1. law, govt and politics

Check List for New US Speedskating Clubs
Club Organization
• Develop a network of people interested in organizing a speedskating club. Organize an
election to select people to serve as the Club Officers.
Register the Speedskating Club
• New clubs must register with their regional Association as well as US Speedskating.
New clubs must be approved by the Membership and Development Committee. In order
to accomplish this, please submit the information below to the USS National
Headquarters at P.O. Box 18370, Kearns, UT, 84118:
• Develop Bylaws to submit to US Speedskating for approval with the MPDC.
• Complete requirements necessary to become a recognized club in your Association. If
applying as a Direct Club with USS, complete requirements below as found in the MPDC
Rules and Procedures and submit to USS National Headquarters:
1. Name of Organization
2. List of Members
3. List of Officers and Board of Directors, all of whom must be members of USS
within 30 days of approval of the USSSO as a provisional member.
4. Principle address of Skating Headquarters
5. A statement that the new USSSO will uphold the Bylaws, enforce the rules
and regulations of US speedskating, its officers and Board of Directors
6. Payment of dues ($100 yearly for Direct Clubs)
Purchase an Insurance Rider Policy
• For a small fee, this covers liability issues. Contact Marty Wolfinsohn at JAS Insurance at
847-755-1010. He can explain the issue and write up the waiver for the club.
501 (c) 3 status
• USSSO's are encouraged but not required to have federal 501 (c) 3 tax-exempt status.
Failure to do so may exclude the USSSO from receiving grants or contributions that may
normally be given to 501 (c) 3 organizations.
Coaches and Ice Time
• Clubs should obtain a qualified coaching staff and secure ice time at the local rink.
Additionally, determine if ice time is available through other area clubs.
Obtain Necessary Equipment
• Pads
• Blocks (14 blocks on the track plus 4 extra)
• Starting gun and shells (22 caliber and 22 caliber caps)
• Water Buckets (3-4 large plastic buckets with handles)
• Two large Squeegees
• First-Aid Kit
Optional equipment:
• Club skate to loan
• Skate sharpening boxes to loan
• Helmets, neck guards or knee pads to sell
• Pad carts to hold and move pads
• Lap Counter
Develop Club Promotion Program
• Create methods to recruit new skaters and maintain current skaters
• Develop materials (some materials can be obtained through USS) to help promote club.
Some ideas for promotional materials:
• Develop a club newsletter
• Set up an Open House and distribute invitations to local schools
• Have brochures available explaining speedskating
• Contact a local newspaper for coverage
• Incorporate the One-Day, One-Dollar membership to get new skaters on
the ice. (Contact Emily Robbins at [email protected] for
information.)
• Create a bulletin board at the ice rink with Club news, photos and
information
Regular Contact with USS
• Each year, all Direct Clubs must submit a current copy of its duly adopted constitution
and bylaws to USS Headquarters by November 1 and no earlier than September 1. Direct
Clubs shall notify USS of any revisions. Bylaws on file at USS will be referenced for any
conflict or issue.
• Each Direct Club must submit a copy of the minutes of its most recent general
membership meeting (held anytime in the previous 6-month period).
• Each Direct Club must submit $100 each year to USS before September 15 for
membership dues.
• Meets can be sanctioned by USS if sanctioning requirements are met. Sanctioned events
can be posted on the USS website speedskating schedule with registration information
and results.
US SPEEDSKATING APPLICATION FOR
DIRECT CLUB MEMBERSHIP
Valid September 1, 2012 - August 31, 2013
Send Form & Payment To: [email protected] or mail to
US Speedskating, 5662 S Cougar Lane, Kearns, UT 84118
CONTACT INFORMATION
CLUB NAME: _____________________________________________________________________________________
MAIN POINT OF CONTACT: _________________________________ EMAIL: ________________________________
ADDRESS: _________________________________ CITY: ____________________ STATE: _______ ZIP: ________
WEBSITE ADDRESS: ______________________________________________________________________________
RINK INFO
RINK NAME: ___________________________________
RINK NAME: ___________________________________
ADDRESS:
ADDRESS:
___________________________________
CITY, STATE, ZIP: _______________________________
___________________________________
CITY, STATE, ZIP: _______________________________
BOARD MEMBERS
PRESIDENT: _____________________
USS MEMBER # ____________
EMAIL: _________________________
VICE PRESIDENT: ________________
USS MEMBER # ____________
EMAIL: _________________________
SECRETARY: ____________________
USS MEMBER # ____________
EMAIL: _________________________
TREASURER: ____________________
USS MEMBER # ____________
EMAIL: _________________________
ADDITIONAL: ____________________
USS MEMBER # ____________
EMAIL: _________________________
ADDITIONAL: ____________________
USS MEMBER # ____________
EMAIL: _________________________
ADDITIONAL: ____________________
USS MEMBER # ____________
EMAIL: _________________________
ADDITIONAL: ____________________
USS MEMBER # ____________
EMAIL: _________________________
ADDITIONAL: ____________________
USS MEMBER # ____________
EMAIL: _________________________
PAYMENT INFORMATION - $100
Check enclosed, made payable to U.S. Speedskating | Charge my:
Visa
MasterCard
American Express
Card #: ____________________________________ Name as it appears on card: _______________________________
Exp. date: ____________ Security Code: _________ Signature: ___________________________________________
ADDITIONAL DOCUMENTS NEEDED
PLEASE SEND WITH APPLICATION
COPY OF CURRENT BYLAWS
COPY OF LATEST MEETING MINUTES
Sample Ideas for Club Organization
OFFICERS
President:
Provides leadership and direction for all club activities. Represents the
club at Association meetings. Plans and conducts club meetings.
Vice President: Assists the president in his or her activities and represents the
president and club in his or her absence.
Secretary: Keeps minutes, maintains all historical records and generates
communications.
Treasurer:
Accountable for all financial reporting. Writes checks and maintains the
records for all income and expenses.
COACHES
Head Coach on ice:
Is in charge of writing workouts/year plan and runs the main
ice practice. Attends all the competitions and is available for all questions from skaters
and parents.
Assistant Coaches on ice:
Assists the Head Coach with ice practice and
demonstrations.
Dryland Coach:
Prepares and leads the dryland workouts including weight training
and general conditioning.
OTHER KEY PERSONNEL
Skate Manager:
Inventories and manages the club's rental skates. Keeps a
detailed spreadsheet of size and condition of boots and blades. Decides when equipment
needs repair or if additional skate equipment needs to be purchased.
Meet Director:
Individual that organizes your local/regional meet.
Ice Rink Liaison:
Works with rink management on ice times and ice conditions.
Registration Coordinator:
Organizes and sets-up registration night in the
beginning of the year. Lines up location, time and works with the communication
individual to prepare flyer and media articles.
Badge Program Coordinator:
Is in charge of distributing the badge book to all
skaters in the club. Keeps the badge inventory and distributes the badges to the skaters
as they achieve the new level. Keeps a record of the skaters' performances.
Jig Coordinator: Maintains jig boxes (jig, stones, burr stones, rags, oil) and sets up
jig teams (rotates between 3-4 families). Determines if additional boxes need to be
made and when the equipment needs to be replaced. Responsible for sharpening
instructions, sharpening videos and monthly demonstrations at practice.
Videography:
Video tapes practice and replays the tapes for the athletes.
Communications/Publicity/Newsletter/Graphic Designer: Key contact
for e-mail distribution list. Designs and creates newsletters and other flyers. Is in
charge of press releases and sending meet results to the newspapers.
Webmaster:
Designs, maintains and keeps the club's web site current.
Uniform Manager:
Maintains the club uniform inventory. Determines when
repairs and/or replacements are needed.
Pad Maintenance: In charge of yearly cleaning and maintenance.
pads need to be replaced and if additional pads need to be purchased.
Determines when
Tryspeedskating.com Contact:
Main contact for inquiries from the
tryspeedskating.com web site. Responsible for mailing packets of information and for
follow-up phone calls.
Board of Directors and Key Personnel Duties at
The Club Level
President: The president presides at all general membership and special meetings of the
club or board of directors. The president assures business operations are conducted in
accordance with all applicable laws, regulations, accounting standards and good
business practices and performs other chief executive office duties consistent with the
requirement herein. The president is authorized to cast the deciding vote only in the case
of a tie. The president, at her or his discretion, is an at-large voting member of all
committees.
Vice-President: The vice-president serves as the senior officer in the absence, disability,
removal or resignation of the president, with the same authority and duties as the
president. The vice-president shall be a voting member on all business-related
committees and shall be the primary liaison with the coaching staff.
Secretary: The secretary keeps an accurate record of all proceedings of the club. The
secretary shall also keep an accurate membership list and handle club correspondence.
The secretary shall be a voting member on all business-related committees.
Treasurer: The treasurer receives all club monies from dues, donations and fundraising,
pays all club expenses, keeps accurate records of all financial transactions and provides
financial reports at each regular and special meeting of the club. All checks issued by the
treasurer shall bear the signature of one additional designated member. The treasurer
shall be a non-voting member on all business-related committees.
Head Coach: The head coach represents the collective coaches at the board of directors
meeting. The head coach shall provide the board with a coaching status report and shall
have the primary responsibility for recruiting, appointing and hiring coaching personnel.
The head coach shall be responsible for the long-range skater development program and
final approval of new members.
Skate Manager: Inventories and manages the club’s rental skates; keeps a detailed
spreadsheet of size and condition of boots and blades; maintains skates and keeps them
in good skating condition; decides when equipment needs repair or if additional skate
equipment needs to be purchased.
Meet Director: Organizes local or regional meets. Forms a relationship with the rink
manager in order to hold efficient, fun and marketable events.
Sample Direct Club
Constitution and By Laws
ARTICLE I: NAME AND PURPOSE
Section 1:
As established in the Articles of Incorporation, the name of this not-for-profit
corporation shall be the Club Name Incorporation as a Direct Club to US
Speedskating. The initial board members are volunteers who will be in office
until the first board meeting of the club to be held in September 2010 at which
time the first club election will be held. The initial board is only in place for
the establishment of the club.
Section 2:
As a club organized of US Speedskating we attest that the board and members will
uphold the Bylaws, enforce the rules and regulations of US Speedskating, its officers
and Board of Directors. Those not complying with this section and unwilling to correct
their behavior will be asked to resign the club or be removed from the club per
articles of the constitution and Bylaws.
Section 3:
The purposes as established in the Articles of Incorporation are as follows:
A. to develop, promote and administer the sports of ice speed skating both to
foster state, regional, national and international amateur sports competition;
B. to encourage, support, coordinate, sponsor and organize sports competition for
membership and the general public;
C. to support and develop amateur athletes and Special Olympians; to help each
individual member achieve their highest level of personal sports competence;
to promote sport safety, fellowship, and respect among members;
D. to support training and licensing of coaching staff
Section 4:
Notwithstanding any provisions to the contrary, this corporation is organized
exclusively for such purposes as are authorized and permitted by Section 501(c) (3) of
the Internal Revenue Code of 1986 (or the corresponding provision of any future
United States Internal Revenue Law), and this Corporation shall not carry on any
activities which are not permitted to be carried on by a corporation exempt from
taxation under said Section 501(c) (3) of the Internal Revenue Code of 1986, as
amended.
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Sample Direct Club
Constitution and By Laws
ARTICLE II: MEMBERSHIP
Section 1: Membership Classes:
A.
Member: Are individuals or families who have joined the Club Name and
are current with dues. Membership is open to anyone irrespective of
age, gender, race or creed, who displays an active interest in learning
and or participating in the sport associated with PROGRAM. Members
aged 18 years or older shall be eligible to vote, hold office, and serve on
committees.
B.
Family Membership: All related persons living at the same address may
be included in the membership and be considered a “family” regarding
“family membership”. Individuals under the age of 18 may attend
meetings; however, the parent(s) of minor members will be eligible to
vote, hold office, and serve on committees. The family membership
may have 2 votes where both parents/step parents are active in the club
activities and one vote where only one parent/step parent is active with
club activities.
C.
Associate Member: Individuals interested in the Program activities and
who wish to support the purposes and objectives of the Program are
eligible for Associate Membership. Associate Members shall be entitled
to attend the annual meeting, but do not have the right to vote, hold
office, or serve on a committee.
D.
Contributing Membership: Organizations, Institutions, or Foundations,
which contribute annually to the Program, may be eligible for
Contributing Membership. Contributing Members shall be entitled to
attend the annual meeting, but shall not have the right to vote, hold
office, or serve on a committee.
Section 2: Qualifications:
Qualifications: Application for Membership: Application for membership or
change of membership status will use the above definitions to determine the
most appropriate membership and shall be in accord with procedures
established by the Board of Directors
Section 3: Denial of membership:
A. Denial of membership may occur for past delinquent payment of fees/due;
unsafe behaviors; disruptive behavior; disregard to coaching instructions which
could put others at risk; consistent use of profane language; and/or sexually
inappropriate comments/ behaviors unbecoming to sportsmanship and respect
for other skaters.
B. In the event membership is denied, the applicant/member shall be entitled to
appear before the Board of Directors and request reconsideration. Denial of
membership will not be allowed based on issues of discrimination to age,
gender, race or creed.
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Sample Direct Club
Constitution and By Laws
ARTICLE II: MEMBERSHIP continued:
Section 4: Waiver Release:
A. Each individual must sign a current waiver used by the Program, assuming full
responsibility for any accident, damage, injury, or loss incurred at any Program
sanctioned practice, event or activity.
B. A parent or guardian must sign a waiver for each child under 18 years of age.
Section 4: Dues and Ice Fees:
A. Dues for each category of membership shall be established by the Board of
Directors.
B. Dues shall be due on September first (1) of each year and payable within 60
days or at time of written application for membership. Dues will be pro-rated
for members who join at different months within the membership calendar
year.
C. Ice Fees will be established by the Board of Directors for Club activities related
to the sport of speedskating.
Section 5: Termination and Appeal:
Termination:
A. Termination Members failing to pay dues sixty (60) days from September first
(1) of each year shall automatically forfeit their membership on the sixty-first
(61) day.
B. Individuals who have forfeited membership because of nonpayment of dues
may be reinstated upon payment of dues and any late fee established by the
Board of Directors.
C. The Board of Directors may, by a two-thirds (2/3) vote of the entire Board
membership, suspend or expel any member of the PROGRAM for violation of
these Bylaws, any rules, policies and procedures established by the PROGRAM.
Appeals regarding Termination:
A. Before the Board of Directors takes such action, written notice shall be sent to
the member not less than thirty (30) days prior to the meeting of the Board of
Directors at which the matter is to be considered.
B. Said individual shall be entitled to a hearing before the Board of Directors
before a decision is reached.
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Sample Direct Club
Constitution and By Laws
ARTICLE III: BOARD OF DIRECTORS/ OFFICERS
Section l. General Powers:
The affairs of the Program shall be managed by its Board of Directors.
Section 2: The Board of Directors Composition:
The Board of Directors shall consist of 5 to 7 Board Members:
A. Four (4) elected Officers,
a. namely a President;
b. a Vice President;
c. a Secretary;
d. a Treasurer; and,
B. One (1) to three (3) Director at Large.
C. The Board will start with 5 Board Members when initiating the club and
increase to 7 Board members as the club membership increases.
Section 3: Duties of the Board of Directors:
A. The Board of Directors shall be responsible for the management of the affairs
of the PROGRAM and shall use its best efforts to carry out the purposes of the
Club Name.
B. The Board of Directors shall provide the membership with a financial audit
prior to each annual meeting.
Section 4: Meetings of the Board of Directors:
A. Regular meetings of the Board of Directors shall be held at least twice each
year at times designated by the President.
B. Special meetings of the Board of Directors may be called by the President or
upon written request from a Board member or member of the club. Discussion
at such special meetings shall be limited to the topic(s) mentioned in the
notice sent to all Board members.
C. Notification of regular meetings shall be sent to all Board members not less
than fourteen (14) days before the regular meetings. Notification of special
meetings shall be sent no less than seven (7) days before the special meeting.
No notice of any meeting need be given if all Board members sign before,
during, or after said meeting a written Waiver of Notice.
D. A quorum for all meetings of the Board of Directors shall be a majority of those
members in office at the time of the meeting.
E. Any Member may attend Board meetings in order to present his/her view(s) on
a specific matter.
Page 4 of 20
Sample Direct Club
Constitution and By Laws
ARTICLE III: BOARD OF DIRECTORS/ OFFICERS continued
Section 5: Qualifications:
A. Individuals who have are at least 18 years old and Members in good
standing of the program to be eligible to hold office.
B. Officers shall be members of US Speedskating.
Section 6: Term of Office:
A. Officers shall serve a two (2) year term.
B. There is no limit to the number of terms that an officer may serve.
C. The term of office shall begin at the close of the annual business
meeting in which the election is announced and conducted.
D. Director’s offices shall be staggered so half the Directors are familiar
with Program business.
E. The office of President, Secretary, and one Director Position shall be up
for election on the Odd years.
F. The office of Vice President, Treasure, and two Director Positions shall
be up for election on the Even years.
Section 7: Nominations and Elections:
A. Election shall be solely by closed ballot.
B. Nominations are done under parliamentary procedure with a verbal
nomination and a second of any Program member.
C. The nominated member should be willing and agree to serve on the
board.
D. Ballots must be returned prior to the end of the annual meeting.
E. A majority of a quorum of the membership shall be required to elect.
F. Tie votes shall be broken by drawing lots with members present.
Section 8: Removal:
Any member of the Board of Directors, regardless of the manner of election or
appointment, may be removed by the Board of Directors or upon two-thirds
(2/3) affirmative vote of the majority of the active membership; whenever, in
its judgment, said director’s malfeasance, misfeasance, or nonfeasance impairs
his or her effectiveness as a Board member, or brings disrepute to the
PROGRAM.
Page 5 of 20
Sample Direct Club
Constitution and By Laws
ARTICLE III: BOARD OF DIRECTORS/ OFFICERS continued
Section 9: Vacancies on the Board:
A. Should a vacancy occur in the office of President, the Vice President
shall automatically succeed to the office of the President and shall serve
for the unexpired term in addition to the term for which he/she was
elected.
B. A vacancy in the office of Vice President shall remain vacant until the
next scheduled balloting.
C. Should a vacancy occur in the offices of both, President and Vice
President, the Board of Directors shall appoint a President pro tem from
among its members until the next scheduled balloting at which time
both a President and Vice President shall be elected.
D. Vacancies occurring among all other offices shall be filled by the
President, with the Board of Directors’ approval, for the unexpired term.
Section 10: Duties of Officers of the Board:
A. Unless stated otherwise, Officers shall perform those duties prescribed
by Law, the Articles of Incorporation, these Bylaws, the Parliamentary
Authority adopted by the PROGRAM, and those duties prescribed from
time to time by the Board of Directors.
B. The President shall be the principal executive officer of the Program and
shall in general supervise and control all the business and affairs of the
Program. He/she shall preside at all meetings of the members and of the
Board of Directors. The president may sign, with the treasurer any
contracts or other instruments authorized to be executed. In general
he/she shall perform all duties incident to the office of President
including serving as an ex-officio member of all committees, except the
nominating committee. The President should take the initiative to
appoint all committee chairs from member volunteers.
C. The Vice President shall exercise the power of the President in the
President’s absence or inability to serve. The Vice President may also
fill in for any single board member in their absence at any meeting. The
Vice President is to help provide arrangements for meetings, arrange for
programs and the social part of general meetings.
D. The Secretary will take minutes at Program and board meetings and
conduct the necessary correspondence of the Program. He/she shall
perform all duties incident to the office of Secretary.
Page 6 of 20
Sample Direct Club
Constitution and By Laws
ARTICLE III: BOARD OF DIRECTORS/ OFFICERS continued
E. The Treasurer shall have charge and custody of and be responsible for
all funds of the Program and deposit all such monies in a timely manner
in the name of the Program in a bank approved by the Board of
Directors.
a. Shall keep a written ledger of expenses and income and present a
verbal or written report at each meeting of the PROGRAM and
Board of Directors
b. Shall file the annual not-for-profit organization charter fee with
the Program-recognized office.
c. The Treasurer may make budgeted expenditures up to $150
without Board approval.
d. The Board of Directors can approve expenditures up to $2499.99.
e. Amounts over $2500 must be approved by a majority of the
membership present at a general meeting, with the exception of
expenses pre-approved for the PROGRAM.
f. The treasurer shall prepare an annual report at the end of each
elected term.
g. Shall pursue contracts for equipment/supplies, Fund Raising,
sponsorship opportunities, donations, equipment sponsors, and
grant applications. Assist with budget writing and adjustments.
