service (c) Compensation

d Total number of other independent contractors each receiving over $100,000 . . ▶

52 Did the organization complete Schedule A? Note: All section 501(c)(3) organizations must attach a completed Schedule A . . . . . . . . . . . . . . . . . . . . . . . . . . . .▶ Yes No

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 officer) is based on all information of which preparer has any knowledge.

Sign Here

▲

Signature of officer Date

▲

Type or print name and title

Paid Preparer Use Only

Print/Type preparer’s name Preparer’s signature DateCheck if self-employed

PTIN

Firm’s name ▶ Firm’s EIN ▶

Firm’s address ▶ Phone no.

May the IRS discuss this return with the preparer shown above? See instructions . . . . . . . . . . ▶ Yes No

Form 990-EZ (2017)

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10. The Board’s Role in Reviewing Form 990

Form 990, Return of Organization Exempt From Income Tax, is an informational return that must be filed each year to maintain exemption from federal taxes. The form is also required by many state agencies for regulation purposes. It is a public document of increasing interest to the IRS, state attorneys general, watchdog agencies, the press and the public.

Because of the vital link between the work of a not-for-profit’s board and the success of the mission, the IRS encourages an active and engaged board. For this reason, Form 990 asks if the return was furnished to the board prior to filing. In addition, all organizations must describe the process, if any, the board or a designated committee used to review the form.

Form 990 is designed to enhance transparency of the mission and activities, and promote compliance with tax law. An understanding of both transparency and compliance is essential for board members to effectively perform their fiduciary responsibilities.

Our checklist offers you an interpretation of particularly important sections and schedules, and prompts to confirm your organization’s responses are complete and accurate while presenting the organization in the most favorable light to readers of the Form 990.

Part I: SummaryPart I provides a snapshot of the mission, governance and key financial, compensation and operational information.

• Is the brief description of the organization’s mission candid and clearly articulated? Does it exert a positive influence upon a prospective donor?

• Does the current year summary of financial information compare favorably or unfavorably with the prior year?

Part III: Statement of Program Service AccomplishmentsPart III offers an organization the chance to increase awareness by fully describing its program services, and related expenditures and revenues.

• Does the information in Part III explain to the Form 990 user (e.g., the IRS, prospective donors and investigative reporters) why the organization exists, whom it serves and information about the activities it will undertake to accomplish its mission?

• Are program services described in sufficient detail to present a comprehensive and accurate portrayal of the organization?

Form 990: A board member’s checklist

One of the duties of a not-for-profit organization’s board is understanding the document upon which its tax exemption depends — Form 990.



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Part IV: Checklist of Required SchedulesPart IV asks questions to determine if a particular schedule must be completed. The schedules provide detailed information that enables the IRS to evaluate the likelihood of rule violations.

• Should the board consider changes in its policies and procedures, especially if there is a “yes” response to questions 25, 26 or 27?

Part V: Statements Regarding Other IRS Filings and Tax CompliancePart V acts as a checklist of other IRS compliance that might be required. It’s intended as an alert for other potential compliance requirements that are not necessarily related to Form 990.

• Have paid personnel been properly classified as employees rather than independent contractors to avoid payroll tax problems?

• If the organization has foreign bank accounts, has it properly reported them on FinCEN Form 114, Report of Foreign Bank and Financial Accounts? Has it alerted employees with signature authority over the organization’s bank accounts that they may have a filing requirement?

• If the organization is a charitable organization and received more than $250 from a single donor, was a receipt furnished to enable the donor to substantiate the charitable contribution deduction?

• Is the organization potentially subject to unrecorded penalties and interest (e.g., if line 3b, 5c, 6b, 7b, 7g or 7h is answered “no,” or if line 5a, 5b, 8, 9a or 9b is answered “yes”)?

Part VI: Governance, Management, and DisclosurePart VI asks about the governing body and management policies, as well as if and how the organization promotes transparency and accountability to its donors.

• If the organization does not have the board-adopted written policies indicated in lines 12a, 13–14 and 16b, should the board consider adopting any of these?

• If line 15a or 15b is answered “no,” should the board consider a change in the procedures for setting executive compensation to minimize the future risk of challenge by the IRS and exposure to tax on excess benefits if the organization is a Section 501(c)(3) or (c)(4) organization?

• If the organization is conducting activities in multiple states, is it properly registered in those states and does it satisfy those filing requirements?

