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Department of the Treasury
Internal Revenue Service
Instructions for Form 8940

(Rev. April 2023)
Request for Miscellaneous Determination

Section references are to the Internal Revenue • Private foundations giving notice only of to the later question may simply refer to
Code unless otherwise noted. intent to terminate private foundation your previous answer.
status under section 507(b)(1)(B)
Financial data. Financial data, whether
Future Developments (previously provided on Form 8940 or by
budgets or actual, should be consistent
For the latest information about general correspondence).
with other information presented in your
developments related to Form 8940 and requested determination. Budgeted
its instructions, such as legislation How To Get Forms and financial data should be prepared based
enacted after they were published, go to on your current plans. We recognize that
IRS.gov/Form8940. Publications
your actual financial results may vary from
Internet. You can access the IRS website the budgeted amounts.
Reminder 24 hours a day, 7 days a week, at IRS.gov
Don’t include social security numbers to do the following. Past, present, and planned activities.
on publicly disclosed forms. Because • Download forms, instructions, and Many items on Form 8940 are written in
the IRS is required to disclose certain publications. the present tense; however, base your
types of determination requests, don't • Order IRS products online. answers on your past, present, and
include social security numbers on this • Research your tax questions online. planned activities.
form. Documents subject to disclosure • Search publications by topic or Language and currency requirements.
include supporting information filed with keyword. Complete Form 8940 and attachments in
the form and correspondence with the IRS • Use the online Internal Revenue Code, English. Provide an English translation if
about the filing. regulations, or other official guidance. your organizational document, bylaws, or
• View Internal Revenue Bulletins (IRBs) any other attachments are in any other
Phone Help published since 1995. language.
If you have questions and/or need help • Sign up at IRS.gov/Charities to receive
completing Form 8940, please call local and national tax news by email. Report financial information in U.S.
dollars (specify the conversion rate used).
877-829-5500. This toll-free telephone Tax forms and publications. You can Combine amounts from within and outside
service is available Monday through download or print all of the forms and the United States and report the totals on
Friday. publications you may need at IRS.gov/ the financial statements.
Email Subscription FormsPubs. Otherwise, you can go to
The IRS provides a subscription-based IRS.gov/OrderForms to place an order Purpose of Form
email service for tax professionals and and have forms mailed to you. You should
representatives of tax-exempt receive your order within 10 business These instructions supplement the general
organizations. The IRS sends subscribers days. procedures for issuing determination
letters under Rev. Proc. 2022-5, 2022-1
periodic updates regarding exempt I.R.B. 256 (updated annually).
organization tax law and regulations, General Instructions Organizations described in section
available services, and other information.
To subscribe, visit IRS.gov/Charities. Social security number. Don't enter 501(a). Organizations exempt under
social security numbers on this form or section 501(a) file Form 8940 for
any attachments because the IRS is miscellaneous determinations under
What’s New required to disclose certain types of sections 507, 509(a), 4940, 4942, 4945,
Organizations filing Form 8940, Request approved determination requests. and 6033. Canadian registered charities
for Miscellaneous Determination, must Documents subject to disclosure include file Form 8940 to request inclusion in
complete and submit their Form 8940 supporting information filed with the form TEOS (Pub. 78 data) or request public
electronically (including paying the correct and correspondence with the IRS related charity status. Government entities
user fee) using Pay.gov. to the request. requesting voluntary termination of
exempt status under section 501(c)(3) file
In addition to the miscellaneous “You” and “us.” Throughout these Form 8940. See the specific instructions
requests that have previously been made instructions and Form 8940, the terms below for more information about each
using Form 8940, the following “you” and “your” refer to the organization type of request.
miscellaneous requests are now also that is requesting a miscellaneous
made on Form 8940: determination. The terms “us” and “we” Note. An organization applying for
• Government entities requesting refer to the IRS. recognition of exemption under section
voluntary termination of exempt status 501(c)(3) with Form 1023-EZ, Streamlined
under section 501(c)(3) (previously a letter Answers Application for Recognition of Exemption
request). Under Section 501(c)(3) of the Internal
• Canadian registered charities Form 8940 asks you to answer a series of
requesting inclusion in the Tax Exempt questions and provide information to Revenue Code, must file Form 8940 if it
Organization Search (TEOS) database of assist us in determining if you meet the wishes to obtain a determination regarding
organizations eligible to receive requirements of the miscellaneous advance approval of scholarship
tax-deductible charitable contributions determination you requested. Answer procedures under section 4945(g) or an
(Pub. 78 data) or a determination on questions completely. If an explanation exception from the filing requirements to
public charity classification (previously a provided for an earlier question also file Form 990, Return of Organization
letter request). applies to a later question, your response Exempt From Income Tax. However, an
organization applying for recognition of

Apr 3, 2023 Cat. No. 55341C

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exemption with Form 1023, Application for omitting any that don’t apply to your Authorized Representative
Recognition of Exemption Under Section request.
501(c)(3) of the Internal Revenue Code • Organizing document. Form 2848. Upload a completed Form
(not Form 1023-EZ), may simultaneously • Amendments to your organizing 2848 if you want to authorize a
request such determinations as part of its document in chronological order. representative to represent you regarding
Form 1023 and need not file Form 8940. • Bylaws or other rules of operation and your request. An individual authorized by
amendments. Form 2848 may not sign Form 8940
Nonexempt charitable trusts. unless that person is also an officer,
Nonexempt charitable trusts may also file • Form 2848, Power of Attorney and
Declaration of Representative. director, trustee, or other official who is
this form for an initial determination of authorized to sign the form.
foundation classification under section • Form 8821, Tax Information
509(a)(3). Authorization. A Centralized Authorization File
• Schedule A (Form 990), Part II or III. TIP (CAF) number isn’t required to be
Requesting Expedited Review • Form 990-PF, Part XIII-Private listed on Form 2848.
We generally review requests in the order Operating Foundations.
we receive them. We expedite processing • Form 872-B, Consent to Extend the Form 8821. Upload a completed Form
of a request only where a written request Time to Assess Miscellaneous Excise 8821 if you want to authorize us to discuss
presents a compelling reason for Taxes. your request with the person you have
processing the request ahead of others. • Supplemental responses (if your appointed on that form.
Even if your request for expedited response won't fit in the provided text
processing is approved, this does not field) and any additional information you Form 8821 doesn’t authorize your
mean your request will be immediately want to provide to support your request. appointee to advocate your position with
approved or denied. Expedited processing • Expedite request. respect to federal tax laws; to execute
waivers, consents, or closing agreements;
means that it will be assigned to a Put your name and EIN on each page or to otherwise represent you before the
specialist for review ahead of requests of your supplemental response and IRS. If you want to authorize an individual
received earlier in time. Circumstances identify the part and line number to which to represent you, use Form 2848.
generally warranting expedited processing the information relates.
include the following. After You Submit Form
• A grant to the applicant is pending and How To File
8940
the failure to secure the grant may have an As of April 3, 2023, the IRS requires that
adverse impact on the organization's the Form 8940, Request for Miscellaneous No additional information needed. If
ability to continue operations. Determination, be submitted electronically our review shows that you meet the
• The purpose of the newly created online at Pay.gov. To submit Form 8940, requirements for your requested
organization is to provide disaster relief to you must: miscellaneous determination, we’ll send
victims of emergencies such as floods and you a determination letter stating that your
hurricanes. 1. Register or have previously
• An IRS error has caused delays in registered for an account on Pay.gov. request was approved.
review of the form. 2. Enter “Form 8940” or “8940” in the Additional information needed. If we
search box and select Form 8940. can’t make a determination without more
User Fee information, we’ll write or call you.
3. Complete the form.
The law requires payment of a user fee Examples of the types of questions you
with each request. You must pay this fee may be asked are available at Application
through Pay.gov when you file Form 8940. Filing Assistance for Exemption or Misc. Determination:
Payments can be made directly from your For help in completing this form or general Sample Questions. If the additional
bank account or by credit or debit card. questions relating to an exempt information you provide shows that you
You won't be able to submit Form 8940 organization, you may access information meet the requirements for your request,
without paying the correct fee. on our website at IRS.gov/EO. we’ll send you a letter approving your
User fee amounts are listed in Rev. You may find the following publications request. If we determine that you don’t
Proc. 2022-5, 2022-1 I.R.B. 256 (updated available on IRS.gov helpful. meet the requirements for your request,
annually). For the current Form 8940 user • Pub. 557, Tax-Exempt Status for Your we’ll send you a letter that explains our
fee, go to IRS.gov/Charities-Non-Profits/ Organization. position and your appeal rights (if
User-Fees-for-Tax-Exempt-and- • Pub. 598, Tax on Unrelated Business applicable).
Government-Entities-Division. You can Income of Exempt Organizations. Annual Return or Notice While
also call 877-829-5500. • Pub. 3079, Tax-Exempt Organizations
and Gaming. Your Request Is Pending
• Pub. 4221-NC, Compliance Guide for Unless you qualify for an exception from
What To File Tax Exempt Organizations (other than the requirement to file an annual return or
All organizations must complete Parts I 501(c)(3) Public Charities and Private notice, your filing obligations began as
through IV, including any applicable Foundations). soon as you were formed. You can find
Schedules of Form 8940 plus any required • Pub. 4221-PC, Compliance Guide for information on return filing requirements
attachments. Submit a separate request 501(c)(3) Public Charities. and exceptions in Pubs. 557 and 598, and
for each type of request set forth in Part II. • Pub. 4221-PF, Compliance Guide for in the instructions for Forms 990 and
501(c)(3) Private Foundations. 990-EZ.
Attachments to Form 8940
A complete request may include one or You may also be required to file
more documents in addition to Form 8940. Signature Requirements TIP other returns, such as
An officer, director, trustee, or other official employment tax returns or benefit
Pay.gov can accommodate only one who is authorized to sign for you must plan returns, which aren't discussed here.
uploaded file. Before submitting Form digitally sign Form 8940 at the end of Part
8940, consolidate your attachments into a IV. The signature must be accompanied
single PDF file. Combine your by the title or authority of the signer and
attachments in the following order, the date.