F. Skater/Community Representative shall represent the skaters,
community and rink interest as a Board Member.
Section 11: Active Board Members:
Members elected to the Board of Directors are encouraged to take an active part in
PROGRAM events.
Page 7 of 20
Sample Direct Club
Constitution and By Laws
ARTICLE IV: Coaches:
Section 1: Head Coach:
A. The Head Coach shall organize the sports activities and workouts, and ensure
that workouts are focused toward the goals and abilities of the amateur sports
members involved.
B. The Coach has authority to remove anyone in danger to others or themselves
from the field of play at any time.
C. The Office of Head coach is a volunteer position (unless recruited and paid).
D. The Head Coach must be certified with US Speed Skating to coach speed
skating and to have the health and welfare of the members in mind.
E. The Head Coach may delegate responsibilities to assistants and developmental
coaches at any time.
F. The Head Coach will be the primary representative of the team at competitive
events and will file any disputes except when required by the member
involved, and will provide the members with appropriate sport and health
fitness guidance for sports activities.
G. The Head Coach should attend Board meetings to provide reports,
recommendations, and suggestions for program activities.
Section 2: Assistant / Developmental Coaches:
A. Assistant / Developmental Coaches will follow the general workout plan for
each session or workout as designed by the head coach, but may focus on a
smaller group of individuals assigned to them during the workout.
B. The Assistant coach will conduct practices in the absence of the Head coach
and will be the skater’s representative in case the head coach cannot attend a
competition.
C. The Assistant head coach may attend the Board meetings as representative for
the Head Coach as needed and to provide suggestions for program activities.
Page 8 of 20
Sample Direct Club
Constitution and By Laws
ARTICLE V. Committees
Section 1: Committees:
A. The Board of Directors may appoint committees to assist the Board in
performing its functions. Such committees shall derive their authority
directly from the Board of Directors and are responsible to the Board.
B. The Board President shall appoint the chairpersons to ad hoc
committees.
C. The Audit Committee will be made up of Directors or members of the
Club that do not have responsibility for paying, balancing the account,
or signing/co-signing the PROGRAM checkbook and shall conduct an
internal audit of the expenses
D. Unless specified otherwise, all special and standing committees shall be
determined by the Board of Directors.
E. Unless specified otherwise, the composition, powers, terms, and duties
of all special and standing committees shall be determined by the Board
of Directors.
F. The President or his/her designee shall be an ex-officio member of all
committees except the Nominating Committee and Ethics Committee.
G. The term of office for an ad hoc committee member shall be one (1)
year.
H. There is no limit to the number of terms that a committee member may
serve.
I. The Committee Chair will appoint Committee members.
ARTICLE VI: Meetings and Quorum:
Section 1: Meetings:
A. The annual meeting of the PROGRAM shall be held each year at such
time and place as determined by the Board of Directors preferably
between July fifteen (15) and September twenty-fifth (25) for the
purpose of electing officers. More meetings may be called to conduct
business of the PROGRAM.
B. The meeting shall be held at a time and place designated by the
President and with agreement of a majority of the Board of Directors for
the purpose of planning the year’s activities, budget review and audits,
reviewing and establishing PROGRAM goals.
C. Subsequent meetings may be held as needed throughout the year to
conduct the necessary business of managing the PROGRAM.
Page 9 of 20
Sample Direct Club
Constitution and By Laws
ARTICLE VI: Meetings and Quorum:
Section 2: Notification of Meetings:
A. Notification of the Annual Meeting shall be sent to the membership no
less than fourteen (14) days prior to the meeting and no more than thirty
(30) days before the date of such meeting.
B. Special Meetings may be called by the President or upon written request
from a Board member or member of the club. Discussion at such special
meetings shall be limited to the topic(s) mentioned in the notice sent to
all Board members. Notification of the special meetings requires
notification no less than seven (7) days prior to the meeting.
C. Meeting notices shall be written, stating the place, day and hour of any
meeting of members and shall be delivered to each member entitled to
vote using the above timeframes based on meeting type by the President
or persons calling the meeting.
D. In the case of a special meeting the purpose for which the meeting is
called shall be stated in the notice.
Section 2: Quorum:
A. Forty percent of members eligible to vote shall constitute a quorum at
any annual meeting.
B. Forty percent of Board Members and Members eligible to vote at a Board
meeting shall constitute a quorum.
C. The presiding officer shall vote only in the case of a tie vote.
D. Refer to quorum rules for holding a meeting under Article VII Section 3.
ARTICLE VII: PARLIAMENTARY AUTHORITY
Section 1: Rules:
The rules contained in the current edition of Robert’s Rules of Order, Newly Revised,
shall govern the PROGRAM in all cases to which they are applicable and in which they
are not inconsistent with these Bylaws and any special rules of order the PROGRAM
may adopt.
Section 2: Content for regular membership and Board of Directors Meetings:
A. The President/Secretary shall provide a written agenda whenever
possible for each meeting.
Page 10 of 20
Sample Direct Club
Constitution and By Laws
ARTICLE VII: PARLIAMENTARY AUTHORITY continued
Section 2: Content for regular membership and Board of Directors Meetings
continued:
B. The following shall occur at regular membership and Board of Directors
Meetings:
1. Call to Order (by presiding officer)
2. Reading and approval of the previous meeting’s minutes-Secretary
3. Treasurer’s Report and Fund Raising Activities Report
4. Membership Director’s report
5. Committee’s reports
6. Old Business
7. New Business
8. Adjournment
Section 3: Quorum:
A. The quorum at a general meeting shall constitute a minimum of forty
percent of the voting membership.
B. A quorum for the Board of Directors shall consist of a majority of the
total directors.
C. The presiding officer shall vote only in the case of a tie vote.
D. Refer to Quorum for meetings in Article VI Meetings and Quorums.
ARTICLE VIII: Not-for-Profit Status Dissolution:
Section 1: NOT-FOR-PROFIT STATUS DISSOLUTION:
A. Club Name, Inc. is organized exclusively for charitable, religious, educational,
and or educational purposes under section 501(c) 3 of the Internal Revenue
Code (Currently applying for 501(c) 3.
B. No part of the net earnings of the organization shall inure to the benefit of, or
be distributable to, its members, trustees, officers or other private persons,
except that the organization shall be authorized and empowered to pay
reasonable compensation for services rendered and to make payments and
distributions in furtherance of the purposes set forth in the purpose clause
hereof. No substantial part of the activities of the organization shall be the
carrying on of propaganda, or otherwise attempting to influence legislation,
and the organization shall not participate in, or intervene in (including the
publishing or distribution of statements) any political campaign on behalf of
any candidate for public office. Notwithstanding any other provision of this
document, the organization shall not carry on any other activities not
permitted to be carried on )a) by an organization, contributions to which are
deductible under section 170(c) (2) of the Internal Revenue Code, or
corresponding section of any future federal tax code.
Page 11 of 20
Sample Direct Club
Constitution and By Laws
ARTICLE VIII: Not-for-Profit Status Dissolution continued:
Section 1: NOT-FOR-PROFIT STATUS DISSOLUTION continued:
C. Upon dissolution of the 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 the state or local government,
for a public purpose.
ARTICLE IX: ETHICS:
Section 1: Ethics Committee:
A. The Ethics Committee shall be a standing committee of the PROGRAM.
B. The Ethics Committee shall have the responsibility to recommend, implement,
and enforce Ethical Standards for Club Name ("Ethical Standards") as adopted
by the Board of Directors and as may be amended from time to time.
C. The ethical standards adopted by Club Name will not conflict with the
standards established by the US Olympic Committee, US Speedskating, and
represented by the Program.
Section 2: Adoption of Procedures:
A. As part of its enforcement responsibilities, the Ethics Committee shall adopt
procedures, subject to the approval of the Board of Directors, for the conduct
of investigations, hearings, disciplinary proceedings, and other enforcement
action to ensure compliance with the Ethical Standards.
B. The Ethics Committee and/or any panel formed by the Ethics Committee shall
make recommendations to the Board of Directors regarding the imposition of
sanctions or termination or suspension upon PROGRAM members for a period of
time upon a finding that a member has violated the Ethical Standards.
C. Such sanctions shall be at the sound discretion of the Ethics Committee or
panel and may include, but not be limited to, suspension or termination of
PROGRAM membership.
Section 3: Bound To Ethical Standards:
A. By applying for and accepting PROGRAM membership in any category, each
member of PROGRAM agrees to be bound by the Ethical Standards as amended
from time to time and fully cooperate in any inquiry or proceeding by or before
the Ethics Committee.
B. Each member shall be bound by any final determination of the Ethics
Committee.
Page 12 of 20
Sample Direct Club
Constitution and By Laws
ARTICLE X: INDEMNIFICATION of Members, Directors, and Officers
Section 1:
A. The members, Directors, and officers of the PROGRAM shall be indemnified by
the PROGRAM to the fullest extent now or hereafter permitted by law in
connection with any actual or threatened civil, criminal, administrative or
investigative action, suit or proceeding (whether brought by or in the name of
the PROGRAM or otherwise) arising out of their position in or service to the
PROGRAM or any other organization at the Program’s request.
B. Persons who are not members, Directors, or officers of the PROGRAM may be
similarly indemnified in respect of such service to the extent authorized at the
members, Directors, officer, or other person against any liability, cost or
expense incurred in connection with any such action, suit, or proceeding.
C. The provisions of this Article shall be applicable to actions, suits, or
proceedings commenced after the adoption hereof, whether arising from acts
or omissions occurring before or after the adoption thereof.
D. The indemnification herein provided for shall not be deemed exclusive of any
other rights to which those indemnified may be entitled under any by-laws
agreement, or otherwise.
E. The PROGRAM may by a quorum of disinterested members of the Board of
Directors or by independent legal counsel indemnify in whole or in part its
officers, directors, employees and agents against expenses, including
attorney’s fees, judgments, fines, and amounts paid in settlement actually and
reasonably incurred by him/her in connection with such action, suit or
proceeding, if such person acted in good faith and in a manner he/she
reasonably believed to be in or not opposed to the best interest of the
corporation.
F. With respect to any criminal action or proceeding, an officer, director,
employee, or agent may be indemnified if he/she had no reasonable cause to
believe his/her conduct was unlawful.
G. There shall be no indemnification made in respect to any claim, issue, or
matter as to a person who has been found liable to the corporation.
Page 13 of 20
Sample Direct Club
Constitution and By Laws
ARTICLE XI: AMENDMENTS:
Section 1: Amendments proposals:
Amendments to these Bylaws may be proposed by the Board of Directors, committees,
or by written petition signed by any voting member.
Section 2: Board Review of Amendments proposal:
All proposed amendments should be received, considered, and put in proper
parliamentary form and approved by the Board of Directors before being submitted to
the membership for approval at the annual membership meeting.
Section 3: Proposed amendments to voting membership notification:
Proposed amendments shall be submitted to the voting membership by closed ballot
at least thirty (30) days in advance of the deadline for receiving ballots.
Section 4: Approval majority vote:
A two thirds (2/3) majority vote of the Members voting shall be required to adopt any
proposed Bylaw amendment.
Section 5: No amendments to interfere with Section 501 (c) 3:
No amendment shall be made to the Bylaws, which would interfere with or terminate
the PROGRAM status as a charitable organization pursuant to Section 501(c) (3) of the
Internal Revenue Code of 1986 (or the corresponding provisions of any future United
States Internal Revenue Law).
Section 6: Notification of State and Federal Governmental Agencies:
The Treasurer shall file/notify the Indiana Revenue, Internal Revenue Services,
and/or the Secretary of State any amendments that affect the Articles of
Incorporation.
ARTICLE XII: Contracts, Checks, Deposits and Funds:
Section 1: Contracts:
The Board of Directors may authorize any officer or officers, agent or agents of the
PROGRAM, in addition to the President and Treasurer so authorized by Article III,
Section 10 of these By-Laws, to enter into any contract or execute and deliver any
instrument in the name of or on behalf of the PROGRAM, and such authority may be
general or confined to specific instances.
Page 14 of 20
Sample Direct Club
Constitution and By Laws
ARTICLE XII: Contracts, Checks, Deposits and Funds continued:
Section 2: Checks, Drafts, etc.:
A. The Treasurer or the President shall sign all checks, drafts or other orders for
payment of money, notes, or other evidences of indebtedness issued in the
name of the PROGRAM.
B. These two signatures shall be registered at the bank of agreement with the
Board of Directors.
C. All bills shall be presented in writing. Any bills over $2500 shall require a
Membership approval.
Section 3: Limitation of Spending:
A. The Board of Directors may spend no more than $2499.99 without the consent
of a majority of members present at a regular meeting.
B. Exception is for the expenditures necessary for the purchase of ice time, the
PROGRAM Invitational, and the annual banquet meeting.
C. These are not expected to exceed the proceeds taken in at the day of the
PROGRAM Invitational.
Section 4: Deposits:
All funds of the PROGRAM shall be deposited in a timely manner to the credit of the
PROGRAM in such banks, trust companies or other depositories as the Board of
Directors may select.
Section 5: Savings Account:
Any savings account maintained by the PROGRAM shall require the signatures of either
the President or the Treasurer for any withdrawal.
Section 6: Gifts:
The Board of Directors may accept, on behalf of the PROGRAM, any contribution, gift,
bequest, or devise for the general purpose or for any specific purpose of the
PROGRAM.
Page 15 of 20
Sample Direct Club
Constitution and By Laws
ARTICLE XIII: Books and Records:
Section 1:
The PROGRAM shall keep correct and complete books and records of account and shall
also keep minutes of the proceedings of its members, Board of Directors, and
committees having any of the authority of the Board of Directors.
Section 2:
A. Officers and Committee chairpersons are responsible to transfer the records
and notes kept during their term of office and previous years to their
replacements.
B. These are to be kept in containers supplied by the PROGRAM.
ARTICLE XIII: Books and Records continued:
Section 3:
Any member, or his agent or attorney may inspect all books and records
of the PROGRAM, for any proper purpose at any reasonable time.
Section 4:
A simple audit shall be performed quarterly by the Vice President or appointed
representative to verify that the accounting system is orderly and balanced.
Section 5:
A full audit shall be conducted every two (2) years or upon a change in Treasurer or
can be requested by a minimum of 3 members at any time when deemed feasible.
Section 6:
The Board shall approve the accounting system used by the treasurer.
Section 7:
The fiscal year of the PROGRAM shall begin on the first day of January and end on the
last day of December in each year.
Page 16 of 20
Sample Direct Club
Constitution and By Laws
ARTICLE XIV: Compensation of officers:
Section 1: Compensation:
A. In the event Club Name, Inc. should find need to compensate members of the
coaching staff or any member of the administration in order to retain or attract
their talent to the Program, the board or a committee of the board will follow
steps to approve in advance the compensation.
B. The board or a committee of the board awarding the compensation will consult
and rely upon data as to comparable salaries.
C. Club Name, Inc. shall conduct market research basing suggested salaries on
levels of experience and certification where applicable.
D. The board will adequately document the basis for its compensation award.
E. Documentation supporting the compensation’s reasonableness will be available
upon request.
F. In the event of a conflict of interest on the part of a Board or Committee
member, they shall recuse themselves from the process in order to guarantee
objective decision making in the matter of compensation.
Page 17 of 20
Sample Direct Club
Constitution and By Laws
ARTICLE XV: Approved Release and Waiver:
The Undersigned hereby:
ACKNOLWEDGE AND FULLY UNDERSTAND THAT EACH PARTICIPANT IS
VOLUNTARILY ENGAGING IN ACTIVITIES THAT INVOLVE RISK OR INJURY (EVEN
CATASTRIOPHIC INJURY OR DEATH) which might result not only from their own
actions, inactions or negligence, but the actions, inactions or negligence of
others, the rules, the conditions of the premises or any of the equipment used,
and that further, there may be a risk not known to the organizers or not
reasonably foreseeable at this time. These risks may include, but are not limited
to the following: Collisions with the wall of the rink, either covered or not
covered by mats, mats that may move, collisions with other skaters or riders, cuts
from my own skate’s blades or skates of others, tripping over track markers,
falling on debris on the ice, inadequate safety equipment, road hazards, dogs,
motor vehicles, flat tires, the released parties own negligence.
Acknowledge that Skating (both ice and in-line) is inherently dangerous sports and
fully realize the dangers of participation in skating and or activities and FULLY
ASSUME ALL THE RISKS AS A CONDITION OF PARTICIPATION AND ACCEPT
PERSONAL RESPONSIBILITY FOR THE DAMAGES FOLLOWING AND SUCH INJURY.
INTENDING TO BE LEGALLY BOUND, THEREBY DOES HEREBY RELEASE, WAIVE,
UNCONDITIONAL DISCHARGE,HOLD HARMLESS AND PROMISE NOT TO SUE The
sponsors, the coaches, Indiana State and location parks and recreation
departments, cities, counties, U.S. Speed Skating, organizers, administrators,
officers, directors, agents and other employees or volunteers of the organization
for any and all liability to each the undersigned , his or her heirs and next of kin
for any claims, demands, losses for damages on account of injury, including death
or damage to property, caused or alleged to be caused in whole or in part by the
negligence to the released or otherwise in connection with association or entry in
and / or arising in participation in any or all official or unofficial activities, events
or competitions dealing with Club Name, inc. .
Agree to the sole responsibility to be familiar with the facilities for training and
competition, rules and any special regulations for any events I am attending. I
understand and agree that situations may arise during the activity, which may be
beyond the immediate control of officials, coaches or organizers, and I must
continually skate so as to neither endanger others nor myself. I accept
responsibility for the condition and adequacy of my equipment and or equipment
loaned to me by Club Name, Inc. I will participate wearing appropriate safety
gear which satisfies the requirements of U.S Speedskating racing rules and that
can protect against serious injury, and assume all responsibility and liability for
the selection of such a helmet. I have no physical or medical condition which to
my knowledge, would endanger myself or others if I participate in the activities
provided by Club Name, inc. , or would interfere with my ability to participate. I
hereby consent to accept responsibility for final decisions regarding continued
participation if suffering from injuries.
THE UNDERSIGNED HAS READ AND UNDERSTANDS THIS DOCUMENT AND UNDERSTANDS
THAT HE/SHE HAS GIVEN UP SUBTANTIAL RIGHTS BY SIGNING, AND SIGNS IT VOLUNTARILY.
Date:
Signature
Witness
Initials
Page 18 of 20
Sample Direct Club
Constitution and By Laws
Attachment 1: List of Members, Officers and Current Equipment:
Section 1: List of Members:
Following are Skaters, coaches, board members and supporters who currently have
expressed interest in joining the Program, some have current USS Memberships while
others do not.
1.
Section 2: Board of Directors:
A. Temporary until first Elections can be held in Fall of 2010.
B. Officers Board Members:
1. - President
2. – Vice President
3. – Secretary
4. – Treasurer
5.
C. Coaching Volunteers:
1. - Head Coach
2. - Assistant Coach
Section 3: Equipment:
• Sixteen (16) Regulation Mats for Critical Areas
• Fourteen (14) Older Mats 6” Thick in Less Critical Areas
• Fourteen (14) Markers
• Sixteen (16) Plunger Ends
• Eight (8) Buckets
The Rink provides other items and equipment such as squeegees’.
Page 19 of 20
Sample Direct Club
Constitution and By Laws
Attachment II – Board Approval of the Constitution and Bylaws.
This constitution and by-laws are hereby ratified by the following board
Members and is a quorum for initial establishment of the club. This
document will be re-ratified by the elected board in September 2010.
As a club organized of US Speedskating we attest that the board and members
will uphold the Bylaws, enforce the rules and regulations of US Speedskating,
its officers and Board of Directors. Those not complying with this section and
unwilling to correct their behavior will be asked to resign the club or be
removed from the club per articles of the constitution and by laws.
Page 20 of 20
US SPEEDSKATING INSURANCE COVERAGE INFORMATION
BENEFIT OF MEMBERSHIP
A part of your Individual Membership Registration Fee is for insurance coverage. For this coverage to be in
effect, the following criteria must be met:
1. Each Participant must be registered member of the US Speedskating.
2. The event must be a “sanctioned” U.S. Speedskating event.
3. US Speedskating rules and regulations must be followed.
DEFINITION OF PARTICIPANT
A participant will include skaters, coaches, managers, staff members, team workers, referees, officials,
scorekeepers, and all other personnel including, but not limited to media personnel permitted to enter any
restricted areas which are defined as those areas prohibiting access to general public spectators. Also
includes all member clubs and associations.