Part VII: Compensation of Officers, Directors, Trustees, Key Employees, Highest Compensated Employees, and Independent ContractorsBecause the IRS is concerned that many exempt organizations are providing excessive compensation and benefits to officers, directors and key employees, Form 990 may require extensive compensatory data in Part VII and Schedule J.

• Does the compensation of those listed in Part VII appear justifiable in view of their responsibilities and the organization’s activities? (Note: Revisit Part VI, lines 15a and 15b, especially if there is a “no” response.)



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Part VIII: Statement of RevenuePart VIII asks for detailed information about the organization’s sources of support, including potentially taxable unrelated business income.

• Do the revenue data indicate too much reliance on a source that could be jeopardized by a weak economy, declining stock market or other external factors (i.e., should alternative revenue sources be considered or emphasized)?

• Substantial unrelated business income reported in column C could risk an organization’s exempt status. Is column C significant compared to the total revenues in column A?

Part IX: Statement of Functional ExpensesPart IX provides the IRS and donors with information for determining if appropriate expenditures are being directed to activities that further the organization’s exempt purpose.

• Are compensation and benefits (lines 5–9) consuming too much of the organization’s revenue?

• Are certain expenses justifiable (e.g., lines 11a–11g, 12 and 17–19)?

• If completed, do the totals of column C, Management and General Expenses, and column D, Fundraising Expenses, appear excessive relative to column B, Program Service Expenses?

Part X: Balance SheetPart X asks for information that may indicate if the organization is financially stable.

• Is an excessive amount of cash (line 1) being kept in noninterest-bearing accounts?

• Are resources being diverted from program service activities to related-party loans (lines 5–6)?

• Is oversight being exercised over related-party loans to ensure adequate collateral, interest, timely repayment, etc.?

• Are notes and loans receivable (line 7) adequately collateralized and monitored for timely repayment?

• Does an increase, if any, in accounts payable or accrued expenses (line 17) suggest potential cash flow problems?

Part XII: Financial Statements and ReportingPart XII asks for an explanation of the level of an independent accountant’s involvement and the reporting of audits required of organizations that receive federal grants under the Single Audit Act and OMB Circular A-133.

• If the organization does not have an independent audit (line 2b), are its financial resources large enough to make an independent audit prudent?

• If audited, do the auditors report to the group responsible for overseeing the financial reporting process (e.g., an audit or finance committee or a governing board)?



4


Schedule A: Public Charity Status and Public SupportSchedule A asks for a description of an organization’s reason for public charity status (i.e., why it isn’t a private foundation) and detailed information about the sources of its financial support.

• Do the data in Part II, Section C or Part III, Sections C and D indicate that the organization is in danger of becoming a private foundation rather than remaining a public charity?

• If the organization is a supporting organization, have the required organizational and operational tests been met? Has the support required been provided and have the supported organization(s) been notified?

Schedule C: Political Campaign and Lobbying ActivitiesSchedule C asks for information about the political and lobbying activities of certain organizations. Section 501(c)(3) organizations are prohibited from participating in political campaigns and are subject to limitations on their lobbying activities.

• If exempt under Section 501(c)(3), are policies followed to prevent participation in a political campaign that could jeopardize the organization’s tax-exempt status?

• If the organization is a Section 501(c)(3) entity that is eligible to make the lobbying expenditure election but has not, should it do so to minimize the likelihood that exempt status will be lost because of excessive lobbying (see Part II-A)?

Schedule F: Statement of Activities Outside the United StatesSchedule F asks for information about foreign activities, including programs, grantmaking, expenditures, offices, employees and contractors, and investments. The IRS wants to ensure that the assets and income of U.S. charities are not diverted for noncharitable purposes when funds are sent abroad.

• Does the organization follow a grant-making policy that enforces proper recordkeeping and reporting?

• Has the organization complied with potential foreign filing forms listed in Part IV?

Schedule J: Compensation Information The compensation information required in Schedule J is much more detailed than Part VII. Form 990 users review Schedule J for evidence of waste, extravagance and financial abuse.

• If any box on line 1a is checked, is the economic benefit warranted, or should it be re-examined?

• Does the organization require strict accountability for expense reimbursements to prevent abuse (lines 1b and 2)?

• Is the organization setting compensation based on one or more methods indicated by the box descriptions for line 3? (Note: The more boxes, the better.) Make sure the methods indicated are consistent with the disclosure for Form 990, Part VI, line 15b.

• If any of the questions on lines 4–8 are answered “yes,” do the indicated transactions suggest that changes should be made in nonfixed compensation arrangements to avoid windfall payouts?