-2- Instructions for Form 8940 (Rev. 04-2023)

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        If a Form 990-series return is due  If you post the documents on your 
  !     while your request is pending,      website, you can give any person             Specific Instructions
CAUTION complete and submit the return      requesting copies the website where the 
according to Form 990-series instructions.  documents may be found, but you don’t        Part I. Identification of 
                                            need to provide copies of the information. 
                                            However, even if these documents are         Applicant
Public Inspection                           posted on your website, you must still       Line 1. Full name of applicant.   Enter 
Information available for public in-        allow public inspection without charge at    your complete name exactly as it appears 
spection. If your requested                 your main office during regular business     in your organizing document, including 
miscellaneous determination is among        hours.                                       amendments.
those disclosable to the public, the        Documents aren't considered available        Line 2. If you have an “in care of” name, 
information that will be open for public    for public inspection on a website if the    enter it here; otherwise, leave this space 
inspection includes the following.          otherwise disclosable information is edited  blank.
• Your complete Form 8940 and any           or subject to editing by a third party when 
supporting documents.                       posted. To date, the IRS hasn’t approved     Lines 3–9. Mailing address. Enter your 
• All correspondence between you and        any third-party websites for posting.        complete address where all 
the IRS concerning Form 8940, including     See Pub. 557 for additional information      correspondence will be sent. If mail isn't 
Form 2848.                                  on public inspection requirements.           delivered to your street address and you 
• Your determination letter.                                                             have a P.O. box, list your P.O. box 
• Annual information returns (Form 990,     Foreign Organizations                        information instead of your street address. 
990-EZ, or 990-N) including schedules,      Foreign organizations are those that were    For a foreign address, enter your province 
except for the names and addresses of       created in countries other than the United   or state and foreign postal code where 
contributors and other identifying          States, its territories, or its possessions. indicated.
information about contributors.             Foreign organizations may request            Line 10. Employer identification num-
Information not available for public in-    miscellaneous determinations in the same     ber (EIN). You must have your own EIN. 
spection. The following items won’t be      way that domestic organizations request      Enter the 9-digit EIN the IRS assigned to 
open for public inspection.                 miscellaneous determinations. See            you. If you don't have an EIN, you must 
• Any information relating to a trade       Language and currency requirements,          apply for one before submitting your 
secret, patent, style of work, or apparatus earlier.                                     request. You can find out how to apply for 
that, if released, would adversely affect            Contributions by U.S. residents to  an EIN by visiting IRS.gov and searching 
you (we must approve withholding this       TIP      foreign organizations generally     for “apply for an EIN.” You may apply for 
information).                                        aren’t deductible. Tax treaties     an EIN online or by fax or mail. 
• Any other information that would          between the United States and certain        International applicants may call 
adversely affect national defense (we       foreign countries provide specific limited   267-941-1099 (toll call).
must approve withholding this               exceptions.                                          Don't apply for an EIN more than 
information).                                                                            TIP     once. If you’re unsure of your EIN 
• User fee payment information.             Annual returns for foreign organiza-                 or whether you have one, call 
• Contributors’ names and addresses         tions. A foreign organization that           877-829-5500 for assistance.
and other identifying information about     establishes or claims tax-exempt status 
contributors included with Form 990 or      generally must file an information return            Don’t use the EIN of a related or 
990-EZ.                                     annually (Form 990 or 990-EZ). However,      !       other organization.
  When submitting your request for a        a foreign organization (other than a private CAUTION
miscellaneous determination, you must       foundation or supporting organization) 
clearly identify any information that isn’t may file Form 990-N (e-Postcard) instead     Line 11. Month tax year ends.     Select 
open to public inspection by marking it as  of Form 990 or 990-EZ when its gross         the month your tax year (annual 
“NOT SUBJECT TO PUBLIC                      receipts from U.S. source income are         accounting period) ends. Your tax year is 
INSPECTION” and include an explanation      normally $50,000 or less and it hasn't       the 12-month period on which your annual 
of why you’re asking for the information to conducted significant activity in the United financial records are based.
be withheld. We will decide whether to      States. See the instructions for Forms 990           Check your bylaws or other rules 
withhold the identified information from    and 990-EZ for further information. A        TIP     of operation for consistency with 
public inspection.                          foreign organization that is subject to              the tax year you enter here.
Making documents available for public       unrelated business income tax must file 
inspection. Both you and the IRS must       Form 990-T, Exempt Organization              Line 12. Person to contact. Enter the 
make the information that is subject to     Business Income Tax Return.                  name and title of the person you want us 
disclosure available for public inspection. Organizations created in U.S. territo-       to contact if we need more information. 
The public may request a copy of the        ries and possessions. Organizations          The person to contact may be an officer, 
information available for public inspection created in possessions and territories of    director, trustee, or other individual who is 
from us by submitting Form 4506-B. The      the United States are generally treated as   permitted to speak with us according to 
public may also request inspection of the   domestic organizations. If you were          your bylaws or other rules of operation. 
information or a copy of the information    created in a U.S. possession or territory,   Your person to contact may also be an 
directly from you.                          you must complete all required parts of      authorized representative, such as an 
  You may post the documents required       Form 8940 to request a miscellaneous         attorney, certified public accountant, or 
to be available for public inspection on    determination.                               enrolled agent, for whom you’re submitting 
                                                                                         a completed Form 2848 with Form 8940.
your own website. Information returns and   Annual filing requirements for an 
your exemption application materials must   organization created in a U.S. territory or  Line 13. Provide a daytime telephone 
be posted exactly as filed with the IRS.    possession are similar to those outlined     number for the contact listed on line 12.
You may only delete the information that    above for foreign organizations (see         Line 14. You may provide a fax number 
isn't open for public inspection.           Regulations section 1.6033-2(g)(1)(viii)).   for the contact listed on line 12.

Instructions for Form 8940 (Rev. 04-2023)                  -3-

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Line 15. Pay.gov will populate this field       1.6033-2(g) and (h) and Rev. Proc. 96-10,      Reclassification of foundation status. 
with the current user fee for filing Form       1996-1 C.B. 577.                               Check this box if you are requesting a 
8940.                                           If you are claiming an exception from          reclassification of foundation status. 
                                                Form 990 filing requirements as a state        These instructions supplement the 
Line 16. If you have a website, enter the 
                                                institution (other than a section 509(a)(3)    procedures set forth in Rev. Proc. 2022-5, 
complete web address. Also, list any 
                                                supporting organization) whose income is       2022-1 I.R.B. 256 (updated annually). 
websites maintained on your behalf. The 
                                                excluded from gross income under section       Complete Form 8940, Schedule G.
information on your website should be 
                                                115, at the end of this form, upload a copy 
consistent with the information in your                                                          Also check this box if:
                                                of the ruling letter from the IRS stating that 
Form 8940.                                                                                     • You erroneously determined that you 
                                                your income, derived from activities           were a private foundation but you were 
Line 17. Officers, directors, and trust-        constituting the basis for your exemption      actually qualified, and have continued to 
ees. Enter the full names, titles, and          under section 501(c), is excluded from         qualify, as a public charity since your 
mailing addresses of your officers,             gross income under section 115.                inception as an organization described in 
directors, and/or trustees. You may use         If you believe you should be exempt            section 501(c)(3).
the organization's address for mailing. If      from filing Form 990 or 990-EZ because         • You are a public charity seeking 
you have more than five entries, check the      you are a governmental unit or affiliated      classification as a private foundation.
box provided to add more officer, director,     with a governmental unit, please review 
and/or trustee information.                     Rev. Proc. 95-48, 1995-2 C.B. 418.             Note. A public charity that has become a 
The person who is signing Form 8940             If you are claiming an exception from          private foundation can indicate its new 
must be listed within the first five entries of Form 990 filing requirements as an             private foundation status simply by filing a 
line 17.                                        organization described in section 501(c)       Form 990-PF, Return of Private 
                                                (1), at the end of this form, upload a copy    Foundation or Section 4947(a)(1) Trust 
Part II. Type of Request                        of your determination letter or other          Treated as a Private Foundation, and 
Line 1.  Select the item that best              documentation from the IRS that indicates      following any procedures specified in the 
describes your request. Submit a separate       whether you are described in section           form, instructions, or other published 
request for each type of request set forth      501(c)(1).                                     guidance.
                                                                                               • You are a private foundation seeking 
in Part II. For additional information on any   Advance approval that a potential              classification as an operating foundation 
of the determination issues covered by          grant or contribution is an “unusual           or exempt operating foundation.
Form 8940, visit our website at                 grant.” Check this box if you are              • You are a nonexempt charitable trust 
IRS.gov/EO.                                     requesting advance approval that a grant       described in section 4947(a)(1) and are 
Advance approval of certain                     (including a contribution or bequest for this  requesting an initial determination that you 
set-asides described in section                 purpose) is an “unusual grant.” Complete       are described in section 509(a)(3).
4942(g)(2). Check this box if you are (1)       Form 8940, Schedule E.                           A private foundation that wishes to 
a private foundation requesting approval        If you are described in sections 509(a)        become a public charity does not check 
of a set-aside as described in section          (1) and 170(b)(1)(A)(vi) or section 509(a)     this box but instead must terminate its 
4942(g)(2), or (2) a non-functionally           (2), you may request a determination that      private foundation status. See Termination 
integrated supporting organization              a grant you received be classified as an       of private foundation status under section 
requesting approval of a set-aside as           “unusual grant” under Regulations section      507(b)(1)(B) below.
described in Regulations section                1.170A-9(f)(6)(ii) or 1.509(a)-3(c)(3).
                                                                                               Required attachments. 
1.509(a)-4(i)(6)(v). Complete Form 8940,        Regulations sections 1.170A-9(f)(6)(iii)       • If you are requesting reclassification as 
Schedule A.                                     and 1.509(a)-3(c)(4) set forth the criteria    a public charity described under sections 
Advance approval of voter registration          for an unusual grant. Grants are               509(a)(1) and 170(b)(1)(A)(iv), 509(a)(1) 
activities described in section 4945(f).        considered unusual if each of the following    and 170(b)(1)(A)(vi), or 509(a)(2), submit 
Check this box if you are requesting            three requirements is met.                     a completed Schedule A (Form 990), Part 
advance approval of voter registration          1. The grant is attracted by reason of         II or III (as applicable).
activities described in section 4945(f).        the publicly supported nature of the           • If you are requesting reclassification as 
Complete Form 8940, Schedule B.                 organization;                                  a private operating foundation, submit a 
Advance approval of individual grant            2. The grant is unusual or unexpected          completed Form 990-PF, Part 
procedures. Check this box if you are a         with respect to the amount thereof; and        XIII—Private Operating Foundations.
private foundation and are requesting           3. The grant, by reason of its size,           Termination of private foundation sta-
advance approval of your individual             would adversely affect the status of the       tus under section 507(b)(1)(B)—ad-
grant-making procedures under section           organization as normally being publicly        vance ruling request.     Check this box if 
4945(g). Complete Form 8940,                    supported for the applicable period.           you are requesting an advance ruling on 
Schedule C.                                                                                    termination of your private foundation 
                                                In determining whether a particular            status under section 507(b)(1)(B). 
Exception from Form 990 filing re-              grant may be excluded as an unusual            Complete Form 8940, Schedule H.
quirements. Check this box if you are           grant, all pertinent facts and 
requesting an exception from filing Form        circumstances will be taken into                 An organization may terminate its 
990, Return of Organization Exempt From         consideration. No single factor will           private foundation status under section 
Income Tax; Form 990-EZ, Short Form of          necessarily be determinative.                  507(b)(1)(B) if it meets the requirements of 
Organization Exempt From Income Tax; or                                                        section 509(a)(1), (2), or (3)) for a 
Form 990-N (e-Postcard). Complete Form          Change in type (or initial determina-          continuous 60-month period beginning 
8940, Schedule D.                               tion of type) for 509(a)(3) organiza-          with the first day of any tax year, and 
                                                tions. Check this box if you are a 509(a)      notifies the IRS before beginning the 
If you believe you should be exempt             (3) supporting organization requesting a       60-month period that it is terminating its 
from Form 990 filing requirements               change in Type or initial determination of     private foundation status.
because you are affiliated with a church or     Type. Complete Form 8940, Schedule F.            An organization that seeks an advance 
a convention or association of churches, 
please review Regulations sections                                                             ruling and files Form 8940 will be required 

                                                                 -4-                           Instructions for Form 8940 (Rev. 04-2023)