US SPEEDSKATING LIABILTY COVERAGE
US Speedskating liability coverage provides broad legal liability protection for all participants against
lawsuits arising out of an accidental bodily injury resulting in a liability claim brought against them while
within the scope of their responsibilities on behalf of US Speedskating. The total liability is written with
limits of $1,000,000 per Each Occurrence and $5,000,000 General Aggregate per policy year. The major
coverage’s afforded by these policies are:
1. All activities necessary or incidental to the conduct of schedule competitions, practices,
exhibitions, post season activities, including fund raising, meeting and award banquets (all
U.S. Speedskating activities).
2. Spectator Liability.
3. Personal Injury Liability- Legal liability for libel, slander or defamation of character, wrongful
eviction, invasion of privacy.
4. Participant Legal Liability.
5. Host Liquor Liability- Protects against claim arising from serving alcoholic beverages at
business functions. Excludes sales of liquor.
6. Fire Legal Liability-$100,000.
7. Sexual Abuse/Molestation Liability
8. Drug Testing Liability
9. Participant vs. Participant Liability
10. Medical Payments
11. No Deductible
12. Worldwide Coverage.
ACCIDENT MEDICAL COVERAGE
This is full excess medical expense for all participants with a 52 week Benefit Period. The amount of
coverage is $100,000 maximum benefit/person with a $500 deductible. Coverage also includes $5,000 for
Accidental Death and $10,000 for Accidental Death and Dismemberment. Dental, Chiropractic, and
Physical Therapy are also included. Accidental Medical Coverage’s include regularly schedules games and
competitions, practice sessions, traveling to/from games, competitions, and practice traveling with team
&/or club and traveling to/from home and site of activities.
This insurance recap is for illustrative purposes only and is not a contract for insurance. You must refer to
the actual policy language for complete information on policy, coverage, limits, and exclusions. For further
information, please contact Marty Wolfinsohn, JAS Insurance Co., 847-755-1010.
SAMPLE WAIVER & RELEASE
Your logo here
Meet Name Here
Location Here
Dates Here
NOTE: THIS FORM MUST BE READ AND SIGNED BEFORE THE PARTICIPANT IS PERMITTED TO TAKE
PART IN THE “Competition Name” ON “Date” IN “Location”. BY SIGNING THIS AGREEMENT, THE
PARTICIPANT AFFIRMS HAVING READ IT.
IN CONSIDERATION of my involvement in the sport and activities under the auspices of U.S.
Speedskating and/or the “State Association” and/or “Skating Club Name”, I acknowledge, appreciate, and
agree that:
1.
2.
3.
4.
I RISK BODILY INJURY, INCLUDING PARALYSIS, DISMEMEBERMENT, DISABILITY AND DEATH AND while particular
rules of my sport, equipment, and persona training and discipline may reduce this risk THIS RISK OF INJURY DOES
EXIST, AS WELL AS THE RISK OF DAMAGE TO OR LOSS OF PROPERTY;
I KNOWINGLY AND FREELY ASSUME ALL SUCH RISKS; both known and unknown, EVEN IF ARISING FROM THE
NEGLIGENCE OF THE RELEASEES OR OTHERS;
I willingly agree to comply with the stated and customary terms and conditions for participation. If, however, I
observe any unusual or unnecessary hazard during my presence or participation, I will bring such to the attention of
the nearest official; and,
I, FOR MYSELF, AND ON BEHALF OF MY HEIRS, ASSIGNS, PERSONAL REPRESENTATIVES, and NEXT OF KIN,
HEREBY RELEASE, HOLD HARMLESS, and PROMISE NOT TO SUE US SPEEDSKATING, “State Association “, “ Skating
Club Name”, “Name of Rink”, city of “Name”, THE INTERNATIONAL OLYMPIC COMMITTEE, THE UNITED STATES
OLYMPIC COMMITTEE, THE INTERNATIONAL SKATING UNION OR OTHER SPONSORING ORGANZIATIONS, THEIR
OFFICALS, VOLUNTEERS, STAFF, SPONSORSORS AND/OR AGENTS (“RELEASEES”) WITH RESPECT TO ANY AND
ALL INJURY AND LOSS ARISING FROM MY PARTICIPATION, WHETHER CAUSED BY THE NEGLIGENCE OF THE
RELEASEES OR OTHERWISE, EXCEPT THAT WHICH IS THE RESULT OF GROSS NEGLIENCE OR WANTON
MISCONDUCT.
I have read this Release of Liability and Waiver Agreement, fully understand its terms and sign it freely
and voluntarily.
Participant’s Signature: ________________________________________________
Participant’s Name (Printed): __________________________ Date: _____________
FOR PARTICIPANTS OF MINORITY AGE
(Under Age 18 at the Time of Registration)
This is to certify that I/wee as parent(s)/guardian(s) with legal responsibility for this participant, do consent and
agree not only to his/her release, but also for myself/ourselves, and my/our heirs, assigns and next of kin to
release and indemnify the Releasees from any and all Liability incident to my/our minor child’s involvement as
stated above.
Parent/Legal Guardian Signature: _______________________________Date: _______________
Parent/Legal Guardian Name (Printed): ___________________________________
SAFETY PAD INFORMATION
Fitness Serve Products and Services
20630 Center Ridge Road
Rocky River, Ohio 44116
Phone: 1-440-333-0630
Fax: 1-440-333-3825
www.fitnessserve.com
[email protected]
Idaho Sewing for Sports, Inc.
7 Poplar Drive
Grangeville, Idaho 83530
Telephone: (208) 983-0988
Fax: (208) 983-1390
Hours of Operation: Monday – Friday 7am – 3:30 pm (Pacific Time)
www.idsewing.com
US SPEEDSKATING APPLICATION FOR MEMBERSHIP
Valid July 1, 2012 - June 30, 2013
Send Form & Payment To: US Speedskating, P.O. Box 18370, Kearns, UT 84118
Fax: 801-417-5361 or Email: [email protected]
PERSONAL INFORMATION
FIRST NAME: _____________________________ LAST NAME: ______________________________ MI: ________
ADDRESS: _______________________________________________________________________________________
CITY: ________________________________________________ STATE: _____________ ZIP: __________________
PHONE: _______________________________________ FAX: ____________________________________________
EMAIL ADDRESS: _________________________________________________________________________________
DATE OF BIRTH: __________________________________________________
ASSOCIATION: _____________________________________
MALE
FEMALE
CLUB: _____________________________________
PLEASE SELECT YOUR MEMBERSHIP CATEGORY BELOW
1st Year
$30
Adult/Older Child
$75
(Age 11 and up as of June 30, 2012)
Child
(Requires all family
applications to be sent at same time, each
family member must designate membership
category)
$55
NEW Competitors MUST submit Copy of
(Age 10 and under as of June 30, 2012)
$30
with application. (If non-U.S. citizen: Length
of Residency ______ (years). If you are a
non-U.S. citizen Competing Athlete, you must
$15
you permission to skate for the United States
$10
Please see the US Speedskating website
for more information on non-U.S. Citizen
membership eligibility.)
Members - Max of 4 board members per club)
(Non-competing skaters new to speedskating. This
PAYMENT AND FEES
Check enclosed, made payable to U.S. Speedskating | Charge my:
Visa
MasterCard
American Express
A $20.00 fee will be charged on all returned checks.
Card #: ____________________________________ Name as it appears on card: _______________________________
Exp. date: ____________ Security Code: _________ Signature: ___________________________________________
Yes, I am interested in making a tax deductible donation to US Speedskating in the amount of
ASU Scholarship Fund
Hall of Fame General
$ _________ To be used for:
__________
__________
TOTAL: _______
APPLICANT SIGNATURE
Please note This form must be signed by the applicant.
__________________________________ Date: _________ ________________________________ Date: _________
US SPEEDSKATING APPLICATION FOR
One-Day One-Dollar Speedskating Membership
* Not valid for racing and competitions
ASSOCIATION OR DIRECT CLUB___________________________
SKATER’S NAME ________________________________________ ADDRESS ______________________________________________
Send Form & Payment of $1.00 To:
US Speedskating
P.O. Box 18370 Kearns, UT 84118
Phone: 801-417-5360
Fax: 801-417-5361
Em
CITY ______________________ STATE ______ ZIP ____________
PHONE (_____)________________ FAX (_____)________________
EMAIL ADDRESS ________________________________________
Please note:
In all cases, this form must be signed by the applicant. Applicant’s Signature
Date
____________________________________________________ Signature of Parent or Guardian (if under 18)
US SPEEDSKATING APPLICATION FOR
One-Day One-Dollar Speedskating Membership
*Not valid for racing and competitions
ASSOCIATION OR DIRECT CLUB___________________________
SKATER’S NAME ________________________________________ ADDRESS ______________________________________________
Send Form & Payment of $1.00 To:
US Speedskating
P.O. Box 18370 Kearns, UT 84118
Phone: 801-417-5360
Fax: 801-417-5361
Em
CITY ______________________ STATE ______ ZIP ____________
PHONE (_____)________________ FAX (_____)________________
EMAIL ADDRESS ________________________________________
Please note:
In all cases, this form must be signed by the applicant. Applicant’s Signature
____________________________________________________ Signature of Parent or Guardian (if under 18)
Date
“One-Day-One-Dollar.” The One-Time One-Day Membership is designed to encourage new
skaters to participate in speedskating. An individual shall be eligible for a One-Time One-Day
Membership in US Speedskating if he/she has never been a member of US Speedskating, has
never tried speedskating and has never participated in speedskating events. The One-Time
One-Day Membership can be purchased up to five (5) times with the skater filling out the
proper form. US Speedskating is relying on the Association/Club to manage this program.
The process is as follows: 1) The skater completes the One-Time One Day Membership Form
and submits form to Association/Club Officials. 2) The amount charged to the skater will be
at the discretion of the Association/Club. The Association/Club may offer the One-Time OneDay Membership at no fee to the skater as well. 3) Association/Club Officials will submit the
forms and $1.00 fee for each skater to US Speedskating at the end of each month. Not valid
for racing or competitions.
How to Penny a Short Track
General Information: A short track is set up on a hockey rink. The track is 111.12 meters long
and should be centered in the middle of the rink. If your club does not have the money to pay for
a surveyor ($1,500 - $2,000) to come in and set up the track, the following are instructions on
how to "penny" a track. Tools that you need: Diagram of the ISU/USS 111.12 meter track, 100
pennies, 5-6 nails, screw driver, long cloth tape measure, drill with 3/4 inch drill bit and 5 colors
of paint. If you are holding a meet, you will also need a circular saw to make various starting
lines. It is best to penny a track with 4 people. One person holds the "zero" of the tape measure
(person 1). One person holds the other end of the tape measure (person 2) to keep the tape
from getting tangled. One person reads instructions (person 3) and has the 111.12 meter track
diagram. The 4th person marks the arc scratches in the ice and places the pennies on the track
(Person 4). This process takes about 1 1/2 to 2 hours.
Five words of wisdom:
•
•
•
•
•
You need to complete one corner on one side of the rink, before you do the other corner.
Do not start drilling holes until the whole corner has all of the pennies down. In case a
mistake is made, you have a chance to change the penny.
Penny a track on used ice. It is very difficult to walk on freshly resurfaced ice.
Pennies should be used, as apposed to dimes and nickels, because they are much easier
to see on the ice. In addition, the medal actually "melts" into the ice, so they do not move
on the ice. If you use some other type of material, your markers will keep moving and
sliding around.
It is best to keep the tape measure flat on the ice with no twists. This will give you a
more accurate reading.
Center the Track:
1. The first step is to find the middle of the rink. Take a tape measure and measure from
board to board on the center red line. Take the width distance for the rink and divide by
two. This is the center of the rink. Take a penny and place it on that spot (Penny A). It is
easiest if you use the front side of the red line in which you will start most of the races.
Person 1 now goes to Penny A. Measure 8m/26' 3" along the front of the red hockey
center line and place a penny (Penny Z) Do this for the other side of the track (Penny Y)
Pennies Y and Z mark the inside of the track for the starting area. Now move down
about 20-30 meters to the left and to the right and measure from board to board. Divide
the distance by two and place a penny at the two spots (Pennies B & C). Since boards are
not perfectly straight, don't be surprised if the distance is 1/2" to 1" off. You now have 3
pennies that are in a straight line (Penny A, B and C) down the whole rink.
2. Person 1 goes back to Penny A in the center of the rink. Person 2 goes to the
"apex"/center of the corner, past Penny B. You line up the tape from Penny A to Penny B.
This creates a straight line to the apex block so that your track is squared to the boards.
At 14.425m/47' 3 7/8", person 4 places a penny (Penny D) at that distance, directly under
the tape measure. Remove Penny B, as this was only used to make the straight line.
Penny D is used as the focal point to mark each of the block placement areas.
If you are making 3 tracks, place a penny 1 meter on each side of Penny D. If you
are making 5 tracks, place a penny at 1 meter and 2 meters on each side of
Penny D. These 3 or 5 pennies are now the focal points for the 3 or 5 tracks that
you will lay out. These Penny D measurements are critical to the accuracy of the
tracks.
To set the Apex dot:.
To set the Apex dots, person 1 is still at Penny A, person 2 lines up the tape measure
over Penny D and backs up. At 22.425m/73 6 7/8", person 4 places a penny under the
tape measure (Apex Penny E). This is the apex dot for the middle track. Now place a
penny 1 meter on each side of Apex Penny E to make 3 tracks. Place another penny 2
meters on each side of Apex Penny E if you have 5 tracks.
To set blocks 1 and 7 dots:
Words of Wisdom: In order to make the track accurate, you need to find the block
location by always comparing the 8m/26' 3" distance from two different points. This is
done by making an arc scratch in the ice with a screw driver. The intersection of these
two arc scratches indicates the location where the dot needs to be drilled.
3. The next block that is marked is the first block into the corner. Person 1 goes to the
center Penny D. Person 4 takes the screw driver and wraps the tape measure around it
at exactly 8m/26' 3". Person 4 then makes an arc scratch in the ice where he estimates
the block should be. The arc should be about 2 - 3 feet long. Place a nail on top of the
scratch,. with a million ice blade scratches in the ice this will help you keep track of the
scratch you are working with.
4. Now person 1 goes to Penny Z. Person 4 makes an arc scratch that is 14.425m/47' 3
7/8" from Penny Z. This arc scratch should intersect with the first scratch. Place a penny
at the intersection (Penny F) and pick up the nail.
5. With person 1 still at Penny Z, person 4 needs to make 2 or 4 additional arc scratches on
the ice, depending if you are setting up 3 or 5 tracks. These will be 2 meters shorter, 1
meter shorter, 1 meter longer and 2 meters longer than the original Penny F. Place a
nail at each one of these scratch marks.
6. Person 1 now goes back to the 5 Penny D's. Person 4 now makes an arch that is 8m/26'
3" from each of the other 4 Penny D's. [Clarification: Person 1 needs to move to each of
the Penny D's depending on what track is being laid. So the 4th track will need to be
measured from the 4th Penny D.] These arcs should intersect with the arcs made from
Penny Z. Pick up the nails and place a penny at each of the intersections. You now have
5 pennies marking the first block for all the tracks. Remember that Person 1 needs to
move to each of the Penny D's to record an accurate track.
7. This is repeated to get block # 7. Instead of using Penny Z, you need to use Penny Y
which is on the other side of the track.
To set block 2, 3, 5, and 6:
8. To set the 2nd and 6th blocks, you need to base the scratch arcs from the 5 Penny D's and
the 5 Apex Penny E's. Person 1 goes to the center Penny D. Person 4 makes an arc
scratch in the ice that is 8m/26' 3" from the center Penny D, where he estimates the
block should be. Place a nail on top of the scratch. Person 1 then goes to the center
Apex Penny E. Person 4 makes an arc scratch that is 8m/26' 3" from the center Apex
Penny E. Place a penny at the intersection of these arcs. You repeat this for all 5 dots for
the 2nd and 6th block.
9. To set the 3rd and 5th blocks, follow step 8, except you need to base the arcs from the 5
Penny D's and the 5 Pennies at the 1st and 7th block. Again the arc scratch is made
8m/26' 3" from both starting locations. The penny is placed at the intersection of these
arcs.
After you have all the pennies in place on your 3 or 5 tracks for 7 blocks, step back and take a
look to make sure everything "looks" right. When you have half of the track done, you can now
have someone drill 3/4 inch holes where the pennies are. You will then need to color each track
a different color. Remember that the colors follow the same track, so the outside of one side, is
the inside of the other side.
The other half of the rink:
Follow the instructions above for the other half of the rink. You first make the straight line to
the Apex block, set blocks 1 and 7, and then set blocks 2, 3, 5 and 6.
Finish Line:
The finish line needs to extend 1.5m/4' 11" inside of the track. The inside of the track is marked
as Penny Z or Penny Y, depending on which side you use as the finish side. The finish line never
changes.
Start line:
When laying out the starting lines for alternate tracks, the starting line on the back stretch must
move twice (2X) the distance of and in the direction of the track move. In other words, if you set
your tracks 1 meter apart, then the starting line needs to be 2 meters apart. The reason for this
is because the skaters will be skating 1 meter shorter or longer heading toward the apex block,
and then skate another 1 meter shorter or longer returning. If your dots from left to right are
black, blue, red, green and orange. do the following:
Center track of red: Should be the beginning of the red hockey center ice.
2nd track of blue: Need to move 2 meters from the original red line, to the left, and make the
starting line.
1st track of black: Need to move 4 meters from the original red line, to the left, and make the
starting line.
4th track of green: Need to move 2 meters from the original red line, to the right, and make the
starting line.
5th track of orange. Need to move 4 meters from the original red line, to the right, and make the
starting line.
To make the starting line, it is best to get a 2 x 4 long piece of lumber. Have individuals stand on
the wood, while someone runs a circular saw down the edge. You then fill the starting lines with
the same colors as the block colors in which the starting line is for.
Necessary Equipment for Clubs
- Pads: See rules for pad placement.
- Blocks: 14 blocks on the track plus 4 extra.
- Starting Gun & Shells: 22 caliber and 22 caliber caps.
- Water Buckets: 3-4 large plastic buckets with handles.
- Squigges: 2 large
- First-aid Kit: Equipped with laceration products.
Optional but suggested:
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Club skates to loan
Skate Sharpening boxes to loan
Helmets to sell
Neck guards to sell
Knee pads to sell
Pad Carts - to hold and move the pads
Lap Counter
Accounting Tips for USS Speedskating Clubs
There are many ways to keep track of income/expenses for your club. Here are some
tips to make your accounting the most effective:
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Set up a checking account as soon as possible. All deposits and checks written
should go through this account. Balance the check book with your accounting
system every month.
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Appoint a treasurer as soon as possible.
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Apply for the IRS charitable status of 501(c)3 (required by US Speedskating). You
will find it easier to solicit for donations if you have charitable status. (See the
IRS Form 1023 Instructions.)
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Use an accounting software program to track expenses and income, and create
reports. Software like Microsoft Money is easy to use and relatively inexpensive.
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Set up detailed financial categories and explain in detail what expense or income
was related to. Examples:
Income:
Donations
Fundraisers
Donations
Meet - Entry Fees
Membership Fees
Skate Rental
Merchandise Sales Skater Ice Fees
Interest Income
Expenses:
Association Dues
Awards
Banquet Expenses
Coaching Expenses/Salary
Ice fees
Insurance
Meet Expenses
Office Supplies/Postage
Sharpening/Skate Equipment
Uniforms
Tax Filing Fees
Board Meeting Expenses
Marketing
Bank Fees
Stop Watches
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Have your tax year-end after the season is over and before the next season
begins. Most clubs start the fiscal year on June 1 and end the fiscal year on May
31. Mid-season is not the time to worry about preparing financial statements and
filing tax forms.
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Stay on top of record keeping, bill paying and deposits. This will keep the reason
for the expenses fresh in your mind and the money in the bank.
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Buy an accordion file folder, separated by month. This will help organize the
receipts prior to filing them away in your year packet.
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Keep all receipts and write the date paid, name of the signer and check number
on the receipt, as well as the reason for the expense.
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Keep an excel spreadsheet for the details of each skaters ice fees and skate
rental payments.
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Provide financial reports for club meetings so members are aware of the cash
flow for that time period. Include the reason for the expenses. Proper internal
financial controls and a balance of power is very important.
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Keep a separate folder with copies of annual reports that have been filed with the
state and/or IRS. It will be easier the next year when you receive the form in the
mail on how to fill it out. Keep current on your filings, as you could loose your
charitable status if they are not kept up to date.