5


Schedule K: Supplemental Information on Tax-Exempt Bonds Schedule K asks for a snapshot of an organization’s tax-exempt bonds for the filing period. Organizations should work with tax professionals and bond counsel to make sure the information reported in Schedule K matches filed bond documents.

• Have Schedule K, Parts I and II been reviewed in conjunction with their previously filed Forms 8038 and 8038-T to make sure line items tie out? If they do not, are additional details provided in the supplemental information section (Part VI) as clarification for variances?

• Since Schedule K captures just the fiscal reporting period, and not the life of the bond, have there been sufficient reviews of Part III, Private Business Use, and any contracts that could give rise to private business use on an annual basis?

• Are written bond policies reviewed and monitored to help ensure there is a plan for the voluntary closing agreement program, as well as any remediation requirements under the regulations? Are the bond policies reviewed by the board and management on an annual basis?

The IRS, state attorneys general, watchdog agencies, the press and the public all read organizations’ illuminating Form 990s with increased scrutiny of the following areas: • Compensation transactions, including conflicts of

interest and intermediate sanctions • Unrelated business activities and net operating losses • Fundraising activities, including gaming • Lobbying and political activities • Hospitals and community benefit standards • Grant-making policies, practices and procedures • Disclosure of fringe benefits and other

executive perks • Governance structure, including various best

practice policies and transactions with members and their related organizations

• Tax-exempt bond financing, including allowable use of funds and arbitrage calculations

• Disclosure of foreign activity



6


Schedule L: Transactions With Interested PersonsSchedule L asks for financial information on certain financial transactions or arrangements between the organization and disqualified persons or other interested persons. This may include current or former officers, directors, trustees, key employees, substantial contributors and family members of these individuals.

• Did the organization consider all direct or indirect transactions or relationships that may require disclosure? (See Form 990, Part IV, questions 25–28.)

• Are business transactions with interested persons fully disclosed, including the amount; nature of the transaction; and relationship with the organization, management and board?

Schedule O: Supplemental Information Schedule O asks for required narrative information in response to specific questions.

• Is the Form 990 review process fully described?

• Does the narrative explain how potential conflicts of interest are addressed and resolved?

• Are there descriptions for how public documents (Forms 990, 990-T, if applicable, and Form 1023) are made available for public inspection (website, office, GuideStar, etc.)?

The Not-for-Profit Tax Services professionals of Grant Thornton LLP have worked extensively with clients to prepare Forms 990, 990-PF, 990-T and other related returns that are complete and accurate, and present our clients and their tax returns in the most advantageous light.

For more information please visit grantthornton.com/990checklist

Contacts Dan Romano National Partner-in-Charge Tax Services Not-for-Profit and Higher Education Practices T +1 212 542 9609 E [email protected] Qi Wen Liang Senior Manager Tax Services Not-for-Profit and Higher Education Practices T +1 212 624 5399 E [email protected]



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11. How to Verify the 501(c)(3) Status of a Nonprofit


Tax Cuts and Jobs Act H.R.1

12. Form 990 Checklist

1. Name of Organization

2. Organization exempt status (please circle) 501(c)3, 501(c)4, 501(c)5, 501(c)6,

501(c)7

3. Name of principal officer

4. Website address

5. Phone number

6. Type of organization‑Corporation, Trust, Association, or Other (please specify)

7. Year of formation

8. List state where organization was formed

9. Briefly describe the organization’s most significant activities

10. Number of voting members of the governing body

11. Number of independent voting members of the governing body

a. A member is independent if all of the following apply: (1) member is not

compensated as an officer or employee of the organization or any related

organization; (2) member received less than $10,000 as an independent

contractor other than reimbursement under an accountable plan; (3)

neither the member nor any family member was involved in an excess

benefit transaction, loan to or from the organization, or any business

transactions with the organization.



12. Total number of volunteers (estimate if necessary) and a description of the

services provided by the volunteers.

13. Briefly describe the organization’s mission

14. Did the organization undertake any significant program services during the

year which were not listed on the prior Form 990 or 990‑EZ?

• If yes, please describe each below

15. Did the organization cease conducting, or make significant changes in how it

conducts any program services?

• If yes, please describe those changes

16. Describe, in sufficient detail, the exempt purpose achievements for each of the

organization’s three largest program services. If applicable, include specific

measurements and/or statistical information; such as number of clients

served, days care was provided, number of sessions of events held, etc.

17. Did the organization receive, during the year, an aggregate of $5,000 or more

from any one contributor?