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to complete and submit Form 872-B            as tax exempt under the United States–        disbursed. A set-aside under the suitability 
agreeing to extend the statute of            Canada Income Tax Convention (Treaty).        test requires advance approval. Similar 
limitations for paying the section 4940      Check this box if you are a Canadian          rules apply to a non-functionally integrated 
excise tax on net investment income until    charity and want to be listed as an           (NFI Type III) supporting organization 
after the end of the 60-month period. You    organization described in section 501(c)      under Regulations section 1.509(a)-4(i)(6)
must also establish immediately after the    (3) on IRS.gov or request classification as   (v).
end of the 60-month period that you have     a public charity rather than a private 
                                                                                                   Requests must be submitted 
met the requirements of section 509(a)(1),   foundation. Complete Form 8940, 
                                                                                                   before the end of the tax year in 
(2), or (3).                                 Schedule K.                                   CAUTION!
                                                                                                   which the amount is set aside.
Note. If you erroneously determined that     Part III. Explanation of                      Contingent set-aside. If a private 
you were a private foundation but actually 
qualified, and have continued to qualify,    Request                                       foundation is involved in litigation and 
                                                                                           cannot distribute assets or income 
as a public charity, you may request         Line 1. Describe completely and in detail     because of a court order, the foundation 
retroactive reclassification as a public     your request for miscellaneous                may request approval of a set-aside of 
charity instead of terminating private       determination. Your description should        amounts held pursuant to the court order 
foundation status under section 507(b)(1)    include the nature of the request as well     that otherwise would be distributed as 
(B). Select Part II, Reclassification of     as the reason(s) for making the request.      qualifying distributions, known as a 
foundation status, instead. You must 
demonstrate that you have continuously       For more information on what to               contingent set-aside. See Regulations 
qualified as a public charity since your     include, see the instructions for your        section 53.4942(a)-3(b)(9). If you are 
inception as an organization described in    specific request in the appropriate           requesting approval of a contingent 
section 501(c)(3).                           schedule(s) in these instructions.            set-aside, at the end of this form, upload a 
                                                                                           copy of the court order restricting you from 
Notice Only – Termination of private         Part IV. Signature                            distributing assets or income.
foundation status under section 
507(b)(1)(B). Check this box if you are      Signature requirements.   An officer,         Note.   A contingent set-aside is available 
providing notice only on termination of      director, trustee, or other official who is   only to a private foundation. A 
your private foundation status under         authorized to sign for the organization       non-functionally integrated Type III 
section 507(b)(1)(B). Complete Form          must sign Form 8940. The signature must       supporting organization cannot request a 
8940, Schedule I.                            be accompanied by the title or authority of   set-aside under Regulations section 
                                             the signer and the date.
An organization may terminate its                                                          1.509(a)-4(i)(6)(v), applying principles set 
private foundation status under section              The person signing Form 8940          forth in Regulations section 
507(b)(1)(B) if it meets the requirements of TIP     must be listed as an officer,         53.4942(a)-3(b)(7).
section 509(a)(1), (2), or (3) for a                 director, or trustee within the first Line 1a. State the amount of the 
continuous 60-month period beginning         five entries of Part I, line 17.              set-aside.
with the first day of any tax year, and 
notifies the IRS before beginning the                                                      Line 1b. Check “Yes” if the amount set 
60-month period that it is terminating its   Upload Checklist                              aside will be paid by the last day of your 
                                                                                           tax year after your tax year in which the 
private foundation status.                   Documents to upload.    Check the boxes       litigation is terminated. If “No,” explain.
Form 872-B is optional for                   to indicate which documents are included 
organizations not requesting an advance      in the file you upload with your form.        Note.   If the litigation encompasses more 
ruling but, if the organization chooses not  Enter your name and EIN on each page          than one tax year, you may seek 
to submit the form, it must pay the taxes    of your supplemental response and             additional contingent set-asides.
on its investment income during the          identify the schedule/section and line 
period. The organization must also           number to which the information relates.      Line 2. Describe the nature and purposes 
establish immediately after the end of the                                                 of the project and the amount of the 
60-month period that it has met the          Pay.gov can accommodate only one              set-aside.
requirements of section 509(a)(1), (2), or   uploaded file. Consolidate your               Line 3. Describe the amounts and dates 
(3).                                         attachments into a single PDF file not to     of planned additions to the set-aside after 
                                             exceed 15MB.
Termination of private foundation sta-                                                     its initial establishment, if applicable.
tus under section 507(b)(1)                  If your PDF file exceeds the 15MB limit,      Line 4. Explain why the project can be 
(B)—60-month period ended.        Check      remove any items over the limit and           better accomplished by a set-aside rather 
this box if you have completed the           contact IRS Customer Account Services         than an immediate payment of funds.
60-month termination of foundation status    at 877-829-5500 for assistance on how to      Specific projects that can be better 
period. Complete Form 8940, Schedule J.      submit the removed items.                     accomplished by the use of a set-aside 
Voluntary termination of section                                                           include, but are not limited to, projects in 
501(c)(3) recognition by a government                                                      which relatively long-term grants or 
entity. In Part III, describe how you are a  Schedule A. Advance                           expenditures must be made in order to 
government entity not subject to federal     Approval of Certain                           assure the continuity of particular 
income tax (without regard to section        Set-asides                                    charitable projects or program-related 
501(a)), and provide a statement that you                                                  investments (as defined in section 
are requesting to voluntarily terminate      Line 1. Suitability test set-aside.   If the  4944(c)) or where grants are made as part 
your recognition under section 501(c)(3).    requirements of section 4942(g)(2) and        of a matching-grant program. Such 
                                             Regulations section 53.4942(a)-3(b) are       projects include, for example, a plan to 
Canadian registered charities: listing       met, a private foundation may treat an        erect a building to house the direct 
on Pub. 78 Data and/or public charity        amount set aside for a specific charitable    charitable, educational, or other similar 
classification. A Canadian charity           project as a qualifying distribution in the   exempt activity of the private foundation 
registered by the Canada Revenue             year of the set-aside rather than in the      (such as a museum building in which 
Agency (CRA) is automatically recognized     year in which the amount is actually 

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paintings are to be hung), even though the 501(c)(3) that meets the requirements of Schedule C. Advance
exact location and architectural plans section 4945(f) is not considered a taxable
have not been finalized; a plan to expenditure even though the grant is Approval of Individual
purchase an additional group of paintings earmarked for voter registration purposes, Grant Procedures
offered for sale only as a unit that requires generally.
Described in Section
an expenditure of more than one year's
income; or a plan to fund a specific An organization will be given an 4945(g)
research program that is of such advance ruling that it is described in A private foundation's grant to an
magnitude as to require an accumulation section 4945(f) for its first tax year of individual for travel, study, or similar
of funds before beginning the research, operation if it submits evidence purposes generally is a taxable
even though not all of the details of the establishing that it can reasonably be expenditure unless the foundation obtains
program have been finalized. expected to meet the tests under section advance IRS approval of its grant
4945(f) for such year. procedures.
Line 5. Describe the project, including
estimated costs, sources of any future Line 1. Answer “Yes” if you are described
funds expected to be used to complete the in section 501(c)(3) and exempt from The 45th day after a request for
project, and location of any physical taxation under section 501(a). If “No,” stop approval of grant procedures has been
facilities to be acquired or constructed as and do not submit Form 8940 to request properly submitted to the IRS and the
part of the project. advance approval of voter registration organization has not been notified that
activities under section 4945(f). such procedures are not acceptable, such
Line 6. Answer “Yes” if the amounts to be procedures shall be considered as
set aside will actually be paid within a Line 2. Describe how your voter approved from the date of submission until
specified period of time that ends not registration activities are conducted in a receipt of actual notice from the IRS that
more than 60 months after the date of the nonpartisan manner. such procedures do not meet the
first set-aside. Line 3. Answer “Yes” if your voter requirements of this section. If a grant to
Line 6a. State the extension of time registration activities are confined to one an individual for a purpose described in
required. specific election period. section 4945(d)(3) is made after
notification to the organization by the IRS
Line 6b. Explain why the proposed Line 4. Answer “Yes” if your voter that the procedures under which the grant
project could not be divided into two or registration activities are carried out in five is made are not acceptable, such grant is
more projects covering periods of no more or more states. a taxable expenditure under this section.
than 60 months each. Line 5. Answer “Yes” if you spend at least
Line 7. Answer “Yes” if you are described 85% of your income directly for the active For more information about advance
under section 509(a)(3) as a conduct of activities constituting the approval of grant-making procedures of a
non-functionally integrated Type III purpose or function for which you are private foundation, go to IRS.gov/
supporting organization. organized and operated rather than to Charities-Non-Profits/Private-
make grants to fund the activities of other Foundations/Advance-Approval-of-Grant-
Line 7a. Answer “Yes” if you have organizations. Making-Procedures.
obtained a written statement from each Line 1. Check the appropriate box(es)
supported organization whose exempt Line 6. Answer “Yes” if you receive at
purpose the specific project least 85% of your support (other than indicating under which section(s) you want
accomplishes, signed under penalty of gross investment income) from exempt your grant-making procedures to be
perjury by one of their principal officers, organizations, the general public, considered.
stating that they approve the project as governmental units, or any combination of Check the box for section “4945(g)(1)”
one that accomplishes one or more of those. if the purpose of your award is to provide a
scholarship or fellowship grant that is
their exempt purposes and also approves Line 7. Answer “Yes” if you receive more awarded on an objective and
their determination that the project is one than 25% of your support (other than nondiscriminatory basis and is used for
that can be better accomplished by such a gross investment income) from any one study at a school.
set-aside than by the immediate payment exempt organization.
of funds. Check the box for section “4945(g)(3)”
Note. For this purpose, treat private if the purpose of your award is to achieve
Line 7b. Provide an explanation of how foundations that are described in section a specific objective, produce a report or
you meet the responsiveness test under 4946(a)(1)(H) with respect to each other other similar product, or improve or
Regulations section 1.509(a)-4(i)(3) with as one exempt organization. enhance a literary, artistic, musical,
respect to a supported organization whose scientific, teaching, or other similar
exempt purposes are accomplished by the Line 8. Answer “Yes” if you receive more capacity, skill, or talent of the recipient.
specific project. than 50% of your support from gross Include your educational loan program
investment income. under this section.
Schedule B. Advance Line 9. Answer “Yes” if any contributions You may check more than one box.
Approval of Voter to you for voter registration drives are If your prizes or awards are not
subject to conditions that they may be intended to finance a future activity of the
Registration Activities used only in specified states or other recipient and impose no conditions on the
Described in Section localities of the United States, or that they recipient as to how they may be spent, you
4945(f) may be used in only one specific election do not have to request advance approval
An exempt private foundation may pay or period and explain. of your grant-making procedures for such
incur amounts for voter registration prizes or awards because such a prize or
activities without such amounts being award is not a grant for travel, study, or
treated as taxable expenditures if the other similar purposes. See Revenue
requirements of section 4945(f) are met. In Rulings 77-380, 1977-2 C.B. 419; 76-460,
addition, a grant by a private foundation to 1976-2 C.B. 371; and 75-393, 1975-2 C.B.
an organization described in section 451.