Rink Managers’ Guide to Speedskating Clubs
Benefits to having a Speedskating Club in Your Rink:
• Increase sport diversity.
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Develop more users from your public skating sessions. Serious skaters who have
focused on a speedskating discipline will be less price-sensitive, more faithful and less
likely to curtail their activity during a recession.
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Speedskating is the oldest ice sport. You can not offer the full spectrum of skating
excitement unless you include a speedskating program. Your community relations
message of offering something for everyone will increase participation or enhance
support among local voters.
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If you have a skate pro-shop, a speedskating club provides you with a product line
expansion into a very profitable segment of high-end and introductory-level skating
equipment. With five or six stock items you can position yourself as a good local source
for gear and make more money on special orders.
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Speedskating is a family-friendly activity with parents and children on the ice at the same
time. Participants can skate at greatly different levels of ability, yet safely interact and
stay close to each other. Parents and children are able to pursue individual fitness or
development goals in the same space at the same time.
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Outdoor in-line speedskating is a very popular sport. These skaters need a way to
continue training during the winter and indoor ice speedskating is an excellent way to
draw in-liners into ice skating.
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Speed skaters tend to damage the ice far less than other ice sports. The Zamboni
restores the ice surface very easily after a speedskating session.
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Speedskating meets will bring moderately large crowds into your facility. A typical meet
will have 50 to 75 competitors and an additional 50 to 75 parents and spectators. These
people will buy food and equipment and may be attracted to public skating sessions.
What is needed to attract and start a speedskating club:
• At least one hour per week of available ice time during prime-time hours. Speedskating
clubs require ice time starting between 5 and 9 p.m. on weekdays and 8 a.m. to 9 p.m. on
weekends. As the club grows it may request up to three additional hours of ice time per
week, some of which may be during non-prime times or after school hours.
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Space for 30 to 50 safety pads. Each of these rink pads is a bit larger than a single
mattress. Pads are frequently stored on wheeled carts and are placed in front of the
boards by club members before each ice session. Hauling these pads long distances is
hard work, therefore space beneath the stands or along one wall near the ice surface is
preferred.
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Club members will need your permission to ‘survey’ a set of tracks. This procedure
involves locating and drilling a set of shallow, ¾” diameter holes in the ice surface and
filling with crushed, colored ice and water. After one resurfacing, the resulting dots are
almost invisible to most skaters, but allow club members to quickly set up the blocks
that define the track for practices and meets. These dots are far too small to be confused
for pucks during hockey games and are quickly obscured once the surface has been
skated on.
o Surveying is a simple procedure and will take two to three hours during any
downtime at the beginning of each season. Contact US Speedskating to obtain
instructions. There are seven blocks in each of the two turns. Multiple tracks are
used to spread out the wear of the ice. Typically 3 - 5 tracks are set up resulting
in 42 - 70 colored dots in the ice surface.
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Space for a club bulletin board or showcase will allow the club to recruit members and
enhance your community outreach. A visible presence at your rink is essential for
growth and success of a speedskating club.
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Most clubs invest in a small supply of speed skates. A small, securely-locked storage
space is necessary at the rink. Additional stored items might include five-gallon buckets
for ice maintenance, long-handled water squeegees, blocks, extra helmets, and
miscellaneous training equipment.
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Eventually, your club will want to host a meet. A typical meet is a one-day event from
about 8 a.m. to about 5 p.m. on a Saturday or Sunday during the speedskating season
(September through April).
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US Speedskating provides a large amount of materials, information and support to help
your rink and your speedskating club organizers. Promotional brochures and posters are
available upon request.
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Visit our web site at: www.usspeedskating.org
Top 10 Ways to Recruit Speedskaters
1. Offer Free Skating for a Month! It is well worth the investment if the skater falls in love with
speedskating and joins the club.
2. Get permission from school administrators to pass out information at back-to-school or PTA
nights. Get names and contact information of parents; perhaps sign up children for a learn to
skate class right then. Have kids bring their skates to the event and also to show and tell.
Offer to lead a P.E. class or assembly.
3. Organize a learn to skate program when kids are out of schoolat the holidays, summer break
or even one to two week breaks. Integrate racing programs into rinks that have US Figure
Skating Basic Skills Program and also into public skate sessions.
4. Hold a “bring a friend”session. Distribute information about the club and speed skating. A
“family” night where skaters bring extended family members could follow the same pattern.
5. Hang posters, put out brochures and play a looped DVD on the TV at the Rinkor at a kiosk
that the club makes to put in the lobby. This will attract hockey plays, figure skaters and
other youth that hang around the rink.
6. Get permission from the rink and assign club members to set up a table to distribute flyers
during public skate, learn to skate programs or other rink events. Do demonstrations at
hockey games.
7. Make a Facebook page for your club. Have the members link to it and the club website from
their Facebook pages.
8. Every member of the club should have flyers about the clubin their car, backpack, school
locker, and workplace.
9. Invite large groups such as Girl Scout or Boy Scout troops to attend a session. Advertise at
track meets and cycling events.
10. Purchase as many used skates as possible. Inline sites, Ebay and Craig’s List are good places
to find used skates. Set up a speed skate loan program through US Speedskating
Ways to Retain Speedskaters
1. Keep parents involved with regular meetings, socials, and making assignments
2. Conduct fun activity days regularly and play games at the end of the ice sessions
3. Do a badge program rewarding for improvement by the young skaters
4. Ask parents to take turns bringing healthy treats after each session
5. Have your youth coach keep a detailed list of what skaters worked on by session with notes
and give a progress report on a monthly basis.
6. Send press releases and feature articles to local papers and TV/Cable stations with results
and pictures/video of club skaters placement at local/state/regional/national meets
7. Keep fees as low as possible by negotiating remnant ice or drop-in ice and offer Family
Pricing…two family members pay and the rest of the family skates for free
8. Remember…when skaters improve, they will want to keep skating!
“FUN”draisers for Speedskaters
1. Connect with your local supermarket to make a % donation off of club collected receipts. Ask
family and friends to join in. Bag groceries for a day and ask shoppers for their receipts. It
can be on-going or for a set time period.
2. Apply for government and foundation grants. The money can go for anything from new pads
and skates to coaching fees and ice time for youth skaters.
3. Have Boston Chicken or Burger King nights. Same concept as above but when diners come
in for that day and say they are with the club the location gives a % of the sale to the club.
Promote it to all family, friends and even the skaters schools. Pancake Breakfast, Spaghetti
Dinner or a Fish Fry during Lent make money as well.
4. Play BINGO! State websites have all the information for 501c3 organizations to take part. You
can organize a large casino night or it can be ongoing several times per month. Hundreds of
thousands of dollars can be raised each year through BINGO.
5. Have a 3K Fun Run or In-Line Skate for the whole family. Charge a nominal fee of $20 per
walker/runner with discounts for the whole family. Promote it through running
blogs/websites and by volunteering at other local charity runs. You can even combine efforts
with another cause and split the proceeds.
6. Work concessions or the parking lot at local or professional sports, concert, or state/county
fair events with a portion of the proceeds going to the club.
7. Have seasonal sales with flowers in the spring, mums in the fall and wreaths and poinsettias
at Christmas.
8. Have a Car Wash or Garage Sale.
Elements of a Grant Proposal
A proposal must convince the prospective donor of two things:
1. That a problem need of significant magnitude exists, and
2. That the applicant agency has the means and the imagination to solve the
problem or meet the need.
When no specific format or guidance is given by the funding source, it is safe to
generally assume that the proposal should be no more than 15 pages in length (singlespaced) and should include the following sections:
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Qualifications of the Organization
Problem Statement or Needs Assessment
Program Goals and Objectives
Methodology
Evaluation
Future Funding
Budget
Appendices
Letter of Inquiry/Intent
Some foundations/corporations prefer a letter of inquiry to determine whether the
applicant falls within the foundation’s guidelines. In this case, an inquiry letter used
instead of a cover letter and proposal. It is very succinct, and attachments are not
included. If the funder determines the organization and project fit within it’s scope, the
organization will be directed to submit a complete proposal. If not, a decline letter is
usually issued at that time. A letter of inquiry should meet the following criteria:
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Includes funder’s name, title, and address
Is directed at the individual responsible for the funding program
Provides a brief overview of the organization and its purpose
Includes the reason for the funding request
Includes the amount requested (if required by funder)
Describes the need the project intends to meet (including target population,
statistics, example)
Provides a brief description of the project
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Lists other prospective funder’s for the project
Includes thank you and next step to be taken
Does not exceed two pages (one page is recommended)
Includes name and Phone number of contact at the organization
Is signed by the person who can speak with authority on behalf of the
organization
Cover Letter
Full Proposal
The cover letter serves as the organization’s introduction and should always accompany
a proposal. A cover letter should meet the following criteria:
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Includes funder’s name, title, and address
Is directed at the individual responsible for the funding program (is not
addressed “To Whom It May Concern”, Dear Sirs” etc.)
Provides a brief overview of the organization and its purpose
Includes the reason for the funding request
Includes the amount requested (if required by funder)
Does not exceed two pages (one page is recommended)
Includes name and phone number of contact at the organization
Is signed by the person who can speak with authority on behalf of the
organization
Summary (1/2 page)
This section clearly and concisely summarizes the request. It should provide the reader
with a framework that will help him/her visualize the project. The remainder of the
proposal will then serve to deepen and amplify the “vision” presented in the summary
section at the beginning. A summary should meet the following criteria:
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Appears at the beginning of the proposal
Identifies the grant applicant
Includes at least one sentence on credibility
Includes at least one sentence on problem
Includes at least one sentence on objectives
Includes at least one sentence on methods
Includes total cost, funds already obtained and amount requested in this proposal
Is brief (limited to several paragraphs, half a page at most)
Is clear
Is interesting
Qualifications of the Organization (1-2 pages)
This section describes the applicant agency and its qualifications for funding and
establishes its credibility. The programs and accomplishments of the organization will be
examined in light of how they address current demographics, social issues, specific
constituencies, etc. In addition to convincing the funder of the extent of the need for the
proposed project, the agency must also demonstrate that theirs is the appropriate
agency to conduct the project. In this section, the organization should demonstrate that
it has the means and the imagination to solve the particular problem or meet the need.
A proposal will often sink or swim based on the need for the project and the project
methodology, not on the accomplishments of the overall organization. Therefore, an
agency should not make the mistake of devoting half of its proposal to the history or
programs of the agency.
The proposal should address the projects and programs the organization intends to
undertake over the next twelve to fifteen months. If growth is project in the program,
anticipated goals should be stated, as should any new projects to be undertaken. If a
detailed program description or annual report exists, it should be included as the fist
item in the proposal appendices. The qualifications of the organization section should
meet the following criteria:
• Clearly establishes who is applying for funds
• Briefly addresses the rationale for the founding of the organization
• Describes applicant agency’s purposes and long-range goals
• Describes applicant’s current programs and activities
• Describes applicant’s clients or constituents
• Provides evidence of the applicant’s accomplishments
• Offers statistical support of accomplishment
• Supports qualifications in area of activity in which funds are sought (e.g. research,
training)
• Describes qualifications of key staff member
• Provides other evidence of administrative competence
• Leads logically to the problem statement
• Is as brief as possible
• Is interesting
Problem Statement or Needs Assessment (3-4 pages)
When seeking funds a specific problem area or need should be addressed. This is a
critically important section of the proposal. Information based on objective research, not
subjective impressions, should be provided to justify the need or problem. This data,
however, should not be voluminous, but sufficient to demonstrate that a problem or
need exists. A problem statement or needs assessment should meet6 the following
criteria:
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Describes the target population to be served
Defines the community problem to be addressed and the need in the
geographical area where the organization operates
Is related to the purposes and goals of the applicant agency
Is of reasonable dimensions – not trying to solve all the problems of the world
Is supported by relevant statistical evidence
Is supported by statements from authorities
Is stated in terms of clients’ needs and problems – not the applicant’s
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Is developed with input from clients and beneficiaries
Is not the “lack of a program”, unless the program always works?
Makes no unsupported assumptions
Is as brief as possible
Is interesting to read
Is free of jargon
Makes a compelling case
Program Goals and Objectives (1-2 pages)
This section of the proposal describes the outcomes of the grant in measurable terms. It
is a succinct description of what the organization hopes to accomplish. Program goals
and objectives should meet the following criteria:
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At least one objective for each problem or need committed to in the problem
statement.
Objectives are outcomes
Objectives are not methods
Describes the population that will benefit from the program
States the time by which objectives will be accomplished
Objectives are measurable and quantifiable (if at all possible)
TYPES OF OBJECTIVES
There are at least four types of objectives:
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Behavioral – A human action is anticipated.
Example: Fifty of the seventy children participating will learn to speedskate.
Example: The number of speedskating clubs in the U.S. will increase from X toY.
Performance – a specific time frame, within which a behavior will occur, at an
expected proficiency level, is expected.
Example: Fifty of the seventy children will learn to speedskate within six months
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and will pass a basic speedskating proficiency test administered by a U.S.
Speedskating-certified coach.
Process – The manner in which something occurs is an end in itself.
Example: We will document the teaching methods utilized, identifying those with
the greatest success.
Product – A t5angible item results
Example: A manual will be created to be used in teaching speedskating to this
age and proficiency group in the future.
Methodology (4+ pages)
This section describes the activities to be conducted to achieve the desired objectives. It
also includes the rationale for choosing a particular approach.
Generally, a straightforward, chronological description of the operations of the proposed
Project works most effectively. The Methodology section should meet the following
criteria:
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Flows naturally from problems and objectives
Clearly describes program activities
States reasons for the selection of activities
Describes sequence of activities
Describes staffing of program
Describes clients and client selection
Presents a reasonable scope of activities that can be accomplished within the
time and resources of the program
Provides a timeline of activities (if possible)
Evaluation (1-2 pages)
Proposals must include a plan for determining the degree to which objectives are met
and methods are followed. This section is extremely important as funders pay particular
attention to evaluation methods since they need help determining whether a proposed
project represents an intelligent investment for them. The evaluation section should
meet the following criteria:
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Present a plan for evaluating accomplishment of objectives
Presents a plan for evaluating and modifying methods over course of the
program
Tells who will be doing the evaluation criteria
Describes how data will be gathered
Explains any test instruments or questionnaires to be used
Describes the process of data analysis
Shows how evaluation will be used for program improvements
Describes any evaluation reports to be produced
Future Funding (1/2 page)
This section describes a plan for continuation beyond the grant and/or the availability of
other resources necessary to implement the grant. In equipment/capital request, many
funders require organizations to demonstrate how the on-going cost of operations and
equipment maintenance will be met. A statement about future funding sources is also
advisable for the maintenance equipment. The section on future funding should meet the
following criteria:
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Presents a specific plan to obtain funding if program is to be continue
Describes how maintenance and future program costs will be covered (if
applicable)
Describes how other funds will be obtained, if necessary to implement the grant
(include individual solicitation efforts specifically aimed at this project)
Includes list of other funders approached on behalf of project (name of funder,
date of proposal submission, amount requested, current status)
Has minimal reliance on future grant support
Is accompanied by letters of commitment (if necessary)
Does not indicate that the agency will approach the funder for additional money
Budget
All proposals should include a budget-which clearly delineates costs to be met by the
funding source and those provided by other parties and outlines both administrative and
program costs. If a proposal is for a specific project, separate budgets for the general
operating budget and special project budget should be included. Budgets should show
income as will as expenses and should be structured in columnar form, listing the
expense on the left and the dollar amount in the right column, according to general
accounting/bookkeeping principles. Budgets should not be submitted in narrative form.
Budget expense information should delineate personnel costs such as salary and benefit
information, and non-personnel expenses such as facility costs (rent/mortgage, utilities,
maintenance, taxes), fundraising expenses, travel, postage, equipment cost, supplies,
and insurance. These should be reflected in both the expense and income columns.
Sources of income should be listed separately as part of budget information. Sources
should be actual funders, not merely prospects. However, pending proposals may be
listed separately, if desired. Sources for funding may include fees for service,
government funds, corporate/private grants, individual donations, etc. A budget should
meet the following criteria:
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Tells the same story as the proposal narrative
Is detailed in all aspects
Includes project costs that will be incurred at the time of the program’s
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implementation
Contains no unexplained amounts for miscellaneous or contingency
Includes all items asked of the funding source
Includes all items paid for by other sources
Includes all volunteers
Includes all consultants
Details fringe benefits separate from salaries
Separately details all non-personnel costs
Includes separate columns for listing all donated services
Includes indirect costs where appropriate
Is sufficient to perform the tasks described in the narrative
Appendices
Some attachments are recommended in all proposals, while others may be included at
the author’s discretion. If a recent article or endorsement has been written about your
organization, and if it is germane, it may be included as an attachment to the proposal.
Generally funders will look at only one or two articles/endorsement to submit.
Additional attachments can be included at the author’s discretion. Appendices may
include:
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Verification of tax-exempt status (generally the IRS determination letter)
Names and affiliation of officers and Board of Directors members
Financial statements for last completed fiscal year (audited, if available)
Current general operating budget and special project budget (if applicable)
List of clients served (if appropriate)
List of other current funding sources
Biographies of key personnel (only if requested)
Articles/endorsements (no more than two)
Diagrams for equipment or building requests Organization’s by laws
Format and Appearance
There are different forms and formats for proposals. Sometimes these style aspects are
at the author’s discretion. However, the author should research the prospective funding
source to know the funder’s usual requirements.
Funders often have specific requirements for the format of the proposal they will
consider. It is the responsibility of the organization to submit the proposal in the required
form, if there is one. Some funders issue specific grant applications which organizations
must submit as the proposal. These are typically discussed in the funder’s published
guidelines or in research directories. A proposal should always be concise no more than
15 pages single-spaced. (Consider the page length indicated after each section – the
recommended maximum length.)
In addition to the contents of the proposal, its appearance is important. Foremost, a
proposal should be presented neatly. The cover letter should be typed on the nonprofit
organization’s letterhead, followed by the proposal and attachments, respectively. Since
proposals are not voluminous, it is not necessary to include an index or table of contents.
Proposals should not be submitted with binding (like a book), as funders often dismantle
the proposal and make copies of it when referring to a review committee for
consideration. To assemble a proposal, an organization should consider using staples or
a folder to contain the proposal and attachments. Funders do not judge a proposal on its
weight, but on its contents and presentation. Thus, it is important to assemble the
proposal in an organized, concise, and attractive manner.
Conclusion
In summary a proposal should re4flect planning, research and vision. The importance of
research cannot be overemphasized, both in terms of the funders solicited and the types
of funds requested. The appropriate format should be used, and the required
attachments should be included.
The most successful proposals are those which clearly and concisely state the
community’s and organization’s needs and are targeted to donors which fund that field, a
reflection of careful planning and research.
In writing and/or evaluating a proposal, the following conclusions drawn from a
University of Pennsylvania study may be useful. A study team investigated the criteria
foundations and government agencies consider most important when reviewing
proposals for community-based projects. They concluded that there are five factors all
funders consider “highly important”:
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Project purpose
Feasibility
Community need for the project
Applicant accountability
Competence
Other factors also considered important include:
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Project logic
Probable impact
Language
Money needed
Community support
Although there is some disagreement about the factors which are considered
unimportant, funders generally agreed that the least important factors in assessing a
proposal are:
•
•
•
•
•
•
Working relationships
Advocates
Minority status
Social acceptability
Prior funding
Influence of acquaintances
This article was adapted from the following articles and publications:
1. Guidelines for Proposal Preparation. Los Angeles, CA: Center for Nonprofit
Management/Southern California and Southern California Gas Company.
(Booklet)
2. Kiritz, Norton J. Proposal Checklist and Evaluation Form. Los Angeles, CA: The
Grantsmanship Center; 1979. (Pamphlet)
3. Townsend, Ted H. Criteria Grantors Use In Assessing Proposals. Foundation
News; March/April 1974. (Report)
4. Zimmerman, Robert M. Grantseeking: a Step-by-Step Approach. San Francisco:
Zimmerman, Lehman & Associates; 1994. 51 pages (training materials)
Thursday, November 20, 2003
GRANTS
1.
Assign a committee of three people to research and develop a grant for your club or association.
2.
Develop a time line for each step of the grant request process, ending with the final date the
requests will be sent.
3.
Use the Internet to find companies or groups that are interested in your particular type of request.
4.
Review the successful grants and how they used their individual information.
a. A problem need of significant magnitude exists
b. The applicant agency has the means and imagination to solve the problem or meet the need.
5.