• If yes, please provide a list of those donors (which include

individuals, fiduciaries, partnerships, corporations, associations,

trusts, foundations, and exempt organizations). That list should

include:

Name, address, and total amount donated for the year

If the donation was other than cash, note what the non‑cash donation

consisted of and the fair market value and date received if property or

stock.

Indicate if the donor is a family member of an officer or key employee



18. Did the organization engage in direct or indirect political campaign activities

on behalf of or in opposition to candidates for public office?

• If yes, see Schedule C Checklist.

19. Section 501(c)(3) organizations. Did the organization engage in lobbying

activities?


20. Section 501(c)(4), 501(c)(5), and 501(c)(6) organizations. Is the organization

subject to the §6033(e) notice (lobbying activities) and reporting requirement

and proxy tax?


21. Did the organization maintain any donor advised funds or any accounts where

donors have the right to provide advice on the distribution or investment of

amounts in such funds or accounts?

• If yes, see Schedule D Checklist.

22. Did the organization receive or hold a conservation easement, including

easements to preserve open space, the environment, historic land areas, or

historic structures?


23. Did the organization maintain collections of works of art, historical treasures,

or other similar assets?


24. Did the organization have an Escrow Liability at the end of the year? Did the

organization serve as a custodian for an escrow account; or provide credit

counseling, debt management, credit repair, or debt negotiation services?

• If yes to any of these, see Schedule D Checklist.



25. Did the organization, directly or through a related organization, hold assets in

term, permanent, or quasi‑endowments?


26. Does the organization report on their Balance Sheet, any of the following:

If yes, see Schedule D Checklist.

a. Land, buildings, and equipment

b. Investments‑other securities

c. Investments – program related

d. Other Assets

e. Other Liabilities

27. Did the organization receive an audited financial statement for the year for

which it is completing this return that was prepared in accordance with GAAP?

28. Is the organization a school?

• If yes, see Schedule E Checklist.

29. Did the organization maintain an office, employees, or agents outside of the

U.S.?

30. Did the organization have aggregate revenues or expenses of more than

$10,000 from grant making, fundraising, business, and program service

activities outside the U.S.? Did the organization have aggregate foreign

investments valued at $100,000 or more?

• If yes, see Schedule F Checklist.

31. Did the organization make more than $5,000 of grants or assistance to any

organization, entity, or individual located outside the United States?

• If yes, see Schedule F Checklist.



32. Did the organization pay more than $15,000 for professional fundraising

services?

• If yes, see Schedule G Checklist.

33. Did the organization report more than $15,000 in gross fundraising revenue?


34. Did the organization report more than $15,000 in gross income from gaming

activities?


35. Did the organization operate one or more hospitals?

• If yes, please provide the name, address, and type of hospital for

each facility operated.

36. Did the organization make more than $5,000 in grants and assistance to

governments, organizations, and individuals in the U.S.?

• If yes, see Schedule I Checklist.

37. Provide a list of the officers, directors, trustees, and key employees for the tax

year and provide the following information for each one listed:

• Name

• Title and average hours per week devoted to position

• Compensation, if not paid, enter‑0‑

• Deferred compensation and contributions to employee benefit

plans

• Expense account and other allowances



For any employee (s) who received more than $100,000 of compensation from

the organization, please provide the following information:

a. Name

b. Title and average hours per week devoted to the position

c. Compensation

d. Deferred compensation and contributions to employee benefit plans

e. Expense account and other allowances

38. For the five highest compensated independent contractors that received

more than $100,000 from the organization during the fiscal year, provide the

following information:

a. Name and address

b. Type of service rendered

c. Amount of compensation

39. Did the organization pay any former officer, director, trustee, key employee,

or highly compensated employee more than $100,000 in reportable

compensation?

• If yes, see Schedule J Checklist.

40. Did the organization pay any officer, director, trustee, key employee, or highly

compensated employee more than $150,000 in reportable compensation?


41. Did any officer, director, trustee, key employee, or highly compensated

employee receive or accrue compensation from any unrelated organization for

services rendered to your organization?




42. Did the organization have a tax‑exempt bond issue with an outstanding

principal amount of more than $100,000 as of the last day of the year that was

issued after December 31, 2002?

43. If yes, provide the additional information listed below:

a. Issuer’s Name

b. Issuer’s Federal Identification Number

c. CUSIP#

d. Date Issued and Issue Price

e. Description of Purpose

f. Was the bond defeased?

g. Was the bond defeased on behalf of the issuer?