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Line 2. If you conduct more than one             (G) a trust or estate in which persons       Section 1 or 2 of Schedule D (as 
grant program, describe each program             described in subparagraph (A), (B), (C), or  applicable).
separately.                                      (D) hold more than 35% of the beneficial 
                                                 interest.                                    If you are claiming an exception from 
If you make educational loans,                   Section 4946(b) defines the term             Form 990 filing requirements as a state 
describe the terms of the loan (for              “foundation manager,” with respect to any    institution (other than a section 509(a)(3) 
example, the factors you consider in             private foundation as an officer, director,  supporting organization) whose income is 
selecting or approving loan recipients,          or trustee of a foundation (or an individual excluded from gross income under section 
interest rate, duration, forgiveness             having powers or responsibilities similar to 115, at the end of this form, upload a copy 
provision, etc.). Also, describe whether         those of officers, directors, or trustees of of the ruling letter from the IRS stating that 
any financial institutions or other lenders      the foundation).                             your income, derived from activities 
are involved in your program.                                                                 constituting the basis for your exemption 
Explain how you will publicize your              Line 10.  Answer “Yes” if you will:          under section 501(c), is excluded from 
program and whether you publicize to the          (1) arrange to receive and review           gross income under section 115.
general public or to another group of             grantee reports annually and upon           If you believe you should be exempt 
possible recipients. Include specific             completion of the purpose for which         from filing Form 990 or 990-EZ because 
information about the geographic area in          the grant was awarded;                      you are a governmental unit or affiliated 
which your program will be publicized and         (2) investigate diversions of funds         with a governmental unit, please review 
the means you will use, such as through           from their intended purposes upon           Rev. Proc. 95-48, 1995-2 C.B. 418. 
newspaper advertisements, school district         having reason to expect such                Complete Form 8940, Section 4 of 
announcements, or community groups.               diversions (including failure to receive    Schedule D.
                                                  required reports); and
Line 3. Organizations that make grants to         (3) take all reasonable and                 If you are claiming an exception from 
individuals must maintain adequate                appropriate steps to recover diverted       Form 990 filing requirements as an 
records and case histories showing the            funds, ensure other grant funds held        organization described in section 501(c)
name and address of each recipient,               by a grantee are used for their             (1), at the end of this form, upload a copy 
under Rev. Rul. 56-304, 1956-2 C.B. 306,          intended purposes, and withhold             of your determination letter or other 
but don’t provide this information as part of     further payments to grantees until you      documentation from the IRS that indicates 
your application.                                 obtain grantees' assurances that            you are described in section 501(c)(1).
Line 9. If “Yes,” what measures do you            future diversions will not occur and 
take to ensure unbiased selections and            that grantees will take extraordinary       Section 1. An integrated 
that awards are not provided to                   precautions to prevent future               auxiliary of a church described 
disqualified persons?                             diversions from occurring.                  in Regulations section 
Note. As a private foundation, you are not       Line 11.  Answer “Yes” if you will maintain  1.6033-2(h) (such as a men’s or 
permitted to provide grants to disqualified      all records relating to individual grants,   women’s organization, 
persons. Disqualified persons include your       including information obtained to evaluate   seminary, mission society, or 
substantial contributors, foundation             grantees, identify whether a grantee is a 
managers, and certain family members of          disqualified person, establish the amount    youth group) or a school below 
disqualified persons. Section 4946(a)(1)         and purpose of each grant, and establish     college level affiliated with a 
defines the term “disqualified person” as a      that you undertook the supervision and       church or operated by a 
person who is:                                   investigation of grants described in         religious order
(A) a substantial contributor, as defined in     line 10.
                                                                                              Line 1. Answer “Yes” if you are described 
section 507(d)(2) (generally, a person who       Line 12.  Answer “Yes” if you award          both in sections 501(c)(3) and 509(a)(1), 
has contributed or bequeathed more than          scholarships on a preferential basis         509(a)(2), or 509(a)(3). If “No,” stop and 
2% of your total contributions and               because you require, as an initial           do not submit Form 8940 to request a 
bequests received, if over $5000);               qualification, that the individual be an     Form 990 filing exception.
(B) a foundation manager (within the             employee or be related to an employee of 
meaning of section 4946(b)(1));                  a particular employer, or because you give   Line 2. Answer “Yes” if you are an 
(C) an owner of more than 20% of (i) the         preference or priority to such persons.      educational organization below college 
total combined voting power of a                                                              level, have a program of general academic 
corporation, (ii) the profits interest of a      Line 15.  For purposes of this schedule, a   nature, and are operated by a religious 
partnership, or (iii) the beneficial interest of program for children of employees of a       order. Explain and stop here.
a trust or unincorporated enterprise, which      particular employer includes children and 
is a substantial contributor to the              other family members of employees.           Line 3. Answer “Yes” if you are covered 
foundation;                                                                                   by a group exemption letter issued to a 
(D) a member of the family (as defined in        Schedule D. Exception                        church or convention or association of 
                                                                                              churches under an administrative 
section 4946(d) (spouse, ancestors,              From Form 990 Filing                         procedure (such as Rev. Proc. 80-27, 
children, grandchildren, 
great-grandchildren, and spouses of              Requirements                                 1980-1 C.B. 677). Provide the corporate 
                                                                                              name of the church or convention or 
children, grandchildren, and                     Line 1. Indicate under which exception       association of churches and the Group 
great-grandchildren)) of any individual          you are requesting an exemption from         Exemption Number (GEN). Continue to 
described in subparagraph (A), (B), or (C);      filing.                                      line 4.
(E) a corporation of which persons                If you believe you should be exempt 
described in subparagraph (A), (B), (C), or      from filing Form 990 or Form 990-EZ          Line 3a. Answer “Yes” if you are 
(D) own more than 35% of the total               because you are affiliated with a church or  operated, supervised, or controlled by or 
combined voting power;                           a convention or association of churches,     in connection with a church or convention 
(F) a partnership in which persons               please review Regulations sections           or association of churches (as defined in 
described in subparagraph (A), (B), (C), or      1.6033-2(g) and (h) and Rev. Proc. 96-10,    Regulations section 1.509(a)-4). Explain 
(D) own more than 35% of the profits             1996-1 C.B. 577. Complete Form 8940,         and cite the references from your bylaws 
interest; or                                                                                  or other organizational documents that 

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demonstrate how you are operated, you are operated, supervised, or factor you meet and explain how you meet
supervised, or controlled by or in controlled by a church or a convention or it.
connection with a church or a convention association of churches.
or association of churches within the Section 4. A governmental unit
Line 2a. Answer “Yes” if you are engaged
meaning of Regulations section or an affiliate of a governmental
exclusively in financing, funding the
1.509(a)-4. Continue to line 4. unit (other than a section
activities of, or managing the funds of one
Line 3b. Answer “Yes” if the facts and or more churches, integrated auxiliaries, 509(a)(3) supporting
circumstances show that you’re affiliated or conventions or associations of organization) described in Rev.
with a church or convention or association churches. Explain and stop here.
of churches. Check the appropriate Proc. 95-48, 1995-2 C.B. 418
Line 2b. Answer “Yes” if you are engaged
box(es) for each affiliation factor you meet Note. This form is not for organizations
exclusively in financing, funding the
and explain how you meet it. exempt from federal income tax under
activities of, or managing the funds of a section 501(c) requesting reclassification
Line 4. Answer “Yes” if you are a men's group of organizations substantially all of as a governmental unit.
or women's organization, a seminary, a which are churches, integrated auxiliaries, If you are exempt from federal income
mission society, or a youth group and stop or conventions or associations of tax under section 501(c) and are
here. churches, if substantially all of your assets requesting reclassification as a
are provided by, or held for the benefit of,
Line 5. Answer “Yes” if you are a school governmental unit, you must obtain a letter
such organizations. Explain and stop here.
(as described in sections 509(a)(1) and ruling by following the procedures
170(b)(1)(A)(ii)) below college level and Line 2c. Answer “Yes” if you maintain specified in Rev. Proc. 2022-1, 2022-1
stop here. retirement insurance programs primarily I.R.B. 1, or its successor. There is a fee
for one or more churches, integrated associated with obtaining such a letter
Line 6. If you are internally supported, ruling.
auxiliaries, or conventions or associations
you receive financial support primarily
from internal church sources as opposed of churches and more than 50% of the Line 1. Answer “Yes” if you are described
to public or governmental sources. individuals covered by the programs are under section 501(a) but not under section
directly employed by those organizations. 509(a)(3). If “No,” stop and do not submit
Line 6a. Answer “Yes” if you offer If “Yes,” explain and stop here. Form 8940 to request a Form 990 filing
admissions, goods, services, or facilities exception.
Line 2d. Answer “Yes” if you maintain
for sale, other than on an incidental basis,
retirement insurance programs primarily
to the general public (except goods, Line 2. Answer “Yes” if you are a
for one or more churches, integrated
services, or facilities sold at a nominal governmental unit because you meet one
auxiliaries, or conventions or associations
charge or for an insubstantial portion of of the following definitions.
of churches and more than 50% of the
the cost) and explain. a. A state or local governmental unit
assets are contributed by, or held for the
Line 6b. Answer “Yes” if you normally benefit of, employees of those as defined in Regulations section
receive more than 50% of your support organizations. Explain and stop here. 1.103-1(b), which includes a state,
from a combination of: territory, a possession of the United
Line 3. Answer “Yes” if you are operated,
• government sources; States, the District of Columbia, or any
supervised, or controlled by one or more
• public solicitation of contributions, or political subdivision thereof;
religious orders and engaged in financing,
• receipts from the sale of admissions; b. An organization entitled to receive
funding, or managing assets used for
goods, performance of services, or deductible charitable contributions as
exclusively religious activities and explain.
furnishing of facilities in activities that are an organization described in section
170(c)(1), which is a state, territory, a
not unrelated trades or businesses, and Section 3. A mission society possession of the United States, or
explain. (other than a section 509(a)(3) any political subdivision of any of the
Section 2. A church-affiliated supporting organization) foregoing, or the United States or the
organization (other than a sponsored by, or affiliated with, District of Columbia, but only if the
contribution or gift is made for
section 509(a)(3) organization) one or more churches or exclusively public purposes; or
that is exclusively engaged in church denominations, if more c. An Indian tribal government or a
managing funds or maintaining than half of the society’s political subdivision thereof under
sections 7701(a)(40) and 7871. If
retirement programs and is activities are conducted in or
“Yes,” explain and stop here.
described in Rev. Proc. 96-10, directed at persons in foreign
1996-1 C.B. 577 countries Line 3. Answer “Yes” if you are an affiliate
of a governmental unit because you have
Line 1. Answer “Yes” if you are Line 1. Answer “Yes” if you are described a ruling or determination stating that:
described in section 501(c)(3) and under in section 501(c)(3) and under either a. Your income is excluded from gross
either section 509(a)(1) or 509(a)(2). If section 509(a)(1) or 509(a)(2). If “No,” income under section 115,
“No,” stop and do not submit Form 8940 to stop and do not submit Form 8940 to b. You are entitled to receive
request a Form 990 filing exception under request a Form 990 filing exception under deductible contributions under section
this section. this section. 170(c)(1) on the basis that they are for
Line 2. Answer “Yes” if you are operated, Line 2. Answer “Yes” if more than half of the use of governmental units, or
supervised, or controlled by one or more your activities are conducted in or directed c. You are a wholly owned
churches, integrated auxiliaries, or at persons in foreign countries and instrumentality of a state or political
conventions or associations of churches. explain. subdivision of a state for employment
Explain and cite the reference from your tax purposes (sections 3121(b)(7) and
bylaws or other organizational documents Line 3. Answer “Yes” if you are 3306(c)(7)).
that states whether the affiliated church sponsored by or affiliated with one or more
has the authority to appoint and remove churches or church denominations. Check If “Yes,” at the end of this form, upload a
your directors in order to demonstrate how the appropriate box(es) for each affiliation copy of your ruling or determination letter
and stop here.