General format for a grant.
a. Qualifications of the Organization
b. Problem Statement or Needs Assessment
c. Program Goals and Objectives
d. Methodology
e. Evaluation
f. Future Funding
g. Budget
h. Appendices
6.
Letter of Inquiry/Intent
a. Include your name, title, and address
b. Directed to the individual responsible for the funding program
c. Provide a brief overview of the organization and its purpose.
d. Include the reason for the funding request.
e. Include the amount requested
f. Describe the need for the project intends to meet.
g. Provide a brief description of the project.
h. List other prospective funders for the project
i. Include thank you and next step to be taken.
j. Do not exceed two pages. (Try to keep to one page.)
k. Include name and phone number of contact an organization.
l. Sign by the person who can speak with authority on behalf of the organization.
7.
Full Proposal
a. Cover Letter
b. Summary (1/2 page)
c. Qualifications of the Organization (1-2 pages)
d. Problem Statement or Needs Assessment (3-4 pages)
e. Program Goals and Objectives (1-2 pages)
8.
Types of Objectives
a. Behavioral – a human active is anticipated.
Example: Fifty of the seventy children participating will learn to speed skate.
b. Performance – a specific time frame.
Example: Fifty of the seventy children will lean to speed skate within six month and will passa
basic speedskating test.
c. Process – The manner in which something occurs is an end in itself.
Example: We will document the teaching methods and identify those with the greatest
success.
d. Product - A tangible item results
e. Producing a manual to be used to teach speedskating to future skaters.
f.
g.
h.
Rational for using a particular approach.
Sequence and timeline.
Staffing if needed.
A full grant proposal document is available from U.S. Speedskating. Also, examples of successful
grants.
Department of the Treasury
Internal Revenue Service
Notice 1382
(Rev. September 2009)
Changes for Form 1023:
● Mailing address
● Parts IX, X and XI
Changes for Form 1023, Application for
Recognition of Exemption Under Section
501(c)(3) of the Internal Revenue Code
Change of Mailing Address
The mailing address shown on Form 1023 Checklist, page
28, the first address under the last checkbox; and in the
Instructions for Form 1023, page 4 under Where to File,
has been changed to:
Internal Revenue Service
P.O. Box 12192
Covington, KY 41012-0192
Changes for Parts IX and X
Changes to Parts IX and X are necessary to comply with
new regulations that eliminated the advance ruling process.
Until Form 1023 is revised to reflect this change, please
follow the directions on this notice when completing Part IX
and Part X of Form 1023. For more information about the
elimination of the advance ruling process, visit us at
www.irs.gov and click on Charities & Non-Profits.
Part IX. Financial Data
The instructions at the top of Part IX on page 9 of Form
1023 are now as follows. 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, or
b. Four years of financial information if you have
completed one tax year.
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.
Part X. Public Charity Status
Do not complete line 6a on page 11 of Form 1023, and
do not sign the form under the heading “Consent Fixing
Period of Limitations Upon Assessment of Tax Under
Section 4940 of the Internal Revenue Code.”
Only complete line 6b and line 7 on page 11 of Form
1023, if in existence 5 or more tax years.
Notice 1382 (Rev. 9-2009)
Cat. No. 52336F
Part XI. Increase in User Fees.
User fee increases are effective for all applications
postmarked after January 3, 2010.
1. $400 for organizations whose gross receipts do not
exceed $10,000 or less annually over a 4-year period.
2. $850 for organizations whose gross receipts exceed
$10,000 annually over a 4-year period.
See www.irs.gov web page link on Form 1023, page 12,
Part XI, User Fee Information, for the current user fees.
Cyber Assistant, a web-based software program
designed to help organizations prepare a complete and
accurate Form 1023 application, will become available
during 2010. Once the IRS announces the availability of
Cyber Assistant, the user fees will change again.
1. $200 for organizations using Cyber Assistant
(regardless of size) to prepare their Form 1023, or
2. $850 for all other organizations not using Cyber
Assistant (regardless of size) to prepare their Form 1023.
IRS will announce when Cyber Assistant is available and
the effective date of the user fee change. Sign up for the
Exempt Organization (EO) Update, EO’s subscription
newsletter, at www.irs.gov/charities, to automatically
receive an alert that Cyber Assistant is available.
1023
Form
(Rev. June 2006)
Application for Recognition of Exemption
OMB No. 1545-0056
Note: If exempt status is
approved, this
application will be open
for public inspection.
Under Section 501(c)(3) of the Internal Revenue Code
Department of the Treasury
Internal Revenue Service
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)
3
Mailing address (Number and street) (see instructions)
Room/Suite 4 Employer Identification Number (EIN)
City or town, state or country, and ZIP + 4
6
2 c/o Name (if applicable)
5 Month the annual accounting period ends (01 – 12)
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,”
provide the person’s name, the name and address of the person’s firm, the amounts paid or
promised to be paid, and describe that person’s role.
Yes
No
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
11
Date incorporated if a corporation, or formed, if other than a corporation.
/
12
Were you formed under the laws of a foreign country?
If “Yes,” state the country.
For Paperwork Reduction Act Notice, see page 24 of the instructions.
(MM/DD/YYYY)
/
Yes
Cat. No. 17133K
Form
1023
No
(Rev. 6-2006)
Form 1023 (Rev. 6-2006)
Part II
Name:
EIN:
–
Page
2
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
Yes
No
Yes
Yes
No
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.
b Have you been funded? If “No,” explain how you are formed without anything of value placed in trust.
5
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.
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 reference to 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):
2a 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.
2b 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.
2c 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. 6-2006)
Form 1023 (Rev. 6-2006)
Part V
Name:
EIN:
–
Page
3
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 on what to include as compensation. Do not include officers, directors, or trustees listed in line 1a.
Name
Title
Mailing address
Compensation amount
(annual actual or estimated)
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
instructions for information on what to include as compensation.
Name
Title
Mailing address
Compensation amount
(annual actual or estimated)
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
through their position as an officer, director, or trustee? If “Yes,” identify the individuals and describe
the business relationship 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
Yes
No
Yes
Yes
Yes
No
No
No
3a 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
compensated independent 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 the individuals, explain the relationship between you and the other
organization, and describe the compensation arrangement.
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?
b Do you or will you approve compensation arrangements in advance of paying compensation?
c Do you or will you document in writing the date and terms of approved compensation arrangements?
Form
1023
(Rev. 6-2006)
Form 1023 (Rev. 6-2006)
Part V
Name:
EIN:
–
Page
4
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?
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.
Yes
No
Yes
No
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.
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
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
Yes
No
5a Have you adopted a conflict of interest policy consistent with the sample conflict of interest policy
in Appendix A to the instructions? If “Yes,” provide a copy of the policy and explain how the policy
has been adopted, such as by resolution of your governing board. If “No,” answer lines 5b and 5c.
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.
b
c
d
e
f
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 be negotiated at arm’s length.
Explain how you determine you pay no more than fair market value or you are paid at least fair market value.
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
any individual officer, director, or trustee owns more than a 35% interest? If “Yes,” provide the
information requested in lines 9b through 9f.
Form
1023
(Rev. 6-2006)
Form 1023 (Rev. 6-2006)
Part V
b
c
d
e
Name:
EIN:
–
Page
5
Compensation and Other Financial Arrangements With Your Officers, Directors, Trustees,
Employees, and Independent Contractors (Continued)
Describe any written or oral arrangements you made or intend to make.
Identify with whom you have or will have such arrangements.
Explain how the terms are or will be negotiated at arm’s length.
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.)
1a 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.
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
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 of another organization; or you were established upon the conversion of an organization from
for-profit to non-profit 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
No
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 be negotiated 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
2a 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.
c List the states and local jurisdictions, including Indian Reservations, in which you conduct or will
conduct gaming or bingo.
Form
1023
(Rev. 6-2006)
Form 1023 (Rev. 6-2006)
Name:
EIN:
–
Page
6
Part VIII Your Specific Activities (Continued)
4a Do you or will you undertake fundraising? If “Yes,” check all the fundraising programs you do or will
conduct. (See instructions.)
mail solicitations
email solicitations
personal solicitations
vehicle, boat, plane, or similar donations
foundation grant solicitations
Yes
No
phone solicitations
accept donations on your website
receive donations from another organization’s website
government 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
of all contracts or agreements.
Yes
No
Yes
No
Yes
No
6a Do you or will you engage in economic development? If “Yes,” describe your program.
b Describe in full who benefits from your economic development activities and how the activities
promote exempt purposes.
Yes
No
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
Yes
No
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
lines 9b through 9d. If “No,” go to line 10.
Yes
No
b Do you provide child care 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
in section 501(k).
Yes
No
c Of the children for whom you provide child care, 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
whom your activities are available. Also, see the instructions and explain how you qualify as a
childcare organization described in section 501(k).
Yes
No
Yes
No
d List all states and local jurisdictions in which you conduct fundraising. For each state or local
jurisdiction listed, 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
the right to advise on the use or distribution of funds? Answer “Yes” if the donor may provide advice
on the types 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.
5
Are you affiliated with a governmental unit? If “Yes,” explain.
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.
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
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
own any 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.
Form
1023
(Rev. 6-2006)
Form 1023 (Rev. 6-2006)
Name:
EIN:
–
Page
7
Part VIII Your Specific Activities (Continued)
11
Yes
No
12a 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.
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.
Yes
No
13a Do you or will you make grants, loans, or other distributions to organization(s)? If “Yes,” answer lines
13b through 13g. If “No,” go to line 14a.
Yes
No
Yes
No
Yes
Yes
No
No
Yes
No
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
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
any agreements with the donor regarding the contribution.
b
c
d
e
f
Describe how your grants, loans, or other distributions to organizations further your exempt purposes.
Do you have written contracts with each of these organizations? If “Yes,” attach a copy of each contract.
Identify each recipient organization and any relationship between you and the recipient organization.
Describe the records you keep with respect to the grants, loans, or other distributions you make.
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.
(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
of grant 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.
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.
14a 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.
b Provide the name of each foreign organization, the country and regions within a country in which
each foreign organization operates, and describe any relationship you have with each foreign
organization.
Form
1023
(Rev. 6-2006)
Form 1023 (Rev. 6-2006)
Name:
EIN:
–
Page
8
Part VIII Your Specific Activities (Continued)
15
Do you have a close connection with any organizations? If “Yes,” explain.
Yes
No
16
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.
Are you applying for exemption as a charitable risk pool under section 501(n)? If “Yes,” explain.
Yes
No
Yes
No
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.
Is your main function to provide hospital or medical care? If “Yes,” complete Schedule C.
Yes
No
Yes
No
21
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.
Note: Private foundations may use Schedule H to request advance approval of individual grant
procedures.
Yes
No
18
19
20
Form
1023
(Rev. 6-2006)
Form 1023 (Rev. 6-2006)
Part IX
Name:
–
EIN:
Page
9
Financial Data
For purposes of this schedule, years in existence refer to completed tax years. If in existence 4 or more years, complete the
schedule for the most recent 4 tax years. If in existence more than 1 year but less than 4 years, complete the statements 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 3 years of financial information. If in existence less than 1 year, provide projections
of your likely revenues and expenses for the current year and the 2 following years, based on a reasonable and good faith
estimate of your future finances for a total of 3 years of financial information. (See instructions.)
A. Statement of Revenues and Expenses
Type of revenue or expense
1
Gifts, grants, and
contributions received (do not
include unusual grants)
2
3
4
Membership fees received
Gross investment income
Net unrelated business
income
Taxes levied for your benefit
Revenues
5
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)
Total of lines 8 and 9
Net gain or loss on sale of
capital assets (attach
schedule and see instructions)
10
11
12
13
Expenses
14
3 prior tax years or 2 succeeding tax years
(a) From
(b) From
(c) From
(d) From
To
To
To
To
(e) Provide Total for
(a) through (d)
Unusual grants
Total Revenue
Add lines 10 through 12
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
Other salaries and wages
Interest expense
Occupancy (rent, utilities, etc.)
Depreciation and depletion
Professional fees
18
19
20
21
22
Current tax year
23
Any expense not otherwise
classified, such as program
services (attach itemized list)
24
Total Expenses
Add lines 14 through 23
Form
1023
(Rev. 6-2006)
Form 1023 (Rev. 6-2006)
Part IX
Name:
EIN:
–
Page
B. Balance Sheet (for your most recently completed tax year)
Assets
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
Cash
Accounts receivable, net
Inventories
Bonds and notes receivable (attach an itemized list)
Corporate stocks (attach an itemized list)
Loans receivable (attach an itemized list)
Other investments (attach an itemized list)
Depreciable and depletable assets (attach an itemized list)
Land
Other assets (attach an itemized list)
Total Assets (add lines 1 through 10)
Liabilities
Accounts payable
Contributions, gifts, grants, etc. payable
Mortgages and notes payable (attach an itemized list)
Other liabilities (attach an itemized list)
Total Liabilities (add lines 12 through 15)
Fund Balances or Net Assets
Total fund balances or net assets
Total Liabilities and Fund Balances or Net Assets (add lines 16 and 17)
Have there been any substantial changes in your assets or liabilities since the end of the period
shown above? If “Yes,” explain.
Part X
10
Financial Data (Continued)
Year End:
(Whole dollars)
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
Yes
No
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.)
1a Are you a private foundation? If “Yes,” go to line 1b. If “No,” go to line 5 and proceed as instructed.
If you are 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
confirm that your organizing document meets this requirement, whether by express provision or by
reliance on operation 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 special provisions 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 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. 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 the requirements 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, g, or h
or a publicly supported section 501(c)(4), (5), or (6) organization. Complete and attach Schedule D.
Form
1023
(Rev. 6-2006)
Form 1023 (Rev. 6-2006)
Part X
Name:
EIN:
–
Page
11
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)(vi)—an organization that receives a substantial part of its financial support in the form
of contributions from publicly supported organizations, from a governmental unit, or from the general public.
h 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).
i
6
A publicly supported organization, but unsure if it is described in 5g or 5h. The organization would like the IRS to
decide the correct status.
If you checked box g, h, or i in question 5 above, you must request either an advance or a definitive ruling by
selecting one of the boxes below. Refer to the instructions to determine which type of ruling you are eligible to receive.
a Request for Advance Ruling: By checking this box and signing the consent, pursuant to section 6501(c)(4) of
the Code you request an advance ruling and agree to extend the statute of limitations on the assessment of
excise tax under section 4940 of the Code. The tax will apply only if you do not establish public support status
at the end of the 5-year advance ruling period. The assessment period will be extended for the 5 advance ruling
years to 8 years, 4 months, and 15 days beyond the end of the first year. You have the right to refuse or limit
the extension to a mutually agreed-upon period of time or issue(s). Publication 1035, Extending the Tax
Assessment Period, provides a more detailed explanation of your rights and the consequences of the choices
you make. You may obtain Publication 1035 free of charge from the IRS web site at www.irs.gov or by calling
toll-free 1-800-829-3676. Signing this consent will not deprive you of any appeal rights to which you would
otherwise be entitled. If you decide not to extend the statute of limitations, you are not eligible for an advance
ruling.
Consent Fixing Period of Limitations Upon Assessment of Tax Under Section 4940 of the Internal Revenue Code
For Organization
(Signature of Officer, Director, Trustee, or other
authorized official)
(Type or print name of signer)
(Date)
(Type or print title or authority of signer)
For IRS Use Only
IRS Director, Exempt Organizations
(Date)
b Request for Definitive Ruling: Check this box if you have completed one tax year of at least 8 full months and
you are requesting a definitive ruling. To confirm your public support status, answer line 6b(i) if you checked box
g in line 5 above. Answer line 6b(ii) if you checked box h in line 5 above. If you checked box i in line 5 above,
answer both lines 6b(i) and (ii).
(i) (a) Enter 2% of line 8, column (e) on Part IX-A. Statement of Revenues and Expenses.
(b) 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,” check this box.
(ii) (a) For each year amounts are included on lines 1, 2, and 9 of Part IX-A. Statement of Revenues and
Expenses, attach a list showing the name of and amount received from each disqualified person. If the
answer is “None,” check this box.
(b) For each year amounts are 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. If the answer is “None,” check this box.
7
Yes
Did you receive any unusual grants during any of the years shown on Part IX-A. Statement of
Revenues 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.
Form
1023
No
(Rev. 6-2006)
Form 1023 (Rev. 6-2006)
Part XI
Name:
EIN:
–
Page
12
User Fee Information
You must include a user fee payment with this application. It will not be processed without your paid user fee. If your average
annual gross receipts have exceeded or will exceed $10,000 annually over a 4-year period, you must submit payment of $750. If
your gross receipts have not exceeded or will not exceed $10,000 annually over a 4-year period, the required user fee payment
is $300. See instructions for Part XI, for a definition of gross receipts over a 4-year period. 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 1-877-829-5500 for current information.
1
2
3
Yes
Have your annual gross receipts averaged or are they expected to average not more than $10,000?
If “Yes,” check the box on line 2 and enclose a user fee payment of $300 (Subject to change—see above).
If “No,” check the box on line 3 and enclose a user fee payment of $750 (Subject to change—see above).
Check the box if you have enclosed the reduced user fee payment of $300 (Subject to change).
Check the box if you have enclosed the user fee payment of $750 (Subject to change).
No
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)
Reminder: Send the completed Form 1023 Checklist with your filled-in-application.
Form
1023
(Rev. 6-2006)
Form 1023 (Rev. 6-2006)
Name:
EIN:
–
Page
13
Schedule A. Churches
1a Do you have a written creed, statement of faith, or summary of beliefs? If “Yes,” attach copies of
relevant documents.
Yes
No
Yes
No
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
Yes
No
Yes
No
Yes
No
Yes
No
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
Do you conduct baptisms, weddings, funerals, etc.?
Yes
No
Do you have a school for the religious instruction of the young?
Yes
No
Yes
No
Yes
No
b Do you have a form of worship? If “Yes,” describe your form of worship.
2a Do you have a formal code of doctrine and discipline? If “Yes,” describe your code of doctrine and
discipline.
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.
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.
b Do you own the property where you have an established place of worship?
6
Do you have an established congregation or other regular membership group? If “No,” refer to the
instructions.
7
How many members do you have?
8a Do you have a process by which an individual becomes a member? If “Yes,” describe the process
and complete lines 8b–8d, below.
9
10
11a 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.
b Do you have schools for the preparation of your ordained ministers or religious leaders?
12
Is your minister or religious leader also one of your officers, directors, or trustees?
Yes
No
13
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
No
17
Do you have other information you believe should be considered regarding your status as a church?
If “Yes,” explain.
Yes
No
Form
1023
(Rev. 6-2006)
Form 1023 (Rev. 6-2006)
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
2a 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 the remainder 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
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 of any 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.
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
supply a copy of the policy. If “No,” you must adopt a nondiscriminatory policy as to students
before submitting this application. See Publication 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
basis of 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. 6-2006)
Form 1023 (Rev. 6-2006)
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
the community served).
Racial Category
(a) Student Body
Current Year
Next Year
(b) Faculty
Current Year
Next Year
(c) Administrative Staff
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
Current Year Next Year
Amount of Loans
Number of Scholarships Amount of Scholarships
Current Year Next Year Current Year Next Year Current Year Next Year
Total
7a 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.
8
Will you maintain records according to the non-discrimination provisions contained in Revenue
Procedure 75-50? If “No,” explain. (See instructions.)
Form
Yes
No
Yes
No
1023
(Rev. 6-2006)
Form 1023 (Rev. 6-2006)
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
1a 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
2a 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.
b Does the same deposit requirement, if any, apply to all other patients? If “No,” explain.
Yes
No
Yes
No
4a 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
written or oral agreements. If written, submit copies of all such agreements.
Yes
No
Yes
No
Yes
No
Yes
No
Yes
No
5a Do you provide for a portion of your services and facilities to be used for charity patients? If “Yes,”
answer 5b through 5e.
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
agencies for 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.
6a Do you or will you carry on a formal program of medical training or medical research? If “Yes,”
describe such programs, including the type of programs offered, the scope of such programs, and
affiliations with other hospitals or medical care providers with which you carry on the medical training
or research programs.
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.
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
professional relationship 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.
Note. Make sure your answer is consistent with the information provided in Part VIII, line 8.
Yes
No
Form
1023
(Rev. 6-2006)
Form 1023 (Rev. 6-2006)
Section I
Name:
EIN:
–
Page
17
Schedule C. Hospitals and Medical Research Organizations (Continued)
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 of any 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.
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.