44. Did the organization invest any proceeds of tax‑exempt bonds beyond a

temporary period exception?

a. Did the organization maintain an escrow account other than a refunding

escrow at any time during the year to defease any tax‑exempt bonds?

b. Did the organization act as an “on behalf of” issuer for bonds outstanding

at any time during the year?

45. Section 501(c)(3) and 501(c)(4) organizations. Did the organization engage in

an excess benefit transaction with a disqualified person during the year?

• If yes, see Schedule L Checklist.



46. Did the organization become aware that it had engaged in an excess benefit

transaction with a disqualified person from a prior year?

47. If yes, see Schedule L Checklist.

a. Did the organization hold any receivables or payables to any current

or former officer, director, trustee, key employee, highly compensated

employee, or persons in a position to exercise substantial influence over

the affairs of the organization?


b. Did the organization provide a grant or other assistance to an officer,

director, trustee, key employee, or substantial contributor, or to a person

related to such an individual?


48. During the tax year, did any person who is a current or former officer, director,

trustee, or key employee:

a. Have a direct business relationship with the organization (other than

as an officer, director, trustee, or employee), or an indirect business

relationship through ownership of more than 35% in another entity

(individually or collectively with another officer, director, trustee, or key

employee?


b. Have a family member who had direct or indirect business relationship

with the organization?


c. Serve as an officer, director, trustee, key employee, partner, or member of

an entity (or a shareholder of a professional corporation) doing business

with the organization?




49. Did the organization receive more than $25,000 in non‑cash contributions?

• If yes, see Schedule M Checklist.

50. Did the organization receive contributions of art, historical treasures, or other

similar assets, or qualified conversation contributions?

• If yes, see Schedule M Checklist.

51. Did the organization liquidate, terminate, or dissolve and cease operations?

• If yes, see Schedule N Checklist.

52. Did the organization sell, exchange, dispose of, or transfer more than 25% of

its net assets?

• If yes, see Schedule N Checklist.

53. Did the organization own 100% of an entity disregarded for federal tax

purposes as separate from the organization?

• If yes, see Schedule R Checklist.

54. Was the organization related to any tax‑exempt or taxable entity?


55. Is any related organization a controlled entity within the meaning of §512(b)

(13) (ownership of more than 50% stock in a corporation, more than 50%

profits interest in a partnership or more than 50% ownership in any other

case?


56. Section 501(c)(3) organizations. Did the organization make any transfers to a

related exempt non‑charitable organization?




57. Did the organization conduct more than 5% of its exempt or unrelated

activities through an entity that is not a related organization and that is treated

as a partnership for federal income tax purposes?


58. Number reported in Box 3 of Form 1096, filed for the calendar year ending

within the year covered by the 990 return; enter‑0‑ if not applicable.

59. Number of Forms W‑2G included in Box 3 of Form 1096, filed for the

calendar year ending within the year covered by the 990 return; enter‑0‑ if not

applicable.

60. Did the organization comply with backup withholding rules for reportable

payments to vendors and reportable gaming (gambling) winnings to prize

winners?

61. Total number of employees reported on Form W‑3 filed for the calendar year

ending within the year covered by the 990 return.

62. Did the organization have unrelated business gross income of $1000 or more

during the year covered by this return?

• If yes, provide a description of the type of income and $ amount.

63. 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)?

• If yes, provide name of the foreign country. The organization may

also be required to file Form TD F 90‑22.1.

64. Was the organization a party to prohibited tax shelter transaction at any time

during the tax year?

• If yes, was Form 8886‑T filed?



65. Did any taxable party notify the organization that it was or is a party to a

prohibited tax shelter transaction?

• If yes, was Form 8886‑T filed?

66. Did the organization solicit any contributions that were not tax deductible?

• If yes, was an express statement provided with the solicitation that

such contribution or gifts were not tax deductible?

67. Did the organization provide goods or services in exchange for any

contribution of $75 or more?

• If yes, was the donor notified of the value of the goods or services

provided?

68. Did the organization sell, exchange, or otherwise dispose of tangible personal

property for which it was required to file Form 8282?

• If yes, how many forms?

69. Did the organization receive any funds, directly or indirectly, to pay premiums

on a personal benefit contract?

70. Did the organization pay premiums, directly or indirectly, on a personal benefit

contract?

71. For all contributions of qualified intellectual property, did the organization file

Form 8899 as required?

72. For contributions of cars, boats, airplanes, and other vehicles, did the

organization file a Form 1098‑C as required?