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Line 4. Answer “Yes” if:                     Line 4. Answer “Yes” if the grant, due to        Line 10. Describe any actual program of 
 a. Your governing body is elected by        its size, would adversely affect your status     public solicitation and exempt activities 
 the public under local statute or           as a publicly supported organization and         and whether you have been able to attract 
 ordinance; or                               explain.                                         a significant amount of public support.
 b. A majority of the members of your        Line 5. Provide the name of the grantor,         Line 11. Describe how you may 
 governing body are appointed by a           the amount of the grant, when you expect         reasonably be expected to attract a 
 governmental unit, an affiliate of a        to receive the grant (and whether a single       significant amount of public support 
 governmental unit, or a public official     payment or multiple payments over a              subsequent to the particular contribution.
 acting in an official capacity.             period of time), and the purpose(s) for 
                                                                                              Line 12. Answer “Yes” if, prior to the 
If “Yes,” explain. If “No,” stop here.       which you will use the grant funds.
                                                                                              contribution, you were able to meet your 
Line 4a. Answer “Yes” if you satisfy at      Line 6. Section 4946(a)(1) defines the           applicable public support test without the 
least two of the five affiliation factors    term “disqualified person,” as a person          benefit of any exclusions of unusual grants 
listed. Check the appropriate boxes and      who is:                                          and explain.
explain (including references from your      (A) a substantial contributor, as defined in 
                                                                                              Line 13. If “Yes,” explain how your 
articles, bylaws, etc.).                     section 507(d)(2) (generally, a person who 
                                                                                              governing body is made up of public 
                                             has contributed or bequeathed more than 
                                                                                              officials, or individuals chosen by public 
Schedule E. Advance                          2% of your total contributions and 
                                                                                              officials acting in their capacity as such; of 
                                             bequests received, if over $5000);
                                                                                              persons having special knowledge in the 
Approval That a Potential                    (B) a foundation manager (within the 
                                                                                              particular field or discipline in which you 
Grant or Contribution                        meaning of section 4946(b)(1));
                                                                                              operate; of community leaders, such as 
Constitutes an “Unusual                      (C) an owner of more than 20% of (i) the 
                                                                                              elected officials, clergymen, and 
                                             total combined voting power of a 
                                                                                              educators; or, if you are a membership 
Grant”                                       corporation, (ii) the profits interest of a 
                                                                                              organization, of individuals elected under 
If you are described in sections 509(a)(1)   partnership, or (iii) the beneficial interest of 
                                                                                              your governing instrument or bylaws by a 
and 170(b)(1)(A)(vi) or section 509(a)(2),   a trust or unincorporated enterprise, which 
                                                                                              broadly based membership.
you may request a determination that a       is a substantial contributor to the 
potential grant, contribution, or bequest    foundation;                                      Line 14. Regulations section 1.507-2(a)
(referred to collectively as "grant" in this (D) a member of the family (as defined in        (7) states that whether or not a particular 
Schedule E and instructions) be classified   section 4946(d) (spouse, ancestors,              condition or restriction imposed upon a 
as an “unusual grant” under Regulations      children, grandchildren,                         transfer of assets is material must be 
section 1.170A-9(f)(6)(ii) or 1.509(a)-3(c)  great-grandchildren, and spouses of              determined from all of the facts and 
(3).                                         children, grandchildren, and                     circumstances of the transfer. Some of the 
                                             great-grandchildren) of any individual           more significant facts and circumstances 
 In general, substantial grants from         described in subparagraph (A), (B), or (C);      to be considered in making such a 
disinterested parties will be considered     (E) a corporation of which persons               determination are:
unusual if they:                             described in subparagraph (A), (B), (C), or      • Whether the public charity (including a 
 1. Are attracted by reason of the           (D) own more than 35% of the total               participating trustee, custodian, or agent in 
publicly supported nature of the             combined voting power;                           the case of a community trust) is the 
organization;                                (F) a partnership in which persons               owner in fee of the assets it receives;
 2. Are unusual or unexpected with           described in subparagraph (A), (B), (C), or      • Whether such assets are to be held and 
respect to the amount thereof; and           (D) own more than 35% of the profits             administered by the public charity in a 
 3. Would, by reason of their size,          interest; or                                     manner consistent with one or more of its 
adversely affect the status of the           (G) a trust or estate in which persons           exempt purposes;
organization as normally being publicly      described in subparagraph (A), (B), (C), or      • Whether the governing body of the 
supported for the applicable period for      (D) hold more than 35% of the beneficial         public charity has the ultimate authority 
determining whether the organization         interest.                                        and control over such assets, and the 
meets its public support test.                                                                income derived therefrom; and
                                             Section 4946(b) defines the term                 • Whether, and to what extent, the 
In determining whether a particular grant    “foundation manager,” with respect to any        governing body of the public charity is 
may be excluded as an unusual grant, all     private foundation as an officer, director,      organized and operated so as to be 
pertinent facts and circumstances will be    or trustee of a foundation (or an individual     independent from the transferor.
taken into consideration. No single factor   having powers or responsibilities similar to 
will necessarily be determinative. See       those of officers, directors, or trustees of     Schedule F. Section 509(a)
Regulations sections 1.170A-9(f)(6)(iii)     the foundation).
                                                                                              (3) Supporting 
and 1.509(a)-3(c)(4) for the factors for     Line 7. If “Yes,” explain how the 
determining if a grant is unusual.           contributor or any person standing in a          Organizations
Line 1. Answer “Yes” if you are described    relationship to such contributor, which is       Supporting organizations are described in 
in section 501(c)(3) and under sections      described in section 4946(a)(1)(C)               section 509(a)(3) based on the type of 
509(a)(1) and 170(b)(1)(A)(vi) or section    through (G) (defined above), continues to        relationship they have with their supported 
509(a)(2).                                   directly or indirectly exercise control over     organization(s). Under the Pension 
                                             you.                                             Protection Act of 2006 (PPA) supporting 
Line 2. Answer “Yes” if you were selected                                                     organizations are classified as Type I, 
for the grant because of your publicly       Line 8. Indicate whether the contribution        Type II, or Type III supporting 
supported nature and explain.                was a bequest or an inter vivos transfer. A      organizations.
                                             bequest will ordinarily be given more 
Line 3. Answer “Yes” if the amount of the    favorable consideration than an inter vivos        A Type I supporting organization is 
grant is unusual or unexpected and           transfer.                                        operated, supervised, or controlled by its 
explain.                                                                                      supported organization(s) (comparable to 
                                             Line 9. Describe the type of the expected        a parent–subsidiary relationship).
                                             grant.

Instructions for Form 8940 (Rev. 04-2023)                    -9-

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A Type II supporting organization is              Before you file your application,                 If you don't meet one of these 
supervised or controlled in connection        TIP use Tax Exempt Organization               TIP     three relationship tests, you aren't 
with its supported organization(s)                Search on IRS.gov to confirm                      described in section 509(a)(3).
(comparable to a brother–sister               whether each of your supported 
relationship).                                organizations is currently recognized as      Line 6. Describe how you are organized 
                                              exempt and is classified as a public          to meet the relationship test identified in 
A Type III supporting organization is         charity.                                      Line 5. (See Regulations sections 
operated in connection with its supported                                                   1.509(a)-4(g)–(i) for more information on 
organization(s). The PPA further classifies   Line 4a. Answer “Yes” if any supported        how to meet each relationship test.)
Type III supporting organizations into the    organization you listed on line 2 received a    Type III organizations must also 
following two categories: Type III            letter from the IRS stating that it’s exempt  describe how your officers, directors, or 
supporting organizations that are             under sections 501(c)(4), (5), or (6) and     trustees maintain a close and continuing 
functionally integrated (FI Type III) or Type the supported organization meets the          relationship with the officers, directors, or 
III supporting organizations that are not     public support test under section 509(a)      trustees of your supported organization(s).
functionally integrated (NFI Type III). Thus, (2). See Pub. 557 for information on the 
there are four different types of supporting  public support test for section 509(a)(2).    Lines 7–8. Prohibited control by dis-
                                                                                            qualified person. You can’t be 
organizations.                                  If you answer “No,” describe how each 
                                                                                            described in section 509(a)(3) if you’re 
The rules for functionally integrated         organization you support is a public charity 
                                                                                            directly or indirectly controlled by 
and non-functionally integrated Type III      under section 509(a)(1) or (2). For 
                                                                                            disqualified persons. Without proof of 
supporting organizations are discussed in     example, if you support a church, a foreign 
                                                                                            independent control (as described in 
the Instructions for Schedule A (Form         organization, or an organization described 
                                                                                            Regulations section 1.509(a)-4(j)(2)), you 
990), Public Charity Status and Public        in section 501(c)(4), (5), or (6) that meets 
                                                                                            are controlled if disqualified persons:
Support.                                      the public support test in section 509(a)(2) 
                                              that hasn't received a determination letter   • Can exercise 50% or more of the total 
                                                                                            voting power of your governing body;
If you are a nonexempt charitable trust       recognizing it as an exempt organization, 
described in section 4947(a)(1) and are       you should describe how this organization     • Have authority to affect significant 
                                                                                            decisions, such as power over your 
requesting an initial determination that you  qualifies as a public charity under section 
                                                                                            investment decisions, or power over your 
are described in section 509(a)(3), then      509(a)(1) or (2). See Pub. 557 for 
                                                                                            charitable disbursement decisions; or
furnish the following information from the    information on public charities under 
date that you first became described in       sections 509(a)(1) and (2).                   • Can exercise veto power over your 
                                                                                            actions.
section 4947(a)(1) (but not before October    Line 5. Relationship test.  To qualify          Although control is generally 
9, 1969) to the present.                      under section 509(a)(3), you must show        demonstrated where disqualified persons 
                                              that you meet one of three relationship       have the authority over your governing 
If you did not qualify under section          tests with your supported organization(s).    body to require you to take an action or 
509(a)(3) in one or more prior years after    Select the option that best describes your    refrain from taking an action, indirect 
October 9, 1969, in which you were            relationship with your supported              control by disqualified persons will also 
described in section 4947(a)(1), then you     organization(s).                              disqualify you as a supporting 
cannot be issued a section 509(a)(3)          • Type I (“operated, supervised, or           organization.
determination letter except in accordance     controlled by” relationship; comparable to 
with the procedures for termination of        a parent–subsidiary relationship): A            For a disqualified person, see the 
private foundation status under section       majority of your governing board or           instructions for Schedule E, line 6, earlier.
507(b)(1)(B), set forth in Part II (Form      officers are elected or appointed by the        Family includes an individual's spouse, 
8940, Schedule G).                            governing body, members of the                ancestors, children, grandchildren, 
Line 1. Answer “Yes” if you are a             governing body, officers acting in their      great-grandchildren, and the spouses of 
nonexempt charitable trust described in       official capacity, or the membership of       children, grandchildren, and 
section 4947(a)(1) requesting an initial      your supported organization(s).               great-grandchildren.
determination that you are described in       • Type II (“supervised or controlled in         Foundation managers are officers, 
section 509(a)(3). If “No,” continue to       connection with” relationship; comparable     directors, or trustees, or an individual 
line 2.                                       to a brother–sister relationship): Your       having powers or responsibilities similar to 
                                              control or management is vested in the        those of a foundation's officers, directors, 
Line 1a. Provide a list of all of the         same persons who control or manage            or trustees.
trustees that have served, together with a    your supported organization(s).                 Business relationships are employment 
                                              •
statement stating whether such trustees         Type III (“operated in connection with”     and contractual relationships, and 
were disqualified persons within the          relationship; responsive to the needs or      common ownership of a business where 
meaning of section 4946(a) (other than as     demands of, and having significant            any officers, directors, or trustees, 
foundation managers). At the end of this      involvement in the affairs of, the supported  individually or together, possess more 
form, upload a copy of your original trust    organization(s)): One or more of your         than a 35% ownership interest in common. 
instrument and all amendments adopted         officers, directors, or trustees are elected  Ownership means voting power in a 
thereafter.                                   or appointed by the officers, directors,      corporation, profits interest in a 
Line 2. List the name, address, and EIN       trustees, or membership of your supported     partnership, or beneficial interest in a trust.
of each organization you support.             organization(s); one or more of your 
                                              officers, directors, trustees, or other       Line 9. Organizational test.   If you 
Line 3. Describe your activities and          important office holders are also members     answered “No,” and you are a Type III 
explain how they are solely engaged in to     of the governing body of your supported       supporting organization, you must amend 
support or benefit your supported             organization(s); or your officers, directors, your organizing document to specify your 
organizations.                                or trustees maintain a close and              supported organization(s) by name; or you 
Line 4. Answer “Yes” if each supported        continuous working relationship with the      won’t meet the organizational test under 
organization has a letter from the IRS        officers, directors, or trustees of your      section 509(a)(3) and need to reconsider 
recognizing it as a public charity under      supported organization(s).                    your requested public charity 
section 509(a)(1) or (2).                                                                   classification.