Yes
No
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
the hospital(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 in carrying 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. 6-2006)
Form 1023 (Rev. 6-2006)
Section I
1
Name:
EIN:
–
Page
18
Schedule D. Section 509(a)(3) Supporting Organizations
Identifying Information About the Supported Organization(s)
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
No
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
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 of the supported organization(s)? If “Yes,” describe the process by which your governing
board is appointed and elected; go to Section III. If “No,” go to line 3.
Yes
No
Yes
No
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
1023
(Rev. 6-2006)
If “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(ii)(a), 6b(ii)(b), 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
2
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 these rights and provide a copy of the written communication documenting this; go to
Section II, line 5. If “No,” go to line 4a.
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.
e Describe and provide copies of written communications documenting how you made the supported
organization(s) aware of your supporting activities.
Form
Form 1023 (Rev. 6-2006)
Section II
5
Name:
EIN:
–
Page
19
Schedule D. Section 509(a)(3) Supporting Organizations (Continued)
Relationship with Supported Organization(s)—Three Tests (Continued)
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
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
d Do you or the supported organization(s) earmark your funds for support of a particular program or
activity? If “Yes,” explain.
Yes
No
7a 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.
b Attach a statement describing whether there has been an historic and continuing relationship
between you and the supported organization(s).
Yes
No
Yes
No
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.
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. If your organizing document complies with this requirement, answer “Yes.” If your
organizing document does not comply with this requirement, answer “No,” and see the instructions.
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.
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 relationship with disqualified persons, and the foundation managers appointed,
and (3) explain how control is vested over 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. 6-2006)
Form 1023 (Rev. 6-2006)
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. If you are not eligible for tax exemption
under section 501(c)(3) from your date of incorporation or formation, Schedule E is also intended to determine whether you are
eligible for tax exemption under section 501(c)(4) for the period between your date of incorporation or formation and the
postmark date of your application.
Yes
No
Yes
No
b If your gross receipts were normally more than $5,000, are you filing this application within 90 days
from the 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 the Internal 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
you filing this application within 27 months from the postmark date of the Internal Revenue Service
final adverse ruling letter? If “Yes,” stop here.
Yes
No
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.
2a 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.
4
Were you created on or before October 9, 1969? If “Yes,” stop here. Do not complete the remainder
of this 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
an extension 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 lines 6, 7, or 8. If “No,” go to line 6a.
Yes
No
Yes
No
Yes
No
6a If you answered “No” to line 5, you can only be exempt under section 501(c)(3) from the postmark
date of this application. Therefore, do you want us to treat this application as a request for tax
exemption from the postmark date? If “Yes,” you are eligible for an advance ruling. Complete Part X,
line 6a. If “No,” you will be treated as a private foundation.
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.
Form
1023
(Rev. 6-2006)
Form 1023 (Rev. 6-2006)
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
8
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
(b) From
To
(c) Total
According to your answers, you are only eligible for tax exemption under section 501(c)(3) from the
postmark date of your application. However, you may be eligible for tax exemption under section
501(c)(4) from your date of formation to the postmark date of the Form 1023. Tax exemption under
section 501(c)(4) allows exemption from federal income tax, but generally not deductibility of
contributions under Code section 170. Check the box at right if you want us to treat this as a
request for exemption under 501(c)(4) from your date of formation to the postmark date.
!
Attach a completed Page 1 of Form 1024, Application for Recognition of Exemption Under Section
501(a), to this application.
Form
1023
(Rev. 6-2006)
Form 1023 (Rev. 6-2006)
Section I
Name:
EIN:
–
Page
22
Schedule F. Homes for the Elderly or Handicapped and Low-Income Housing
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.
4a
b
c
d
Provide a description of each facility.
What is the total number of residents each facility can accommodate?
What is your current number of residents in each facility?
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
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.
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 of any 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.
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.
Yes
No
9
Do you participate in any government housing programs? If “Yes,” describe these programs.
Yes
No
Yes
No
Yes
No
10a 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.
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.
Form
1023
(Rev. 6-2006)
Form 1023 (Rev. 6-2006)
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
Yes
No
2a 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
3a Do you have an established policy concerning residents who become unable to pay their regular
charges? If “Yes,” describe your established policy.
Yes
No
Yes
No
b Do you provide housing for the handicapped? If “Yes,” describe who qualifies for your housing in
terms of disability, income levels, or other criteria and explain how you select persons for your
housing.
b Do you have any arrangements with government welfare agencies or others to absorb all or part of
the cost of maintaining residents who become unable to pay their regular charges? If “Yes,” describe
these arrangements.
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
Yes
No
Yes
No
Yes
No
3a Is your housing affordable to low income residents? If “Yes,” describe how your housing is made
affordable to low-income residents.
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.
4
Do you provide social services to residents? If “Yes,” describe these services.
Form
1023
(Rev. 6-2006)
Form 1023 (Rev. 6-2006)
Name:
EIN:
–
Page
24
Schedule G. Successors to Other Organizations
1a 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
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
relationship with the other organzation that resulted in your creation.
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
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.
e Explain why you took over the activities or assets of another organization.
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.
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
5
Address
–
Share/Interest (If a for-profit)
Do or will any of the persons listed in line 4, maintain a working relationship with you? If “Yes,”
describe the 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.
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.
b Were any restrictions placed on the use or sale of the assets? If “Yes,” explain the restrictions.
Yes
No
Yes
No
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?
If “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.
Yes
No
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 own more than a 35% interest? If “Yes,” submit a copy of the lease or rental agreement(s).
Indicate how the lease 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
in which 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 the property or equipment was determined.
Yes
No
Form
1023
(Rev. 6-2006)
–
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.
Form 1023 (Rev. 6-2006)
1a 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
d
e
f
If you award educational loans, explain the terms of the loans (interest rate, length, forgiveness, etc.).
Specify how your program is publicized.
Provide copies of any solicitation or announcement materials.
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.
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.)
Yes
No
4a Describe the specific criteria you use to select recipients. (For example, specific selection criteria could consist of prior
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 educational grants.
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 in good 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.
1a 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 of funds 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 intended purposes, and withhold further payments to grantees until you
obtain grantees’ assurances that 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 the supervision and investigation of grants described in line 2?
Yes
No
Form
1023
(Rev. 6-2006)
–
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)
Form 1023 (Rev. 6-2006)
4a 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.)
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
Yes
No
Yes
No
Yes
No
Yes
No
Yes
No
Yes
No
If “Yes,” will you award grants to 10% or fewer of the eligible applicants who were
actually considered by the selection committee in selecting recipients of grants in that
year as provided by Revenue Procedures 76-47 and 80-39?
d Do you provide scholarships, fellowships, or educational loans to attend an educational
institution to children of employees of a particular employer?
If “Yes,” will you award grants to 25% or fewer of the eligible applicants who were
actually considered 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.
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?
N/A
N/A
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 line 4f.
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 considered compensation 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.
Form
1023
(Rev. 6-2006)
Form 1023 Checklist
(Revised June 2006)
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 E
Yes
No
Schedule B
Yes
No
Schedule F
Yes
No
Schedule C
Yes
No
Schedule G
Yes
No
Schedule D
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
P.O. Box 192
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
201 West Rivercenter Blvd.
Attn: Extracting Stop 312
Covington, KY 41011
Internal Revenue Service
Tax Exempt and
Government Entities
Exempt Organizations
Compliance Guide for
501(c)(3) Public Charities
Covers:
Activities that may jeopardize
a charity's exempt status
Federal information returns, tax
returns or notices that must be filed
Recordkeeping—why, what, when
Governance considerations
Changes to be reported to the IRS
Required public disclosures
Resources for public charities
i
501
What activities may jeopardize
a public charity’s tax-exempt status?. . . . . . . . . . . . . . . . . . . . .
Private Benefit and Inurement. . . . . . . . . . . . . . . . . . . . . . . . .
Political Campaign Intervention . . . . . . . . . . . . . . . . . . . . . . .
Legislative Activities. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
What federal information returns,
tax returns and notices must be filed? . . . . . . . . . . . . . . . . . .
Form 990, Return Of Organization Exempt From Income
Tax, Form 990-EZ, Short Form Return Of Organization
Exempt From Income Tax and Form 990-N, Electronic
Notice (e-Postcard) for Tax-Exempt Organizations not
Required To File Form 990 or 990-EZ . . . . . . . . . . . . . . . .
Form 990 and Form 990-EZ . . . . . . . . . . . . . . . . . . . . . . . . . .
Form 990-N, Electronic Notice (e-Postcard)
for Tax-Exempt Organizations not Required
To File Form 990 or 990-EZ . . . . . . . . . . . . . . . . . . . . . . . .
Form 990-T, Exempt Organization Business
Income Tax Return . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
Employment Tax Returns . . . . . . . . . . . . . . . . . . . . . . . . . . . .
Why keep records? . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
Evaluate Charitable Programs. . . . . . . . . . . . . . . . . . . . . . . .
Monitor Budgetary Results . . . . . . . . . . . . . . . . . . . . . . . . . .
Prepare Financial Statements . . . . . . . . . . . . . . . . . . . . . . . .
Prepare Annual Information and Tax Returns . . . . . . . . . . .
Identify Sources of Receipts . . . . . . . . . . . . . . . . . . . . . . . . .
Substantiate Revenues, Expenses and Deductions
for Unrelated Business Income Tax (UBIT) Purposes . . .
Comply with Grant-Making Procedures . . . . . . . . . . . . . . . .
Comply with Racial Nondiscrimination Requirements . . . .
2
2
3
8
10
10
13
16
18
20
22
23
23
24
24
24
25
25
25
What records should be kept? . . . . . . . . . . . . . . . . . . . . . . . . . 26
Accounting Periods and Methods. . . . . . . . . . . . . . . . . . . . . 26
Supporting Documents . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 27
How long should records be kept?. . . . . . . . . . . . . . . . . . . . . . 30
Record Retention Periods . . . . . . . . . . . . . . . . . . . . . . . . . . . 30
What governance procedures and practices should
an organization consider adopting or have in place?. . . . . . .
Mission Statement & Organizational Documents . . . . . . . .
Governing Body . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
Governance and Management Policies . . . . . . . . . . . . . . . .
Financial Statement and Information Reporting . . . . . . . . .
Transparency. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
31
31
31
32
32
32
How should changes be reported to the IRS?. . . . . . . . . . . . . 33
Reporting Changes on the Annual Information Return . . . 33
Determination Letters and Private Letter Ruling Requests. 33
What disclosures are required?. . . . . . . . . . . . . . . . . . . . . . . . .
Public Inspection of Annual Returns and
Exemption Applications. . . . . . . . . . . . . . . . . . . . . . . . . . .
Sale of Free Government Information . . . . . . . . . . . . . . . . .
Charitable Contributions—Substantiation And Disclosure.
35
35
38
38
How to get IRS assistance and information . . . . . . . . . . . . . . 41
Specialized Assistance for Tax-Exempt Organizations. . . . . 41
Tax Publications for Exempt Organizations . . . . . . . . . . . . . 42
Forms for Exempt Organizations . . . . . . . . . . . . . . . . . . . . . 43
General IRS Assistance . . . . . . . . . . . . . . . . inside back cover
(c)(3)
F
ederal 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 (Code). The Code requires that
tax-exempt organizations must comply with federal
tax law to maintain tax-exempt status and avoid
penalties.
In this publication, the IRS addresses activities
that could jeopardize a public charity's tax-exempt
status. It identifies general compliance requirements on recordkeeping, reporting, and disclosure
for exempt organizations (EO’s) described in section
501(c)(3) of the Code that are classified as public
charities. Content includes references to the statute,
Treasury regulations, IRS publications and IRS forms
with instructions. Publication 4221-PC is neither comprehensive nor intended to address every situation.
To learn more about compliance rules and procedures that apply to public charities exempt from
federal income tax under section 501(c)(3), see
IRS Publication 557, Tax-Exempt Status for Your
Organization, and the Life Cycle of a Public Charity
on www.irs.gov/eo. Stay abreast of new EO
information, also on this Web site, by signing up
for the EO Update, a free newsletter for tax-exempt
organizations and practitioners who represent
them. For further assistance, consult a tax adviser.
1
What activities may
jeopardize a public charity’s
tax-exempt status?
Once a public charity has completed the application process and has established that it is exempt
under section 501(c)(3), the charity’s officers, directors, trustees and employees must ensure that the
organization maintains its tax-exempt status and
meets its ongoing compliance responsibilities.
A 501(c)(3) public charity that does not restrict its
participation in certain activities and does not
absolutely refrain from others, risks failing the
operational test and jeopardizing its tax-exempt
status.The following summarizes the limitations
on the activities of public charities.
Private Benefit and Inurement
A public charity is prohibited from allowing more
than an insubstantial accrual of private benefit to
individuals or organizations.This restriction is to
ensure that a tax-exempt organization serves a
public interest, not a private one. If a private benefit is more than incidental, it could jeopardize the
organization’s tax-exempt status.
No part of an organization’s net earnings may inure
to the benefit of an insider. An insider is a person
who has a personal or private interest in the activities of the organization such as an officer, director,
or a key employee.This means that an organization
is prohibited from allowing its income or assets to
accrue to insiders. An example of prohibited inurement would include payment of unreasonable
2
501
compensation to an insider. Any amount of inurement may be grounds for loss of tax-exempt status.
If a public charity provides an economic benefit to
any person who is in a position to exercise substantial influence over its affairs (that exceeds the
value of any goods or services provided in consideration), the organization has engaged in an excess
benefit transaction. A public charity that engages in
such a transaction must report it to the IRS. Excise
taxes are imposed on any person who engages in
an excess benefit transaction with a public charity,
and on any organization manager who knowingly
approves such a transaction. (See Reporting Excess
Benefit Transactions on page 15).
A public charity that becomes aware that it may
have engaged in an excess benefit transaction
should consult a tax advisor and take appropriate
action to avoid any potential impact it could have
on the organization’s continued exempt status.
Go to www.irs.gov/eo for details about inurement,
private benefit, and excess benefit transactions.
Political Campaign Intervention
Public charities are absolutely prohibited from
directly or indirectly participating in, or intervening
in, any political campaign on behalf of (or in
opposition to) a candidate for public office.
Contributions to political campaign funds or public
statements of position 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. Violation of this
prohibition may result in revocation of tax-exempt
status and/or imposition of certain excise taxes.
501
3
(c)(3)- PC
3
Certain activities or expenditures may not be prohibited depending on the facts and circumstances.
For example, the conduct of certain voter education
activities (including the presentation of public
forums and the publication of voter education
guides) in a non-partisan manner do not constitute
prohibited political campaign activity. Other activities intended to encourage people to participate
in the electoral process, such as voter registration
and get-out-the-vote drives, would not constitute
prohibited political campaign activity if conducted
in a non-partisan manner. On the other hand, voter
education or registration activities with evidence
of bias that would favor one candidate over another, oppose a candidate in some manner, or have
the effect of favoring a candidate or group of
candidates, will constitute campaign intervention.
The political campaign activity prohibition is not
intended to restrict free expression on political
matters by leaders of public charities speaking
for themselves as individuals. However, for their
organizations to remain tax exempt under section 501(c)(3), organization leaders cannot make
partisan comments in official organization publications or at official functions. When speaking in a
non-official capacity, these leaders should clearly
indicate that their comments are personal, and not
intended to represent the views of the organization.
Some section 501(c)(3) organizations take positions
on public policy issues, including issues that divide
candidates in an election for public office. However,
section 501(c)(3) organizations must avoid any
issue advocacy that functions as political campaign
intervention. Even if a statement does not expressly
4
501
tell an audience to vote for or against a specific
candidate, an organization delivering the statement
is at risk of violating the political campaign intervention prohibition if there is any message favoring or opposing a candidate. A statement can identify a candidate not only by stating the candidate's
name but also by other means such as showing a
picture of the candidate, referring to political party
affiliations, or other distinctive features of a candidate's platform or biography. All the facts and circumstances need to be considered to determine if
the advocacy is political campaign intervention.
The IRS considers the following factors that tend
to show an advocacy communication is political
campaign activity:
N
whether the statement identifies one or more
candidates for a given public office,
N
whether the statement expresses approval
or disapproval for one or more candidates'
positions and/or actions,
N
whether the statement is delivered close in
time to the election,
N
whether the statement makes reference
to voting or an election,
N
whether the issue addressed in the
communication has been raised as an issue
distinguishing candidates for a given office,
N
whether the communication is part of an
ongoing series of communications by the
organization on the same issue that are made
independent of the timing of any election, and
N
whether the timing of the communication and
identification of the candidate are related to a
non-electoral event such as a scheduled vote on
501
5
(c)(3)- PC
5
specific legislation by an officeholder who also
happens to be a candidate for public office.
A communication is particularly at risk of political
campaign intervention when it makes reference to
candidates or voting in a specific upcoming election.
Nevertheless, the communication must still be considered in context before arriving at any conclusions.
Political candidates may be invited to appear or
speak at organization events in their capacity as
candidates, or individually (not as a candidate).
Candidates may also appear without an invitation
at organization events that are open to the public.
When a candidate is invited to speak at a public
charity's event as a candidate, factors in determining whether the organization participated or intervened in a political campaign include the following:
N
whether the public charity provides an equal
opportunity to the political candidates seeking the
same office,
N
whether the public charity indicates any support
of or opposition to the candidate.
N
whether any political fundraising occurs.
When a candidate is invited to speak at a public
charity’s event in an individual (non-candidate)
capacity, factors in determining whether the
organization participated or intervened in a political
campaign include the following:
N
whether the individual is chosen to speak solely
for reasons other than candidacy for public office,
N
whether the individual speaks in a non-candidate
capacity or references his or her candidacy or the
election,
6
501
N
whether the organization maintains a nonpartisan
atmosphere on the premises or at the event where
the candidate is present, and
N
whether the organization clearly indicates the
capacity in which the candidate is appearing and
does not mention the individual's political candidacy or the upcoming election in the communications
announcing the candidate's attendance at the event.
In determining whether candidates are given an
equal opportunity to participate, a public charity
should consider the nature of the event to which
each candidate is invited, in addition to the manner
of presentation. For example, a public charity that
invites one candidate to speak at its well attended
annual banquet, but invites the opposing candidate
to speak at a sparsely attended general meeting,
will likely be found to have violated the political
campaign prohibition, even if the manner of presentation for both speakers is otherwise neutral.
Sometimes a public charity invites several candidates to speak at a public forum. A public forum
involving several candidates for public office may
qualify as an exempt educational activity. However,
if the forum is operated to show a bias for or
against any candidate, then the forum would be
prohibited campaign activity, as it would be considered intervention or participation in a political
campaign. When an organization invites several
candidates to speak at a forum, it should consider
the following factors:
N
whether questions for the candidate are prepared
and presented by an independent nonpartisan panel,
N
whether the topics discussed by the candidates
cover a broad range of issues that the candidates
7
501
would address if elected to the office sought and
are of interest to the public,
Nwhether
each candidate is given an equal
opportunity to present his or her views on the
issues discussed,
Nwhether
the candidates are asked to agree or
disagree with positions, agendas, platforms or
statements of the organization, and whether a
moderator comments on the questions or otherwise implies approval or disapproval of the
candidates.
Read Revenue Ruling 2007-41 at www.irs.gov/eo
for additional information on the prohibition against
political campaign intervention.
When a 501(c)(3) public charity participates in political
campaign activity, it jeopardizes both its tax-exempt
status and its eligibility to receive tax-deductible contributions. In addition, an excise tax may be imposed
in addition to, or instead of revocation.
Legislative Activities
A public charity is not permitted to engage in
substantial legislative activity (commonly referred
to as lobbying). 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 purposes of proposing,
supporting or opposing legislation, or advocates
the adoption or rejection of legislation.
If lobbying activities are substantial, a 501(c)(3)
organization may fail the operational test and risk
losing its tax-exempt status and/or be liable for
excise taxes. Substantiality is measured by either
the substantial part test or the expenditure test.
8
501
The substantial part test determines substantiality
on the basis of all the pertinent facts and circumstances in each case.The IRS considers a variety of
factors, including the time and expenditures devoted
by the organization to the activity, when determining
whether the lobbying activity is substantial.
As an alternative, a public charity (other than a
church) may elect to use the expenditure test by
filing Form 5768, Election/Revocation of Election
by an Eligible Section 501(c)(3) Organizations To
Make Expenditures To Influence Legislation. Under
the expenditure test, a public charity’s lobbying activity will not jeopardize its tax-exempt status provided
its expenditures related to lobbying do not normally
exceed a set amount specified in section 4911 of the
Code.This limit is generally based on the size of the
organization and may not exceed $1 million.