73. Section 501(c)(3) and other sponsored organizations maintaining donor

advised funds and Section 509(a)(3) supporting organizations. Did the

supporting organization, or a fund maintained by the sponsoring organization,

have excess business holdings at any time during the year.


advised funds. Did the organization make any taxable distributions under

§4966?


advised funds. Did the organization make a distribution to a donor, donor

advisor, or related person?

76. Section 501(c)(7) organizations. Please provide initiation fees and capital

contributions included your total revenues.

77. Section 501(c)(7) organizations. Please provide gross receipts from public use

of club facilities included in your total revenue.

78. Section 501(c)(12) organizations. Please provide gross income from members

or shareholders.

79. Section 501(c)(12) organizations. Please provide gross income from other

sources (Do not net amounts due or paid to other sources against amounts due

or received from them).

80. Section 4947(a)(1) non‑exempt charitable trusts. Is the organization filing

Form 990 in lieu of Form 1041?

• If yes, enter the total amount of tax‑exempt interest received or

accrued during the year?



81. Did any officer, director, trustee, or key employee have a family relationship or

a business relationship with other officer, director, trustee, or key employee?

• If yes, describe the circumstances.

82. Did the organization delegate control over management duties customarily

performed by or under the direct supervision of officers, directors or trustees,

or key employees to a management company or other person?

• If yes, describe the circumstances.

83. Did the organization make any significant changes to its organizational

documents since the prior Form 990 was filed?

• If yes, please describe those changes.

84. Did the organization become aware during the year of a material diversion of

the organization’s assets?

• If yes, please describe the circumstances.

85. What type of governing body does the organization have; members or

stockholders?

86. Does the organization have members, stockholders, or other persons who may

elect one or more members of the governing body?

• If yes, please describe the process.

87. Are any decisions of the governing body subject to approval by members,

stockholders, or other persons?

• If yes, please describe the approval process.



88. Did the organization contemporaneously document the meetings held or

written actions undertaken during the year by the following?

a. The governing body?

b. Each committee with authority to act on behalf of the governing body?

c. If no, please describe the circumstances or process as to why

documentation did not occur.

89. Does the organization have local chapters, branches, or affiliates?

• If yes, does the organization have written policies and procedures

governing the activities of such chapters, affiliates, and branches

to ensure their operations are consistent with those of the

organization? Please provide a description of this.

90. Will a copy of the Form 990 be provided to the organization’s governing

body before it is filed? Please describe the organizations process, if any, for

reviewing the Form 990.

91. Are there any officers, directors, trustees, or key employees who cannot be

reached at the organization’s mailing address?

a. If “Yes,” provide the names and addresses where they can be reached.

92. Does the organization have a written conflict of interest policy?

a. Are officers, directors, or trustees, and key employees required to disclose

annually interest that could give rise to conflicts?

b. Does the organization regularly and consistently monitor and enforce

compliance with the policy?

c. If yes, describe how this is done.

93. Does the organization have a written whistleblower policy?



94. Does the organization have a written document retention and destruction

policy?

95. Did the process for determining compensation of the following persons include

a review and approval by independent persons, comparability data, and

contemporaneous substantiation of the deliberation and decision?

a. The CEO, Executive Director, or top management official?

b. Other officers or key employees of the organization?

c. Describe the process below.

96. Did the organization invest in, contribute assets to, or participate in a joint

venture or similar arrangement with a taxable entity during the year?

• If yes, has the organization adopted a written policy or procedure

requiring the organization to evaluate its participation in joint

venture arrangements under applicable federal tax law, and take

steps to safeguard the organization’s exempt status?

97. A tax‑exempt organization is required to make its Forms 1023 (or 1024 if

applicable), 990, and 990‑T (501(c)(3)s only) available for public inspection.

Indicate how you make these available: Own Website, Another’s Website, or

Upon Request

98. Describe below whether (and if so, how), the organization makes it governing

documents, conflict of interest policy, and financial statements available to the

public.

99. State the name, physical address, and telephone number of the person who

possesses the books and records of the organization.

100. Were the organization’s financial statements compiled or reviewed by an

independent accountant?



101. Were the financial statements audited by an independent accountant?

Did the audited financial statements include a footnote for the liability for

uncertain tax positions?

• If so, provide a copy of that footnote.

102. Does the organization have a committee that assumes responsibility for

oversight of the audit, review, or compilation of its financial statements and

selection of independent accountant?

• Explain if there has been a change in this process.

103. As a result of a federal award, was the organization required to undergo an

audit or audits as set forth in the Single Audit Act and OMB Circular A‑133?

• If yes, did the organization undergo the required audit or audits?