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Line 9a. If you answered “No,” you won’t 2. Exercise a substantial degree of The distributable amount for the
meet the organizational test under section direction over the policies, programs, and TIP first tax year an organization is
509(a)(3) unless you amend your activities of each supported organization. treated as a non-functionally
integrated Type III supporting organization
organizing document to specify your Example. N, an organization is zero.
supported organization(s) by name, described in section 501(c)(3), is the
purpose, or class, and need to reconsider parent organization of a healthcare system In general, “adjusted net income” is the
your requested public charity consisting of two hospitals (Q and R) and excess of gross income, including gross
classification. an outpatient clinic (S), each of which is income from any unrelated trade or
Line 10. When responding to this described in section 509(a)(1), and a business, determined with certain
question, don’t include organizations taxable subsidiary (T). N is the sole modifications, reduced by total
described in section 509(a)(1), (2), or (4). member of each of Q, R, and S. Under the deductions. Gross income doesn’t include
A family member for this purpose includes charter and bylaws of each of Q, R, and S, gifts, grants, or contributions. Refer to
spouse, ancestors, children, N appoints all members of the board of section 4942(f) and Regulations section
grandchildren, great-grandchildren, and directors of each corporation. N engages 53.4942(a)-2(d) for details on adjusted net
spouses of children, grandchildren, and in the overall coordination and supervision income.
great-grandchildren. of the healthcare system’s exempt The minimum asset amount is 3.5% of
subsidiary corporations Q, R, and S in the fair market value of non-exempt-use
This prohibition on contributions approval of their budgets, strategic assets, decreased by acquisition
TIP from controlling donors only planning, marketing, resource allocation, indebtedness with respect to such assets,
applies to Type I and Type III securing tax-exempt bond financing, and and increased by certain amounts
supporting organizations. community education. N also manages received or accrued that were treated as
and invests assets that serve as distributed in prior tax years. See
Line 11. Type III responsiveness test. endowments of Q, R, and S. Regulations section 1.509(a)-4(i)(5)(ii)(C).
Answer “Yes” if, because of your
relationship described on line 6, the Line 14. Answer “Yes” if substantially all For purposes of this line,
supported organization(s) has a significant of your activities directly further the “non-exempt-use assets” are all assets of
involvement in your investment policies, exempt purposes of one or more the supporting organization other than:
making and timing of grants, and directing supported organizations to which you are
the use of your income and assets, and responsive and explain. 1. Assets described in Regulations
sections 53.4942(a)(2)(c)(2)(i) through
explain how your supported Holding title to and managing assets (iv); and
organization(s) is involved in these that are used (or held for use) directly in
matters. carrying out the exempt purposes of your 2. Exempt-use assets, which are
Line 12. Type III notification require- supported organization (exempt-use assets that are used (or held for use)
ment. A Type III supporting organization assets) are activities that directly further directly in carrying out the exempt
must provide the notice described in this the exempt purposes of your supported purposes of your supported organization.
question. If you’re a Type III supporting organization. Conversely, with certain See Regulations section 1.509(a)-4(i)(8)
organization, you’ll be required to answer exceptions, fundraising, making grants for more information.
this question annually on your annual (whether to the supported organization or Line 15a. List the total amount you
information return (Schedule A (Form to third parties), and investing and distribute(d) annually to each supported
990)). managing non-exempt-use assets aren’t organization. Also, indicate how each
activities that directly further the exempt amount will vary from year to year.
Lines 13–15. Type III integral part test. purposes of the supported organization.
An organization seeking classification as a See Regulations section 1.509(a)-4(i)(4) Line 15b. List the total annual income for
Type III supporting organization must (ii) for more information. each supported organization. If you
meet an integral part test, which is distribute your income to, or for the use of,
satisfied by maintaining significant Line 15. To satisfy the integral part test a particular department or program of an
involvement in the operations of one or as a non-functionally integrated supporting organization, list the annual revenue of the
more supported organizations and organization, you must annually distribute supported department or program.
providing support on which the supported at least 85% of your adjusted net income
organization(s) are dependent. A Type III or your minimum asset amount for the Line 15c. Answer “Yes” if your funds are
supporting organization may be prior tax year (whichever is greater) to “earmarked” for a particular program or
functionally integrated (lines 13–14) or your supported organization(s). A Type III activity conducted by your supported
non-functionally integrated (lines 15 and supporting organization must distribute organization(s).
15a–c) depending on the manner in which one-third or more of its distributable
it meets the integral part test. Functionally amount to one or more supported Schedule G.
integrated Type III supporting organizations that are attentive to the
organizations are subject to fewer operations of the supporting organization Reclassification of
restrictions and requirements than (within the meaning of Regulations section Foundation Status,
non-functionally integrated Type III 1.509(a)-4(i)(5)(iii)(B)). Amounts Including a Voluntary
supporting organizations. determined for a given tax year must be
distributed by the end of the following tax Request From a Public
Line 13. Answer “Yes” if you’re the parent year, and carryovers of excess Charity for Private
of all your supported organizations distributions are permitted for up to five Foundation Status
because you: years. You can use Part V of Schedule A
1. Have the power to appoint or elect, (Form 990) to help determine your answer If you are described in section 501(c)(3)
directly or indirectly, a majority of the to this question. and classified by the IRS as a public
charity, you may request a determination
officers, directors, or trustees of each regarding a change in your public charity
supported organization; and classification. Submit a request indicating
your current public charity classification

Instructions for Form 8940 (Rev. 04-2023) -11-

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and the public charity classification to     sources, or normally receive more than        units, direct or indirect contributions from 
which you are requesting reclassification.   one-third of your support from gross          the public, or a combination of these 
                                             investment income and the excess of the       sources, and you normally fail to receive at 
  If you erroneously determined that you     amount of unrelated business taxable          least 10% but less than 33 % of your total ⅓
were a private foundation but actually       income over the amount of taxes imposed       support from contributions made directly 
qualified and have continued to qualify as   by section 511. If “No,” explain.             or indirectly by the general public or from 
a public charity, you may request                                                          governmental units and fail to satisfy 
reclassification as a public charity instead Line 3. Indicate your requested effective 
                                                                                           several other factors). See Regulations 
of terminating your private foundation       date of reclassification as a private 
                                                                                           section 1.170A-9(f)(3). If “No,” explain.
status under section 507(b)(1)(B). You       foundation.
                                                                                           Line 3b. Answer “Yes” if you normally fail 
must demonstrate that you have               Line 4. Answer “Yes” if your governing 
                                                                                           to receive more than one-third of your 
continuously qualified as a public charity   instrument meets the requirements of 
                                                                                           support from any combination of gifts, 
since being recognized as an organization    section 508(e).
                                                                                           grants, contributions, membership fees, 
described in section 501(c)(3).              Section 508(e) provides that a private        and gross receipts from permitted 
Required attachments.                        foundation isn’t tax exempt unless its        sources, or normally receive more than 
• If you are requesting reclassification as  organizing document contains specific         one-third of your support from gross 
a public charity described under sections    provisions. These specific provisions         investment income and the excess of the 
509(a)(1) and 170(b)(1)(A)(iv), 509(a)(1)    require that you operate to avoid liability   amount of unrelated business taxable 
and 170(b)(1)(A)(vi), or 509(a)(2), submit   for excise taxes under sections 4941(d),      income over the amount of taxes imposed 
a completed Schedule A (Form 990), Part      4942, 4943(c), 4944, and 4945(d). You         by section 511. If “No,” explain.
II or III (as applicable).                   can also meet these provisions by reliance 
• If you are requesting reclassification as  on state law.                                 Line 3c. Indicate your requested effective 
                                                                                           date of reclassification as a private 
a private operating foundation or exempt     See Pub. 557 for samples of provisions        foundation.
operating foundation, submit a completed     that will meet section 508(e). Also, see 
Form 990-PF, Part XIII—Private Operating     Appendix B of the Instructions for Form       Line 3d. Answer “Yes” if your governing 
Foundations.                                 1023 for a list of states that have enacted   instrument meets the requirements of 
Line 1. Select the foundation                statutory provisions that satisfy the         section 508(e).
classification you are requesting and        requirement of section 508(e), subject to       Section 508(e) provides that a private 
complete any required information.           notations. Appendix B is based on Rev.        foundation isn’t tax exempt unless its 
                                             Rul. 75-38, 1975-1 C.B. 161.                  organizing document contains specific 
Section 1. Request for                                                                     provisions. These specific provisions 
                                             Section 2. Request for 
reclassification as a private                                                              require that you operate to avoid liability 
                                             reclassification as a private 
foundation, as described in                                                                for excise taxes under sections 4941(d), 
                                             operating foundation, as                      4942, 4943(c), 4944, and 4945(d). You 
section 509(a)                                                                             can also meet these provisions by reliance 
                                             described in section 4942(j)(3)
Private foundations are required under                                                     on state law.
section 4945(g) to obtain advance            A private operating foundation must make 
approval of their grant-making procedures    direct qualifying distributions to be used      See Pub. 557 for samples of provisions 
related to scholarships, fellowships,        for the active conduct of the operating       that will meet section 508(e). Also, see 
prizes, awards, or other specified grants to foundation's own programs or activities.      Appendix B of the Instructions for Form 
achieve a specific objective, produce a      These activities must be conducted by the     1023 for a list of states that have enacted 
report or similar product, or enhance        foundation rather than by or through one      statutory provisions that satisfy the 
certain capacities, skills, or talents of a  or more grantee organizations that receive    requirement of section 508(e), subject to 
grantee. If you are requesting               distributions directly or indirectly from the notations. Appendix B is based on Rev. 
reclassification as a private foundation     foundation. Regulations section               Rul. 75-38, 1975-1 C.B. 161.
and conduct, or will conduct, grant-making   53.4942(b)-1(b) lists several types of        Section 3. Request for 
activities described under section 4945(g),  expenses that are considered direct 
submit a statement to that effect and        qualifying distributions for the active       reclassification as an exempt 
submit a separate Form 8940 for Part II      conduct of an operating foundation's          operating foundation, as 
(Form 8940, Schedule C).                     exempt activities.                            described in section 4940(d)(2)
Line 1. Answer “Yes” if you normally fail    At the end of this form, upload a             Section 4940(d) provides that the term 
to meet both the 33 % of support and the ⅓   completed Form 990-PF, Part                   “exempt operating foundation,” with 
facts and circumstances test (that is, you   XIII—Private Operating Foundations.           respect to any tax year, applies to any 
                                                                                           private foundation if:
normally fail to receive at least 33 % of ⅓  Line 1. Submit a listing and description of 
your total support from governmental         your distributions that details whether your  • Such foundation is an operating 
                                                                                           foundation, as defined in section 4942(j)
units, direct or indirect contributions from distributions are used directly for the 
                                                                                           (3);
the public, or a combination of these        active conduct of your own programs or 
sources, and you normally fail to receive at activities.                                   • Such foundation has been publicly 
least 10% but less than 33 % of your total ⅓                                               supported under sections 509(a)(1) and 
support from contributions made directly     Line 2. Describe any adverse impact if        170(b)(1)(A)(vi) or 509(a)(2) for at least 10 
or indirectly by the general public or from  you do not receive the requested status.      years, or such foundation was an 
governmental units and fail to satisfy       Line 3. Answer “Yes” if you are changing      operating foundation, as defined in section 
several other factors). See Regulations      from public charity to private foundation     4942(j)(3) as of January 1, 1983;
section 1.170A-9(f)(3). If “No,” explain.    classification.                               • At all times during the tax year, the 
                                                                                           governing body of such foundation (i) 
Line 2. Answer “Yes” if you normally fail    Line 3a. Answer “Yes” if you normally fail    consists of individuals at least 75% of 
to receive more than one-third of your       to meet both the 33 % of support and the ⅓    whom are not disqualified individuals, as 
support from any combination of gifts,       facts and circumstances test (that is, you    defined in section 4940(d)(3)(B), and (ii) is 
grants, contributions, membership fees,      normally fail to receive at least 33 % of ⅓
and gross receipts from permitted            your total support from governmental 