Also, under the expenditure test, a public charity
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. Read the Life Cycle of a Public Charity at
www.irs.gov/eo for additional information about
the rules against substantial legislative activities.
Public charities that engage in lobbying activities
must report lobbying activities on Form 990,
Schedule C, Political Campaign and Lobbying
Activities.
9
501
What federal information
returns, tax returns and
notices must be filed?
While 501(c)(3) public charities are exempt from federal income tax, most of these organizations have
information reporting obligations under the Code
to ensure that they continue to be recognized as
tax-exempt. In addition, they may also be liable for
employment taxes, unrelated business income tax,
excise taxes, and certain state and local taxes.
Form 990, Return Of Organization Exempt
From Income Tax, Form 990-EZ, Short Form
Return Of Organization Exempt From Income
Tax and Form 990-N, Electronic Notice
(e-Postcard) for Tax-Exempt Organizations
not Required To File Form 990 or 990-EZ
Public charities generally file either a:
NForm
990, Return of Organization Exempt
from Income Tax,
NForm
990-EZ, Short Form Return of Organization
Exempt from Income Tax, or
NForm
990-N, Electronic Notice (e-Postcard) for
Tax-Exempt Organizations not RequiredTo File
Form 990 or 990-EZ.
Form 990 has been substantially redesigned for
2008 and beyond (to be filed in 2009 and later).
The type of Form 990 series return a public charity
must file is generally determined by the organization's gross receipts and total assets.The IRS redesigned Form 990 and adjusted the filing thresholds
over a graduated three-year transition period,
starting in 2008, to allow small organizations to file
Form 990-EZ while they become familiar with and
prepare to use the new Form 990.
10
501
The charts below explain which Form 990 tax-exempt
organization is required to file in the coming tax years.
2008 Tax Year
(Filed in 2009 or 2010)
Form
to File
Gross receipts normally ≤ $25,000
990-N
Gross receipts > $25,000 and < $1 million,
and Total assets < $2.5 million
990-EZ
or 990
Gross receipts ≥ $1 million, or
Total assets ≥ $2.5 million
2009 Tax Year
(Filed in 2010 or 2011)
990
Form
to File
Gross receipts normally ≤ $25,000
990-N
Gross receipts > $25,000 and < $500,000,
and Total assets < $1.25 million
990-EZ
or 990
Gross receipts ≥ $500,000, or
Total assets ≥ $1.25 million
2010 Tax Year and later
(Filed in 2011 and later)
990
Form
to File
Gross receipts normally ≤ $50,000
990-N
Gross receipts > $50,000 and < $200,000, and
Total assets < $500,000
990-EZ
or 990
Gross receipts ≥ $200,000, or
Total assets ≥ $500,000
990
Filing Dates
Forms 990, 990-EZ, and 990-N must be filed by
the 15th day of the fifth month after the end of the
organization’s annual accounting period.The due
date for the Forms 990 and 990-EZ may be extended for three months, without showing cause, by filing Form 8868, Application for Extension of Time To
File an Exempt Organization Form, before the due
date. An additional three-month extension may be
501
11
(c)(3)- PC
11
requested on Form 8868 if the organization shows
reasonable cause why the return cannot be filed by
the extended due date.
An organization cannot request for extension for
filing the Form 990-N; however, there is no penalty
for filing it late.
See Filing Penalties and Revocation of Tax-Exempt
Status on page 18.
Filing Exceptions
Public charities that are not required to file
Forms 990 or 990-EZ include:
N
churches and certain church-affiliated organizations,
N
certain organizations affiliated with
governmental units,
N
subordinate organizations included in a group
return filed by the parent organization, and
N
organizations whose annual gross receipts
are normally $25,000 or less (see Form 990-N,
Electronic Notice (e-Postcard) for Tax-Exempt
Organizations not Required To File Form 990 or
990-EZ on page 16).
If a public charity is excepted from filing a Form
990 or Form 990-EZ because annual gross receipts
are normally $25,000 or less, and it elects to file
the Form 990 or Form 990-EZ, it must complete the
entire return; otherwise, it must file the e-Postcard,
Form 990-N, electronically. An organization that only
completes those items of information on the Form
990 or Form 990-EZ that are required to be provided
on an electronic Form 990-N will not be deemed to
have met its electronic notice requirement. See Form
990-N, Electronic Notice (e-Postcard) forTax-Exempt
Organizations not Required To File Form 990 or 990EZ on page 16.
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Special Requirements for Supporting
Organizations and Donor Advised Funds
Public charities that are supporting organizations
described in section 509(a)(3) are generally required
to file Form 990 or Form 990-EZ even if their gross
receipts are normally $25,000 or less, effective for
returns filed after August 17, 2006. Supporting organizations of religious organizations need not file
Form 990 or Form 990-EZ if their gross receipts are
normally $5,000 or less. Such organizations will,
however, be required to file the Form 990-N.
Supporting organizations will be required to
indicate whether they are a Type 1, Type 2, a
Type 3-Functionally Integrated or Type 3-Other
supporting organization, identify their supported
organizations, and annually certify that they are not
controlled by a disqualified person. See the instructions for Schedule A (Form 990 or Form 990-EZ),
Public Charity Status and Public Support and Notice
2006-109 to determine an organization’s appropriate supporting organization type for information
return purposes. Learn about new requirements
applicable to supporting organizations on the IRS
Nonprofits and Charities Web site at www.irs.gov/eo.
Sponsoring organizations of donor advised funds
(defined as organizations that maintain one or
more donor advised funds), and organizations that
have controlled entities are required to file Form
990 rather than Form 990-EZ or 990-N.
Form 990 and Form 990-EZ
Form 990 consists of a core form and schedules.
Each organization that files the form must complete
the entire core form. The core Form 990 includes a
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Summary Page that provides a "snapshot" of the
organization's key financial and operating information for the current and prior year.
All Form 990 filers will provide information about
their program service accomplishments, compensation of certain officers, directors and key employees
as well as information about governance practices
and procedures and financial information.
Each organization that files Form 990 must complete Part IV of Form 990, Checklist of Required
Schedules, to determine which schedules it must
complete based on its activities. See the instructions for Form 990-EZ for information about which
schedules 990-EZ filers must complete.
Schedule A, Public Charity Status
and Public Support, and Schedule B,
Schedule of Contributors
Public charities that file Form 990 or Form 990-EZ
must file Schedule A of that return. Schedule A is
used to report information about the organization's
public charity status and public support.
A new organization will be classified as a public
charity, and not a private foundation, for its first
five years if it can show that it can reasonably be
expected to be publicly supported. If the organization can make this showing, it will be a public charity for its first five years regardless of the public
support it actually receives.
The IRS will monitor a new organization's public
charity status after the first five years of existence
based on the public support information reported
annually by the organization on Schedule A of
Form 990 based on a five year computation period
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that consists of the current year and the four years
immediately preceding the current year.
Beginning with the organization's sixth year and for
all succeeding years, if an organization meets the
public support test on Schedule A, the organization
will remain a public charity for that current year and
the next year.
If a publicly supported charity fails the public
support test for two consecutive years, it will be
reclassified as a private foundation.
An organization that received an advance ruling
determining it a publicly supported organization on
or after June 9, 2008, will automatically be classified
as a publicly supported organization and need not file
Form 8734 at the end of the advance ruling period.
See Publication 4220, Applying for 501(c)(3) TaxExempt Status, for details on the distinctions
between public charities and private foundations.
Also go to www.irs.gov/eo for additional information
on the elimination of the advance ruling process.
Most public charities that received contributions of
$5,000 or more from any one contributor must file
Schedule B, Schedule of Contributors. See Part IV,
line 2 of Form 990 and the instructions to Schedule
B (Form 990, 990-EZ) for complete instructions
Also see www.irs.gov/eo for additional information
about other schedules that a public charity may
be required to complete based on the nature of its
activities.
Reporting Excess Benefit Transactions
If a public charity believes it provided an excess
benefit to a person who is in a position to exercise
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substantial influence over the organization’s affairs,
it must report the transaction on Form 990 or Form
990-EZ. Excess benefit transactions are governed
by section 4958 of the Code. See Appendix G of the
Form 990 Instructions for a discussion of section
4958, and Schedule L, Part I, regarding reporting
of excess benefit transactions .
Form 990-N, Electronic Notice (e-Postcard)
for Tax-Exempt Organizations not Required
To File Form 990 or 990-EZ
Any public charity that is not required to file Form
990 or 990-EZ because its annual gross receipts are
normally $25,000 or less must instead file Form
990-N, Electronic Notice (e-Postcard) for Tax-Exempt
Organizations not Required to File Form 990 or
Form 990-EZ. Only churches, their integrated auxiliaries, and conventions or associations of churches,
and subordinate organizations included in a group
return filed by a parent organization are excused
from filing Form 990-N.
The Form 990-N is due by the 15th day of the
fifth month after the close of your tax period. For
example, if your organization’s tax period ends on
December 31, 2009, the Form 990-N is due May 15,
2010. The e-Postcard cannot be filed until the
organization's tax year ends.
You can access the e-Postcard filing system
through the IRS Charities and Nonprofits Web site,
www.irs.gov/eo or by going directly to the filing
system Web site at http://epostcard.form990.org.
The form must be completed and filed electronically. There is no paper form.
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An organization is required to provide the following
information on Form 990-N:
N
the organization’s legal name,
N
any other names the organization uses,
N
the organization’s mailing address,
N
the organization’s Web site address (if applicable),
N
the organization’s employer identification number
(EIN), also known as a taxpayer identification
number (TIN),
N
name and address of a principal officer of
the organization,
N
the organization’s annual tax period,
N
confirmation that the organization’s annual gross
receipts are still normally $25,000 or less, and
N
if applicable, a statement that the organization
has terminated or is terminating (going out of
business).
Read Filing Penalties and Revocation of Tax-Exempt
Status on page 18 on the consequences for failure
to file this annual electronic notice and www.irs.
gov/eo for information about the Form 990-N.
e-Filing Requirements
Public charities with $10 million or more in total
assets and that also file at least 250 returns in
a calendar year, (including income, excise, employment tax, and information returns such as Forms
W-2 and 1099), are required to electronically file
Form 990. Other public charities are given a choice
to file Form 990 electronically. Click on the “IRS
e-file” logo on the IRS Web site to get the facts
on e-filing.
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FILING PENALTIES AND
REVOCATION OF TAX-EXEMPT STATUS
If a Form 990 or Form 990-EZ is not filed, the IRS may
assess penalties on the organization of $20 per day until
it is filed. This penalty also applies when the filer fails to
include required information or to show correct information. The penalty for failure to file a return or a complete
return may not exceed the lesser of $10,000 or 5 percent
of the organization’s gross receipts. For an organization
that has gross receipts of over $1 million for the year,
the penalty is $100 a day up to a maximum of $50,000.
The IRS may impose penalties on organization managers who do not comply with a written demand that the
information be filed.
Section 6033(j) of the Code provides that failure to file
Form 990, Form 990-EZ, or Form 990-N for 3 consecutive
years results in revocation of tax-exempt status as of
the filing due date for the third return. An organization
whose exemption is revoked under this section must
apply for reinstatement by filing a Form 1023 and paying
a user fee, whether or not the organization was originally
required to file for exemption. Reinstatement of exemption may be retroactive if the organization shows that
the failure to file was for reasonable cause. Information
with respect to the implementation of Section 6033(i) is
available at www.irs.gov/eo.
Form 990-T, Exempt Organization
Business Income Tax Return
A public charity must file a Form 990-T, Exempt
Organization Business Income Tax Return, if it has
$1,000 or more of gross income from an unrelated
trade or business during the year. Net income from
income-producing activities is taxable if the activities:
N
constitute a trade or business,
N
are regularly carried on, and
N
are not substantially related to the organization’s
exempt purpose.
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Examples of unrelated business income may
include income from advertising in publications,
income from gaming (except for income from
traditional bingo under certain circumstances),
and income from the sale of merchandise unrelated
to the organization's exempt purpose. Whether an
income-producing activity is an unrelated trade
or business activity depends on all the facts and
circumstances. For more information, see IRS
Publication 598, Tax on Unrelated Business Income
of Exempt Organizations.
The public charity must pay quarterly estimated tax
on unrelated business income if it expects its tax for
the year to be $500 or more. Form 990-W, Estimated
Tax on Unrelated Business Taxable Income for TaxExempt Organizations, is a worksheet to determine
the amount of estimated tax payments required.
FORM 990-T FILING PENALTIES
An organization may be subject to interest and penalty
charges if it files a late return, fails to pay tax when due,
or fails to pay estimated tax, if required, even if it did not
expect its tax for the year to be $500 or more.
Exceptions and Special Rules
Income from certain trade or business activities
is excepted from the definition of unrelated business income. Earnings from these sources are
not subject to the unrelated business income tax.
Exceptions generally include business income from:
N
activities, including fundraisers, that are
conducted by volunteer workers, or where
donated merchandise is sold;
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N
activities conducted by a charitable organization
or by a governmental college or university for the
convenience of members, students, patients
or employees;
N
qualified conventions and trade shows;
N
qualified sponsorship activities; and
N
qualified bingo activities.
Income from investments and other “passive”
activities is usually excluded from the calculation
of unrelated business taxable income. Examples of
this type of income include earnings from routine
investments such as certificates of deposit, savings
accounts, or stock dividends, royalties, certain rents
from real property, and certain gains or losses from
the sale of property.
Special rules apply to income derived from real
estate or other investments purchased with borrowed funds. Such income is called “debt-financed”
income. Unrelated debt-financed income generally
is subject to the unrelated business income tax.
To learn about unrelated business income, get
Publication 598, Tax on Unrelated Business Income
of Exempt Organizations, Form 990-T instructions,
and Form 990-W instructions at www.irs.gov.
Employment Tax Returns
Like other employers, all public charities that pay
wages to employees must withhold, deposit, and
pay employment tax, including federal income
tax withholding and Social Security and Medicare
(FICA) taxes. A public charity must withhold federal
income tax from employee wages and pay FICA on
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each employee paid $100 or more in wages
during a calendar year.To know how much income
tax to withhold, a public charity should have a
Form W-4, Employee’s Withholding Allowance
Certificate, on file for each employee. Employment
taxes are reported on Form 941, Employer’s
Quarterly Federal Tax Return.
If a small employer (one who has withheld employment taxes of $1,000 or less during the year) has
been instructed by IRS to file Form 944, Employer’s
Annual Federal Tax Return instead of Form 941, the
employer must do so.The employer must file Form
944 even if there is no tax due or if the taxes exceed
$1,000 unless IRS tells it to file Form 941 (or it is filing a final return). See the instructions to Form 944
for information on how to have the filing requirement changed from Form 944 to Form 941.
Any person that fails to withhold and pay employment tax may be subject to penalties. Public charities do not pay federal unemployment (FUTA) tax.
Public charities do not generally have to withhold
or pay employment tax on payments to independent contractors, but they may have information
reporting requirements. If a charity incorrectly
classifies an employee as an independent contractor, it may be held liable for employment taxes for
that worker.
The requirements for withholding, depositing,
reporting and paying employment taxes are
explained in Publication 15, Circular E, Employer’s
Tax Guide. For help in determining if workers
are employees or independent contractors, see
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Publication 15-A, Employer’s Supplemental Tax
Guide. Publication 557, Tax Exempt Status forYour
Organization, covers the employment tax responsibilities of public charities.These IRS publications
can be downloaded at www.irs.gov.
Employment Taxes and Churches
Although churches are excepted from filing
Form 990, they do have employment tax responsibilities. Employees of churches or church-controlled
organizations are subject to income tax withholding, but may be exempt from FICA taxes. Like other
501(c)(3) organizations, churches are not required
to pay federal unemployment tax (FUTA). In addition, although ministers generally are common law
employees, they are not treated as employees for
employment tax purposes.These special employment tax rules for members of the clergy and
religious workers are explained in Publication 517,
Social Security and Other Information for Members
of the Clergy and Religious Workers. Churches
also should consult Publications 15 and 15-A and
Publication 1828, Tax Guide for Churches and
Religious Organizations.
Why keep records?
In general, a public charity must maintain books
and records to show that it complies with tax rules.
The charity must be able to document the sources
of receipts and expenditures reported on Form 990,
Return of Organization Exempt From IncomeTax or
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Form 990-EZ, Short Form Return of Organization
Exempt From Income Tax, and Form 990-T, Exempt
Organization Business Income Tax Return. (See
Prepare Annual Information and Tax Returns on
page 24.)
If an organization does not keep required records,
it may not be able to show that it qualifies for taxexempt status or should be classified as a public
charity.Thus, the organization may lose its taxexempt status or be classified as a private foundation
rather than a public charity. In addition, a public charity may be unable to complete its returns accurately
and, hence, may be subject to penalties described
under Filing Penalties and Revocation of Tax-Exempt
Status on page 18. When good recordkeeping
systems are in place, a public charity can evaluate
the success of its programs, monitor its budget, and
prepare its financial statements and returns.
Evaluate Charitable Programs
A charity can use records to evaluate the success
of its charitable program and determine whether
the organization is achieving desired results. Good
records can also help a charity identify problem
areas and determine what changes it may need to
make to improve performance.
Monitor Budgetary Results
Without proper financial records, it is difficult for a
charity to assess whether it has been successful
in adhering to budgetary guidelines.The ability to
monitor income and expenses and ensure that the
organization is operating within its budget is crucial
to successful stewardship of a public charity.
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Prepare Financial Statements
It is important to maintain sufficient financial
information in order to prepare accurate and timely
annual financial statements. A charity may need
these statements when it is working with banks,
creditors, contributors, and funding organizations.
Some states require charities to make audited
financial statements publicly available.
Prepare Annual
Information and Tax Returns
Records must support income, expenses, and
credits reported on Form 990 series and other tax
returns. Generally, these are the same records used
to monitor programs and prepare financial statements. Books and records of public charities must
be available for inspection by the IRS. If the IRS
examines a public charity’s returns, the organization must have records to explain items reported.
Having a complete set of records will speed up the
examination.
Identify Sources of Receipts
Public charities may receive money or property
from many sources. With thorough recordkeeping, a charity can identify the sources of receipts.
Organizations need this information to separate
program from non-program receipts, taxable from
non-taxable income, and to complete Schedule
A, as well as other schedules of the Form 990 the
organization may be required to complete, noted in
What federal information returns, tax returns, and
notices must be filed? An organization should maintain a list of its donors and grantors and the amount
of cash contributions or grants (or a description of
the noncash contributions) received from each.
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Substantiate Revenues, Expenses
and Deductions for Unrelated Business
Income Tax (UBIT) Purposes
An organization needs to keep records of revenues
derived from, and expenses attributable to, an
unrelated trade or business so that it can properly
prepare Form 990-T and calculate its unrelated
business taxable income.
Comply with Grant-Making
Procedures (Grants to Individuals)
A public charity that makes grants to individuals
must keep adequate records and case histories to
demonstrate that such grants serve its charitable
purposes. Case histories on grants to individuals
should show names, addresses, purposes of grants,
manner of selection, and relationship (if any) that
the recipient has with any members, officers,
trustees, or donors of the organization. For more
information about appropriate records required to
report on grants made within the United States,
see Schedule I of Form 990 and instructions. See
also Schedule F of Form 990 for information about
records required to report on foreign grants.
Comply with Racial Nondiscrimination
Requirements (Private Schools)
Private schools must keep records that show that
they have complied with requirements relating to
racial nondiscrimination, including annual publication of a racially nondiscriminatory policy through
newspaper or broadcast media to the general community served. For more information, see Schedule
E of Form 990.
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What records should be kept?
Except in a few cases, the law does not require a
special kind of record. A public charity can choose
any recordkeeping system, suited to its activities,
that clearly shows the organization’s income and
expenses.The types of activities a public charity
conducts determines the type of records that
should be kept for federal tax purposes. A public
charity should set up a recordkeeping system using
an accounting method that is appropriate for proper
monitoring and reporting of its financial activities
for the tax year. If a public charity has more than
one program, it should ensure that the records
appropriately identify the income and expense
items that are attributable to each program.
A recordkeeping system should generally include a
summary of transactions.This summary is ordinarily
written in the public charity’s books (for example,
accounting journals and ledgers).The books must
show gross receipts, purchases, expenses (other
than purchases), employment taxes, and assets.
For most small organizations, the checkbook might
be the main source for entries in the books while
larger organizations would need more sophisticated
ledgers and records. A public charity must keep
documentation that supports entries in the books.
Accounting Periods and Methods
A public charity must keep its books and records
based on an annual accounting period called a
tax year in order to comply with annual reporting
requirements.