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broadly representative of the general        satisfy the requirements of section 507(b)     continuous 60-month period beginning 
public; and                                  (1)(B)(i) during the 60-month period, then     with the first day of any tax year and 
• At no time during the year does such       contributors may rely on such ruling as set    notifies the IRS before beginning the 
foundation have an officer who is a          forth in Regulations section 1.507-2(d)(3),    60-month period that it is terminating its 
disqualified individual.                     and there will be no penalty under section     private foundation status.
  Submit documentation showing that          6651 for failure to pay section 4940 tax 
you meet the requirements for                during the 60-month period if the                By making this request you attest to the 
classification as an operating foundation,   organization fails to terminate its private    following.
as defined in section 4942(j)(3). Refer to   foundation status. The organization            • The name and address of the private 
the instructions above regarding a request   cannot otherwise rely on the advance           foundation is correct as listed in Part I of 
for reclassification as a private operating  ruling during the 60-month period or           this form.
foundation, as described in section 4942(j)  thereafter. Information regarding the user     • The submission of this form serves as a 
(3).                                         fee for the advance ruling can be found in     statement of your intention to terminate 
                                             Rev. Proc. 2022-5, 2022-1 I.R.B. 256           your private foundation status.
Line 1. In general, a private operating      (updated annually).                            • The date your regular tax year begins is 
foundation (POF) is a private foundation                                                    correctly listed in Part I of this form.
that devotes most of its resources to the      By making this request you attest to the     • The date the 60-month termination 
active conduct of its exempt activities.     following.                                     period begins will be the first day of the tax 
  To qualify as a private operating          • The name and address of the private          period following the date of your request.
foundation, an organization must meet an     foundation is correct as listed in Part I of     Form 872-B is optional for 
income test and one of three alternative     this form.                                     organizations not requesting an advance 
tests. The alternative tests include an      • The submission of this form serves as a      ruling; but, if the organization chooses not 
assets test, an endowment test, or a         statement of your intention to terminate       to submit the form, it must pay the taxes 
support test. The tests are applied each     your private foundation status and you are     on its investment income during the 
year so it is possible a private foundation  requesting an advance ruling.                  period. The organization must also 
could meet the requirements in one year      • The date your regular tax year begins is     establish immediately after the end of the 
and not in the next.                         correctly listed in Part I of this form.       60-month period that it has met the 
                                             • The date the 60-month termination            requirements of section 509(a)(1), (2), or 
Line 2. Submit documentation indicating      period begins will be the first day of the tax (3).
whether or not you have been publicly        period following the date of your request.
supported under sections 509(a)(1) and                                                      Line 1. Select the foundation 
170(b)(1)(A)(vi) or section 509(a)(2) for at   At the end of this form, upload a            classification you are requesting.
least 10 years, or documentation that you    completed Form 872-B. As a condition to 
were an operating foundation, as defined     receiving the advance ruling, you must         Line 2. Enter the date that corresponds to 
in section 4942(j)(3) as of January 1,       use this form to consent to extend the         the first day of the tax year following your 
1983.                                        period of limitations to assess section        request.
                                             4940 tax, for any tax year within the 
Line 3. Answer “Yes” if, at all times during advance ruling period, to 4 years after        Schedule J. Termination of 
the tax year, your governing body (i)        filing the Form 990 or 990-PF annual           Private Foundation Status 
consisted of individuals at least 75% of     information return for the last tax year 
whom are not disqualified individuals, as    within the 60-month period.                    Under Section 507(b)(1)
defined in section 4940(d)(3)(B), and (ii)                                                  (B)—60-month Period 
been broadly representative of the general   Line 1. Select the foundation 
public. If “No,” explain.                    classification you are requesting and          Ended
                                             complete any required information.             Regulations sections 1.507-2(b)(4) and (c) 
Line 4. Answer “Yes” if, at any time                                                        require an organization, which is 
during the year, you had an officer who is   Line 2. Describe your past, current, and 
a disqualified individual and explain.       proposed activities, and how you intend to     terminating its private foundation status, to 
                                             become a public charity (in other words,       notify the IRS that it has met the 
Schedule H. Termination                      how you will attract the necessary public      requirements of a public charity within 90 
                                             support and anticipated sources of             days after the end of the 60-month period. 
of Private Foundation                        support or how you will operate to meet        See Schedules H and I for advance ruling 
Status Under Section                         the requirements of your intended              and advance notice, respectively, of 
                                             classification).                               termination of private foundation status.
507(b)(1)(B)—Advance 
Ruling Request                               Line 3. Enter the date that corresponds to     Required attachment. If you are 
                                             the first day of the tax year following your   terminating your private foundation status 
Section 507(b)(1)(B) allows a private        request.                                       as a public charity described under 
foundation to terminate its private                                                         sections 509(a)(1) and 170(b)(1)(A)(iv), 
foundation status and be reclassified as a                                                  509(a)(1) and 170(b)(1)(A)(vi), or 509(a)
public charity. An organization may          Schedule I. Notice                             (2), at the end of this form, upload a 
terminate its private foundation status      Only—Termination of                            completed Schedule A (Form 990), Part II 
under section 507(b)(1)(B) if it meets the                                                  or III (as applicable), and your previously 
requirements of section 509(a)(1), (2), or   Private Foundation Status 
                                                                                            filed Form 8940 providing notice or 
(3) for a continuous 60-month period         Under Section 507(b)(1)                        requesting an advance ruling.
beginning with the first day of any tax year (B)                                            Line 1. Select the foundation 
and notifies the IRS before beginning the    Section 507(b)(1)(B) allows a private          classification you are seeking 
60-month period that it is terminating its   foundation to terminate its private            reclassification as and complete any 
private foundation status. See schedule J    foundation status and become a public          required information.
for reporting at the end of the 60-month     charity. An organization may terminate its 
period.                                      private foundation status under section        Line 2. Provide a complete description of 
  If a private foundation obtains an         507(b)(1)(B) if it meets the requirements of   your current operations pertinent to the 
advance ruling that it can be expected to    section 509(a)(1), (2), or (3) for a 

Instructions for Form 8940 (Rev. 04-2023)                     -13-

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public charity status, as well as any         Line 6. Select the foundation                 foundation classification under sections 
changes during the 60-month period.           classification you are seeking and            509(a)(1) and 170(b)(1)(A)(i), the term 
                                              complete any required information.            “church” includes, without limitation, 
Schedule K. Canadian                                                                        mosques, temples, and synagogues, and 
                                              Line 6a. Answer “Yes” if you are              certain other forms of religious 
Registered Charities:                         requesting recognition of status as a         organizations. For more information, see 
Listing on Pub. 78 Data                       private operating foundation.                 Pub. 1828, Tax Guide for Churches & 
and/or Public Charity                           To be a private operating foundation        Religious Organizations.
                                              you must engage directly in the active 
Classification                                conduct of charitable, religious,             The practices and rituals associated 
Canadian organizations that have              educational, and similar activities, as       with your religious beliefs or creed must 
received a Notification of Registration from  opposed to indirectly carrying out these      not be illegal or contrary to public policy.
the Canada Revenue Agency (formerly           activities by providing grants to individuals Line 1. Describe your written creed, 
Canada Customs and Revenue Agency),           or other organizations.                       statement of faith, or summary of beliefs.
and whose registrations haven’t been 
revoked (“Canadian registered charities”),    Line 6b. Describe how you meet the            Line 2. Your literature includes any 
are automatically recognized in the United    requirements for private operating            writings about your beliefs, rules, or 
States as an organization described in        foundation status, including how you meet     history.
section 501(c)(3) and aren’t required to file the income test and either the assets test, 
Form 1023. Canadian registered charities      the endowment test, or the support test. If   Line 3. A “code of doctrine and discipline” 
are also presumed to be private               you’ve been in existence for less than one    refers to a body of laws or rules that 
foundations. If you’re a Canadian             year, describe how you are likely to satisfy  govern behavior.
registered charity and want to be listed as   the requirements for private operating        Line 4. A “religious hierarchy or 
an organization described in section          foundation status.                            ecclesiastical government” refers to 
501(c)(3) on IRS.gov or request                                                             people or institutions that exercise 
classification as a public charity rather     Schedule L. A Church, an                      significant influence or authority over your 
than a private foundation, complete this      Interchurch Organization                      “church.”
schedule.                                                                                   Line 5. Answer “Yes” if you’re part of a 
                                              of Local Units of a Church, 
Line 1. Answer “Yes” if you have received                                                   group of churches with similar beliefs and 
a Notification of Registration from the       a Convention or                               structures, such as a convention, 
Canada Revenue Agency. At the end of          Association of Churches                       association, or union of churches.
this form, upload a copy. If “No,” stop       There is no single definition of the word     Line 6. A “form of worship” refers to 
here.                                         “church” for federal tax purposes. When       religious practices that express your 
Line 1a. Answer “Yes” if your registration    determining whether a section 501(c)(3)       devotion to your creed, faith, or beliefs.
has been revoked and explain.                 religious organization is described as a 
                                              church (described in sections 509(a)(1)       Line 7. Indicate the regular days and 
Line 2. Answer “Yes” if you have              and 170(b)(1)(A)(i)), we will consider        times of your religious services. Describe 
completed Form 8833, Treaty Based             characteristics generally attributed to       the order of events during your regular 
Return Position Disclosure Under Section      churches and the facts and circumstances      worship service and explain how the 
6114 or 7701(b). At the end of this form,     of each organization applying for public      activities conducted as part of your 
upload a copy.                                charity classification as a “church.”         services further your religious purposes.
Line 3. Answer “Yes” if you are                 The characteristics generally attributed    Line 7a. Enter the average number of 
requesting recognition of section 501(c)(3)   to churches are:                              members and nonmembers who attend 
exemption and listing in Pub. 78 data as      • A distinct legal existence,                 your regularly scheduled religious 
an organization eligible to receive tax       • A recognized creed and form of              services.
deductible contributions.                     worship,                                      Line 8. An “established place of worship” 
Line 4. Enter the date you formed.            • A definite and distinct ecclesiastical      is a place where you hold regularly 
                                              government,                                   scheduled religious services. It may be a 
Line 5. Select your type of organization.     • A formal code of doctrine and               place that you own, rent, or that is 
A corporation generally is an entity          discipline,                                   provided free for your use.
organized under a Canadian federal,           • A distinct religious history,
provincial, or territorial statute.           • A membership not associated with any        Line 9. An “established congregation” or 
A limited liability company (LLC) that        other church or denomination,                 “other religious membership group” 
files its own exemption application is        • Ordained ministers ministering to the       includes individuals who regularly attend 
treated as a corporation rather than as a     congregation,                                 and take part in the religious services of 
partnership.                                  • Ordained ministers selected after           your organization at an established 
                                              completing prescribed courses of study,       location. An established congregation 
An unincorporated association is                A literature of its own,                    generally doesn’t include members of only 
                                              •
generally organized under a constitution        Established places of worship,              one family. If you answer “No,” because 
                                              •
that is established by two or more              Regular congregations,                      you don’t have an established 
                                              •
individuals.                                    Regular religious services,                 congregation or other religious 
                                              •
A trust may be formed by a trust              • Sunday schools for the religious            membership, you may be a religious 
agreement or declaration of trust. A trust    instruction of the young, and                 organization that doesn’t qualify as a 
may also be formed through a will.            • Schools for the preparation of ministers.   church.
Generally, a trust must be funded with                                                      Line 9a. Enter the total number of your 
property, such as money, real estate, or        Although you don’t need to meet each 
personal property.                            of the above criteria to be classified as a   current members. If you have no 
                                              church, you’re generally required to have     members, enter “0.”
                                              a congregation or other religious             Line 9b. Answer “Yes” if you have a 
                                              membership group. For purposes of             prescribed way to become a member. 