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Accounting Periods - A tax year is usually 12 consecutive months.There are two types of tax years.
calendar tax year
This is a period of 12 consecutive
months beginning January 1 and
ending December 31.
fiscal tax year
This is a period of 12 consecutive
months ending on the last day of
any month except December.
Accounting Method - An accounting method is
a set of rules used to determine when and how
income and expenses are reported. A public
charity chooses an accounting method when it
files its first annual return.There are two basic
accounting methods:
cash method
Under the cash method, a public
charity reports income in the tax
year received. It usually deducts
expenses in the year paid.
accrual method
Under an accrual method, a public
charity generally records income in
the tax year earned, (i.e., in the tax
year in which a pledge is received,
even though it may receive payment
in a later year.) It records expenses
in the tax year incurred, whether or
not it pays the expenses that year.
For more information about accounting periods and
methods, see Publication 538, Accounting Periods
and Methods, and the instructions to Form 990 and
Form 990-EZ.
Supporting Documents
Organization transactions such as contributions,
purchases, sales, and payroll will generate supporting documents.These documents — grant applications and awards, sales slips, paid bills, invoices,
receipts, deposit slips, and canceled checks —
contain information to be recorded in accounting
records. It is important to keep these documents
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because they support the entries in books and the
entries on tax and information returns. Public charities should keep supporting documents organized
by year and type of receipt or expense. Also, keep
records in a safe place.
Records Management
GROSS RECEIPTS
Gross receipts are the amounts received from all
sources, including contributions. A public charity should
keep supporting documents that show the amounts
and sources of its gross receipts. Documents that show
gross receipts include: donor correspondence, pledge
documents, cash register tapes, bank deposit slips,
receipt books, invoices, credit card charge slips, and
Forms 1099-MISC, Miscellaneous Income.
PURCHASES, INCLUDING
ACCOUNTING FOR INVENTORY
Purchases are items bought, including any items resold
to customers. If an organization produces items, it must
account for any items resold to customers. Thus, for
example, the organization must account for the cost of
all raw materials or parts purchased for manufacture into
finished products. Supporting documents should show
the amount paid, and that the amount was for purchases.
Documents for purchases include: canceled checks,
cash register tape receipts, credit card sales slips, and
invoices. These records will help a public charity determine the value of its inventory at the end of the year.
See Publication 538, Accounting Periods and Methods,
for general information on methods for valuing inventory.
EXPENSES
Expenses are the costs a public charity incurs (other
than purchases) to carry on its program. Supporting
documents should show the amount paid and the
purpose of the expense. Documents for expenses
include: canceled checks, cash register tapes, contracts,
account statements, credit card sales slips, invoices,
and petty-cash slips for small cash payments.
EMPLOYMENT TAXES
Organizations that have employees must keep records
of compensation and specific employment tax records.
See Publication 15, Circular E, Employer’s Tax Guide,
for details.
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ASSETS & LIABILITIES
Assets are the property, such as investments, buildings
and furniture an organization owns and uses in its
activities. Liabilities reflect the pecuniary obligations of
the organization. A public charity must keep records to
verify certain information about its assets and liabilities.
Records should show:
- when and how the asset was acquired
- whether any debt was used to acquire the asset
- documents that support mortgages, notes, loans, or
other forms of debt
- purchase price
- cost of any improvements
- deductions taken for depreciation, if any
- deductions taken for casualty losses, if any, such as
losses resulting from fires or storms
- how the asset was used
- when and how the asset was disposed of
- selling price
- expenses of sale
Documents that may show the above information
include: purchase and sales invoices, real estate closing
statements, canceled checks, and financing documents.
If a public charity does not have canceled checks, it may
be able to show payment with certain financial account
statements prepared by financial institutions. These
include account statements prepared for the financial
institution by a third party. All information, including
account statements must be highly legible. The following
defines acceptable account statements.
29
IF payment is by:
THEN statement must show:
check
check number, amount, payee’s
name, and date the check amount
was posted to the account by the
financial institution
electronic
funds transfer
amount transferred, payee’s name,
and date the transfer was posted
to the account by the financial
institution
credit card
amount charged, payee’s name,
and transaction date
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How long should records be kept?
Public charities must keep records for federal tax
purposes for as long as they may be needed to document evidence of compliance with provisions of the
Code. Generally, this means the organization must
keep records that support an item of income or deduction on a return until the statute of limitations for that
return runs.The statute of limitations has run when the
organization can no longer amend its return and the
IRS can no longer assess additional tax. Generally, the
statute of limitations runs three years after the date the
return is due or filed, whichever is later. An organization may be required to retain records longer for other
legal purposes, including state or local tax purposes.
Record Retention Periods
Record retention periods vary depending on the types
of records and returns.
Permanent Records – Some records should be kept
permanently. These include the application for recognition of tax-exempt status, the determination letter
recognizing tax-exempt status, and organizing documents, such as articles of incorporation and by-laws,
with amendments, as well as board minutes.
Employment Tax Records – If an organization
has employees, it must keep employment tax records
for at least four years after the date the tax becomes
due or is paid, whichever is later.
Records for Non-Tax Purposes – When records are no
longer needed for tax purposes, an organization should
keep them until they are no longer needed for
non-tax purposes. For example, a grantor, insurance
company, creditor, or state agency may require that
records be kept longer than the IRS requires.
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What governance procedures
and practices should an
organization consider adopting
or have in place?
While federal law does not mandate any particular
management structures, operational policies or
administrative practices, it is important that public
charities be thoughtful about the governance practices that are most appropriate for that charity in
assuring sound operations and compliance with the
tax law. While you may not be required to have one
policy or another, the IRS is authorized by section
6033 to ask for information we consider to be relevant to tax administration, including governance.
Mission Statement and
Organizational Documents
The IRS encourages every charity to adopt, establish
and regularly review a mission statement to explain
the organization's purposes and guide its work.
Significant changes in your organizational documents
should be reported to the IRS, as noted below.
Governing Body
An active and engaged board is important to the
success of a public charity and compliance with the
tax law. A governing board should be composed of
persons who are informed and active in overseeing
a charity's operations and finances.To guard against
insider transactions that could result in misuse of
charitable assets, the governing board should include
independent members and should not be dominated by employees or others who are not independent because of business or family relationships.
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Governance and Management Policies
Although the Internal Revenue Code does not
require charities to have particular governance
and management polices, the IRS does encourage
boards of charities to consider whether the implementation of policies relating to executive compensation, conflicts of interest, investments, fundraising, documentation of governance decisions, document retention, and whistleblower claims may be
necessary and appropriate.
Further, if a public charity has chapters or affiliates,
it is encouraged to have procedures or policies in
place to ensure consistency in operations.
Financial Statements
and Information Reporting
Board members are encouraged to regularly
review the organization's financial statements
and information returns, and consider whether
an independent auditor is appropriate.
Transparency
Public charities are encouraged to adopt and monitor procedures to ensure that information about its
mission, activities, finance and governance is made
publicly available. Go to www.irs.gov/eo for more
information about governance.
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How should changes
be reported to the IRS?
Reporting Changes on the
Annual Information Return
A public charity that is required to file Form 990 or
Form 990-EZ must report name, address, structural
and operational changes on its annual information
return. Regardless of whether a public charity files an
annual information return, it may also report these
changes to the EO Determinations Office at the mailing address set out in How to get IRS assistance and
information at the end of this publication; however,
such reporting does not relieve the organization from
reporting the changes on its annual information return.
For information about informing the IRS of a termination or merger see Pub 4779, Facts AboutTerminating
or Merging Your Exempt Organizations.
TIP: Attach copies of any signed or state certified
articles of incorporation, or association, constitution
or trust instrument or other organization document,
or the bylaws or other governing document showing
changes to your return. If signed or state certified
copies of a governing document are not available,
an authorized officer may certify that the governing
document provided is a complete and accurate copy
of the original document.
Determination Letters and
Private Letter Ruling Requests
A public charity may request a copy of a lost
exemption letter or an updated exemption letter
that reflects a name or address change from the EO
Determinations office. A public charity that has had
a change in its public charity or private foundation
status should request a new determination letter
from the EO Determinations office as well. See
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How to get IRS assistance and information for the
appropriate address for the EO Determinations office.
An organization may request a determination letter
regarding the effect of certain changes on its tax
exempt status or public charity status. For example,
as noted above, a determination letter will be issued
to classify or reclassify an organization as a public
charity or a private foundation. A public charity may
also request a determination letter to approve the
treatment of a contribution as an unusual grant, or
to determine whether an organization is exempt from
filing annual information returns in certain situations.
However, the IRS will not make any determination
regarding any completed transaction.
If a public charity is unsure about whether a proposed
change in its purposes or activities is consistent with
its status as an exempt organization or as a public
charity, it may want to request a private letter ruling.
The IRS issues private letter rulings on proposed
transactions and on completed transactions—if the
request is submitted before the return is filed for the
year in which the transaction was completed.The IRS
generally does not issue rulings to public charities on
any other completed transactions.The IRS will issue
letter rulings to public charities on matters involving a
public charity’s exempt status, its public charity status,
as well as other matters including issues under sections 501 through 514, 4911, 4912, 4955, 4958, 6033,
6104, and 6115.
Consult www.irs.gov/eo for the appropriate procedures for preparing and submitting a request for a
determination letter, private letter ruling, replacement
exemption letter or a letter reflecting a new name
and address. For general information about reporting changes, you may contact EO customer service at
(877)829-5500.
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What disclosures are required?
There are a number of disclosure requirements for
public charities. Detailed information on federal tax
law disclosure requirements for 501(c)(3) tax-exempt
organizations can be found in Publication 557, Tax
Exempt Status for Your Organization, on the IRS
Charities and Nonprofits Web site at www.irs.gov/eo.
Public Inspection of Annual
Returns and Exemption Applications
A public charity must make the following documents
available for public inspection and copying upon
request and without charge (except for a reasonable
charge for copying). The IRS also makes these documents available for public inspection and copying.
A public charity may place reasonable restrictions
on the time, place, and manner of in person inspection and copying, and may charge a reasonable
fee for providing copies. It can charge no more for
the copies than the per page rate the IRS charges for
providing copies. See www.irs.gov/foia/index.html for
current IRS copying fees. Although the IRS charges no
fee for the first 100 pages, the organization can charge
a fee for all copies. The organization can also charge
the actual postage costs it pays to provide copies.
A tax-exempt organization does not have to comply
with individual requests for copies if it makes the
documents widely available. This can be done by posting the documents on a readily accessible Web site.
For details on disclosure rules and procedures for public charities, see Life Cycle of a Public Charity and the
instructions to Forms 990 and 1023 at www.irs.gov/eo.
Because certain forms, by law, must be made
publicly available by the IRS and the filer, do not
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include any personal identifying information, such
as social security numbers not required by the IRS,
on these forms.
Exemption Application – A public charity must
make available for public inspection its exemption
application, Form 1023, Application for Recognition
of Exemption Under Section 501(c)(3) of the
Internal Revenue Code, along with each of the
following documents:
N
all documents submitted with Form 1023;
N
all documents the IRS requires the organization
to submit in support of its application; and
N
the exemption ruling letter issued by the IRS.
Annual Information Return – A public charity must
make available for public inspection its annual
information return (Form 990 series) with schedules, attachments, and supporting documents
filed with the IRS. However, a public charity that
files a Form 990 or Form 990-EZ does not have to
disclose the names and addresses of contributors
listed on Schedule B. All other information, including the amount of contributions, the description of
noncash contributions, and any other information
provided will be open to public inspection unless it
clearly identifies the contributor.
NOTE: If an organization files a copy of Form 990,
or Form 990-EZ, and attachments, with any state,
it should not include its Schedule B in the attachments for the state, unless a schedule of contributors is specifically required by the state. States that
do not require the information might inadvertently
make the schedule available for public inspection
along with the rest of the Form 990 or Form 990-EZ.
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Certain information may be withheld from public
inspection. A return must be made available for a
period of three years from the date the return is
required to be filed or is actually filed, which ever
is later.
Form 990 -T – A public charity must make its Form
990-T filed after August 17, 2006 available for public
inspection. Schedules, attachments and supporting
documents filed with Form 990-T that do not relate
to unrelated business income tax are not required
to be made available. Read Notice 2007-45 and
Notice 2008-49 at www.irs.gov for interim guidance
regarding how the returns are to be made public.
See Announcement 2008-21 for procedures the
public may use to request a 501(c)(3) organization's
Form 990-T from the IRS.
Public Inspection and Disclosure Procedures –
A public charity may place reasonable restrictions
on the time, place, and manner of in-person inspection and copying, and may charge a reasonable fee
for providing copies. It can charge no more for the
copies than the per page rate the IRS charges for
providing copies. A tax-exempt organization does
not have to comply with individual requests for
copies if it makes the documents widely available.
This can be done by posting the documents on a
readily accessible Web site. For details on disclosure
rules and procedures for 501(c)(3) organizations, see
the Life Cycle of a Public Charity and the instructions
to Forms 990, 990-T and 1023 at www.irs.gov/eo.
All publicly-available information may be obtained
from the IRS for a fee by using Form 4506-A,
Request for Public Inspection or Copy of Exempt
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or Political Organization IRS Form. An organization
may obtain a complete copy of its own application
by filing Form 4506, Request for Copy of Tax Return.
PENALTIES
Penalties apply to responsible persons of a tax-exempt
organization who fail to provide the documents as required.
A penalty of $20 per day may apply for as long as the
failure continues. A $10,000 maximum penalty applies to
a failure to provide an information return; no maximum
penalty applies to application requests.
Sale of Free Government Information
If a public charity offers to sell, or solicits money
for, specific information or a routine service that
is available free from the federal government, the
organization must make an express statement
at the time of solicitation about the free service.
An organization that intentionally disregards this
requirement is subject to a penalty.
Charitable Contributions—
Substantiation And Disclosure
A public charity should be aware of the substantiation and recordkeeping rules imposed on donors
who intend to claim a charitable contribution deduction and the disclosure rules imposed on charities
that receive certain quid pro quo contributions.
Recordkeeping Rules
A donor cannot claim a tax deduction for any cash,
check, or other monetary contribution 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, date,
and the amount of the contribution.
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Substantiation Rules
A donor cannot claim a tax deduction for any
single contribution of $250 or more unless the
donor obtains a contemporaneous written
acknowledgment of the contribution from the
recipient public charity. A public charity may assist
the donor by providing a timely written statement
including the name of the public charity, date and
amount of any cash contribution, and description
of any non-cash contributions.
In addition, the acknowledgment should indicate
whether any goods or services were provided in
return for the contribution. If any goods or services
were provided in return for a contribution, the
organization should provide a description and good
faith estimate of the value of such goods or services.
The public charity may either provide separate
acknowledgments for each single contribution of
$250 or more or one acknowledgment to substantiate several single contributions of $250 or more.
Separate contributions are not aggregated for purposes of measuring the $250 threshold.
There are no IRS forms for the acknowledgment.
Letters, postcards, or computer-generated forms
with the above information are acceptable. An
organization can provide either a paper copy of the
acknowledgment or an electronic acknowledgment,
such as an e-mail, to the donor.
Disclosure Rules That Apply
to Quid Pro Quo Contributions
Contributions are deductible only to the extent
that they are gifts and no consideration is received
in return. Depending on the circumstances,
ticket purchases and similar payments made in
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conjunction with fundraising events may not qualify
as charitable contributions in full. A contribution
made by a donor in exchange for goods or services
is known as a quid pro quo contribution. A donor
may only take a charitable contribution deduction
to the extent that the contribution exceeds the fair
market value of the goods and services the donor
receives in return for the contribution.
If a public charity conducts fundraising events
such as benefit dinners, shows, and membership
drives, where something of value is given to those
in attendance, it must provide a written statement
informing donors of the fair market value of the
specific items or services it provided in exchange
for contributions.Token items and services of intangible religious value need not be taken into account.
A public charity should provide the written disclosure statement in advance of any event, determine
the fair market value of any benefit received, and
state this information in fundraising materials such
as solicitations, tickets, and receipts.The disclosure
statement should be made, at the latest, at the time
payment is received. Subject to certain exceptions,
the disclosure responsibility applies to any fundraising circumstance where each complete payment,
including the contribution portion, exceeds $75.
Read Publication 1771, Charitable Contributions—
Substantiation and Disclosure Requirements, and
Publication 526, Charitable Contributions, for details
on the federal tax law for organizations such as
public charities, including churches, that receive
tax-deductible charitable contributions and for
taxpayers who make contributions.
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How to get IRS assistance
and information
The IRS offers help that is accessible either online,
via mail by telephone, and 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 taxexempt status, annual filing requirements, and
information about exempt organizations through
the IRS Exempt Organizations (EO).
EO Web site
www.irs.gov/eo
Highlights:
NThe
Life Cycle of a Public Charity describes the
compliance obligations of charities.
N
Subscribe to the EO Update, an electronic
newsletter with information for tax-exempt organizations and tax practitioners who represent them.
EO Web based training
www.stayexempt.org
Web based training modules:
NTax
Exempt Status
N
Unrelated Business income
N
Employment Issues
N
Form 990
N
Required Disclosures
Mini-Courses on topics of interest
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EO Customer Service
(877) 829-5500
EO Determinations Office mailing address
Internal Revenue Service
TE/GE, EO Determinations Office
P.O. Box 2508
Cincinnati, OH 45201
Tax Publications for
Exempt Organizations
Get publications via the Internet or by calling the
IRS at (800) 829-3676.
Pub 1, Your Rights as a Taxpayer
Pub 15, Circular E, Employer’s Tax Guide
Pub 15-A, Employer’s Supplemental Tax Guide
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 Contribution
Pub 538, Accounting Periods and Methods
Pub 557, Tax-Exempt Status for Your Organization
Pub 571, Tax-Sheltered Annuity Programs
for Employees of Public Schools and Certain
Tax- Exempt Organizations
Pub 583, Starting a Business and Keeping Records
Pub 598, Tax on Unrelated Business Income of
Exempt Organizations
Pub 1771, Charitable Contributions –
Substantiation and Disclosure Requirements
Pub 1828, Tax Guide for Churches and
Religious Organizations
42
Pub 3079, Gaming Publication for
Tax-Exempt Organizations
Pub 3833, Disaster Relief, Providing Assistance
Through Charitable Organizations
Pub 4220, Applying for 501(c)(3) Tax-Exempt Status
Pub 4221-NC, Compliance Guide for Tax-Exempt
Organizations (other than those described in
section 501(c)(3))
Pub 4221-PF, Compliance Guide for 501(c)(3)
Private Foundations
Pub 4302, A Charity’s Guide to Vehicle Donations
Pub 4303, A Donor’s Guide to Vehicle Donations
Pub 4630, Exempt Organizations Products and
Services Navigator
Pub 4741, The New Form 990-What Tax-Exempt
Organizations Need to Know
Pub. 4742, New Form 990 Preparation Checklist
Pub 4752, The New e-Postcard (Form 990-N)—
What Smaller Organizations Need to Know
to Stay Tax-Exempt
Pub 4779, Facts about Terminating or Merging
Your Exempt Organization
Forms for Exempt Organizations
Get forms via the Internet or by calling the IRS at
(800) 829-3676.
Form 941, Employer’s Quarterly Federal Tax Return
Form 944, Employer’s Annual Federal Tax Return
Form 990, Return of Organization Exempt From
Income Tax
Form 990-EZ, Short Form Return of Organization
Exempt From Income Tax
43
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
Form 990-T, Exempt Organization Business Income
Tax Return
Form 990-W, Estimated Tax on Unrelated Business
Taxable Income for Exempt Organizations
Form 1023, Application for Recognition of
Exemption Under Section 501(c)(3) of the Internal
Revenue Code
Form 1024, Application for Recognition of
Exemption Under Section 501(a)
Form 1041, U.S. Income Tax Return for Estates
and Trusts
Form 4720, Return of Certain Excise Taxes Under
Chapters 41 and 42 of the Internal Revenue Code
Form 5578, Annual Certification of Racial
Non-Discrimination 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 8868, Extension of Time To File an Exempt
Organization Return
TD F 90-22.1, Report of Foreign Bank and
Financial Accounts
44
General IRS Assistance
Get materials on the latest tax laws, assistance with
forms and publications, and filing information.
IRS Web site
www.irs.gov
Federal tax questions
(800) 829-4933
Employment tax questions
(800) 829-4933
Order IRS forms and publications
(800) 829-3676
Publication 4221-PC (07-2009) Catalog Number 49829R
Department of the Treasury Internal Revenue Service
www.irs.gov