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Answer “Yes” even if you just keep purpose without satisfying all the in response to the action against your
records of who is currently a member. conditions listed above that describe a organization or the decision reached.
Describe any actions required for school. Such organizations may qualify as
Line 6. Answer “Yes” if your right to
individuals to become members. public charities based upon their sources
receive financial aid or assistance from a
of support as organizations described in
Line 9c. Describe any rights and benefits governmental agency has ever been
sections 509(a)(1) and 170(B)(1)(A)(vi) or
of members. You should include details of revoked or suspended and explain.
section 509(a)(2).
any levels of membership and the rights
Establishment of Racially Nondiscrimi-
and/or benefits associated with each level. Line 1. Answer “Yes” if you normally have
natory Policy. Every private school is
a regularly scheduled curriculum, a regular
Line 9d. If your members may be subject to the provisions of Rev. Proc.
faculty of qualified teachers, a regularly
associated with another denomination or 75-50, 1975-2 C.B. 587, modified by Rev.
enrolled student body, and facilities where
church, describe the circumstances in Proc. 2019-22, 2019-22 I.R.B. 1260. See
your educational activities are regularly
which your members would be members Pub. 557, which sets forth the
carried on.
of your church and another church. requirements of Rev. Proc. 75-50 under
If you answer “Yes,” you should the section for Private Schools.
Line 9e. Family includes an individual's
maintain in your records evidence
spouse, ancestors, children, TIP Publication of racially nondiscrimina-
that you meet these factors, such
grandchildren, great-grandchildren, tory policy. An organization described in
as:
siblings (whether by whole or half-blood), section 501(c)(3) that is a private school
and the spouses of children, • A list of required courses of study, must publish a notice of its racially
grandchildren, great-grandchildren, and dates and times courses are offered, and nondiscriminatory policy as to students as
siblings. other information about how to complete follows. “The M school admits students of
required courses; any race, color, national origin, and ethnic
Line 10. Answer “Yes” if you conduct
baptisms, weddings, funerals, or other • Certification by the appropriate state origin to all the rights, privileges,
religious rites. authority or successful completion of programs, and activities generally
required training for qualified teachers; accorded or made available to students at
Line 11. A school for the religious • Records of regular attendance by the school. It doesn't discriminate on the
instruction of the young refers to any students at your facility; and basis of race, color, national origin, and
regularly scheduled religious, educational • A lease agreement or deed for your ethnic origin in administration of its
activities for youth. facility. educational policies, admission policies,
scholarship and loan programs, and
Line 12. A “prescribed course of study” If you answer “No,” you may not meet athletic and other school-administered
refers to formal or informal training. It the requirements of a school and you may programs.”
doesn’t include self-ordination or paying a need to reconsider your foundation
fee for an ordination certificate without classification request. Annual certification. A private school
completing a course of study. Describe must certify annually that it meets the
the course of study completed by your Line 2. Answer “Yes” if the primary requirements of Rev. Proc. 75-50, as
religious leaders. function of your school is the presentation modified by Rev. Proc. 2019-22, by filing
of formal instruction. If you answer “No,” Schedule A (Form 990), Public Charity
Line 15. Provide any additional you may not meet the requirements for Status and Public Support.
information you would like us to consider classification as a school and may want to Schools that don’t file Form 990 or
that would help us classify you as a reconsider your foundation classification 990-EZ must make the certification by
church. request. filing Form 5578, Annual Certification of
Schedule M. Schools, Line 2a. Select the best description(s) of Racial Nondiscrimination for a Private
your school. School Exempt From Federal Income Tax.
Colleges, and Universities
An organization qualifies as a school (for Line 3. Answer “Yes” if you’re a public Line 7. Answer “Yes” if your organizing
purposes of classification under sections school and explain how you’re operated document or bylaws contain a
509(a)(1) and 170(b)(1)(A)(ii)) if all the by the state or a subdivision of a state, nondiscriminatory statement as to
following apply. It: including if you have a signed contract or students similar to the one shown above
• Presents formal instruction as its agreement with a state or local or if you adopted such a policy by
primary function, government under which you operate and resolution of your governing body. State
• Has a regularly scheduled curriculum, receive funding. If you answer “Yes,” stop where your policy is located in your
• Has a regular faculty of qualified here. organizing document, bylaws, or if it is in
an adopted resolution. If you answered
teachers, Line 4. Answer “Yes” if you were formed “No,” you must adopt a nondiscriminatory
• Has a regularly enrolled student body, or substantially expanded when public policy before submitting this request.
and schools in your district or county were
• Has a place where educational desegregated by court order. Line 8. Answer “Yes” if your brochures,
activities are regularly carried on. application forms, advertisements, and
If you're unsure whether to answer catalogues dealing with student
The term “school” includes primary, ! “Yes,” contact an appropriate admissions, programs, and scholarships
secondary, preparatory, high schools, CAUTION school official.
contain a similar statement to the
colleges, and universities. An organization
following: “The M school admits students
won’t be described as a school under Line 5. Answer “Yes” if a state or federal
of any race, color, and national or ethnic
sections 509(a)(1) and 170(b)(1)(A)(ii) if it administrative agency or judicial body ever
origin.”
engages in both educational and determined your organization to be racially
noneducational activities unless the latter discriminatory. Identify the parties involved Line 8a. If you answered “No” to line 8,
are merely incidental to the educational and the forum in which the case was check the box on line 8a if you agree that
activities. Nontraditional schools such as presented. Explain the reason for the all future printed materials, including
an outdoor survival school or a yoga action, the decision reached, and provide website content, will contain a statement
school may qualify. However, an legal citations (if any) for the decision. of nondiscriminatory policy as to students
organization may further an educational Also, explain in detail any changes made similar to the one provided above.

Instructions for Form 8940 (Rev. 04-2023) -15-

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Line 9. You must make your Line 12. Enter the racial composition of physical or mental disability or condition,
nondiscriminatory policy known to all students to whom you award loans and on an inpatient or outpatient basis. Thus, if
segments of the general community scholarships in the spaces provided. Enter an organization is a rehabilitation
served by the school. One way to meet actual numbers, rather than percentages, institution, outpatient clinic, or community
this requirement is to publish your for the current year and projected mental health or drug treatment center, it
nondiscriminatory policy annually in a numbers for the next academic year. If the is a hospital if its principal function is
newspaper or over broadcast media. Rev. number is zero, then enter “0.” If you won’t providing treatment services, as described
Proc. 2019-22 now allows this publication provide any loans or scholarships, check above.
requirement to be satisfied by the box provided. A hospital doesn't include convalescent
continuously displaying your homes, homes for children or the aged
Don’t identify students by name.
nondiscrimination statement on your (except for certain skilled nursing facilities
Internet site, as described below. CAUTION! under 42 USC 1395x(j)), or institutions
Check “Yes” if you make your racially whose principal purposes or function is to
nondiscriminatory policy known to all Line 13. Identify each of your train handicapped individuals to pursue a
segments of the general community you incorporators, founders, board members, vocation.
serve by: donors of land, and donors of buildings by
• Publishing a notice of your policy in a name (whether individuals or Medical research organization. An
newspaper of general circulation that organizations). organization is a “medical research
organization” if its principal purpose or
serves all racial segments of the Line 14. Answer “Yes” if any individuals function is the direct, continuous, and
community; or organizations on your list have an active conduct of medical research in
• Publicizing your policy over broadcast objective to keep public or private school conjunction with a hospital. The hospital
media in a way that is reasonably education segregated by race and explain with which the organization is affiliated
expected to be effective; or how these individuals or organizations must be described in section 501(c)(3), a
• Displaying a notice of your policy at all promote segregation in public or private federal hospital, or an instrumentality of a
times on your primary, publicly accessible schools. governmental unit, such as a municipal
Internet homepage in a manner hospital.
reasonably expected to be noticed by Line 15. Answer “Yes” if, on a continuing
visitors to the homepage. basis, you will maintain for a minimum “Medical research” means
period of 3 years the following records. investigations, experiments, and studies
See Rev. Proc. 75-50, as modified by Your racial composition (similar to the to discover, develop, or verify knowledge
Rev. Proc. 2019-22, for guidance on the •
information requested on line 11). relating to the causes, diagnosis,
format and content of the required notice Evidence that your scholarships and treatment, prevention, or control of human
and whether any exceptions may apply to •
loans are awarded on a racially physical or mental diseases and
you. nondiscriminatory basis (similar to the impairments. For more information, see
A notice published in the legal information requested on line 12). Regulations section 1.170A-9(d)(2).
TIP notices section or classified • Copies of all materials used by you or Cooperative hospital service
advertisements of your local on your behalf to solicit contributions. organization. A cooperative hospital
newspaper generally is not acceptable. • Copies of brochures, application forms, service organization performs one or more
advertisements, and catalogues dealing of the specific services listed below for
Line 9a. If you answered “No” to line 9, with student admissions, programs, and one or more exempt hospitals on a
check the box on line 9a if you agree that financial aid. cooperative basis. The services listed
you will publicize your nondiscriminatory Answer “No” if you don’t maintain below are exclusive. A cooperative service
policy in a way that meets the records and explain how you meet the organization that provides services other
requirements of Rev. Proc. 75-50, as recordkeeping requirements under Rev. than those listed below, or that provides
modified by Rev. Proc. 2019-22. Proc. 75-50. services to an organization other than an
Line 10. Answer “Yes” if you (or any Failure to maintain these records exempt hospital, doesn’t qualify for
exemption under section 501(c)(3). The
department or division of your ! or produce them upon the proper list of services includes:
organization) discriminate in any way on CAUTION request will create a presumption
the basis of race with respect to that you haven’t complied with the 1. Data processing,
admissions, use of facilities or exercise of requirements of Rev. Proc. 75-50. 2. Purchasing (including the
student privileges, faculty or administrative
staff, or scholarship or loan programs and purchasing of insurance on a group basis),
explain fully. Schedule N. Hospitals and 3. Warehousing,
Line 11. Enter the racial composition of Medical Research 4. Billing and collection (including the
purchasing of patron accounts receivable
your student body, faculty, and Organizations on a recourse basis),
administrative staff in the spaces An organization qualifies as a hospital for
provided. Enter actual numbers, rather purposes of classification under sections 5. Food,
than percentages, for the current year and 509(a)(1) and 170(b)(1)(iii) if it is a: 6. Clinical,
projected numbers for the next academic • Hospital, 7. Industrial engineering,
year. If the number is zero, then enter “0.” • Medical research organization operated 8. Laboratory,
If you’re not operational, submit an in conjunction with a hospital, or
estimate based on the best information • Cooperative hospital service 9. Printing,
available (such as the racial composition organization. 10. Communications,
of the community you serve). 11. Record center, and
Hospital. An organization is a
Don’t identify students, faculty, “hospital” if its principal purpose or 12. Personnel services (including
! and staff by name. function is providing medical or hospital selection testing, training, and education
CAUTION care or medical education or research. of personnel).
Medical care includes treatment of any

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Line 1. Answer “Yes” if you’re a medical these services promote benefits to the section 501(r)(3), a CHNA must take into
research organization, as described community. account input from persons who represent
above. Example. You may want to indicate the broad interests of the community
Line 1a. As a medical research how you determine who is eligible for the served by the hospital facility, including
organization, you must be associated with services, how you inform the general those with special knowledge of or
a hospital described in section 501(c)(3), public about your policy, any requirements expertise in public health, and must be
a federal hospital, or an instrumentality of you require of patients to receive reduced made widely available to the public. Each
a government. Provide the name of the cost or free care, and any agreements you hospital facility must conduct a CHNA at
hospital(s) you’re associated with and might have with municipalities or least once every 3 years and adopt an
describe the relationship(s). governmental agencies to subsidize the implementation strategy to meet the
cost of admitting or treating patients community health need identified through
Line 1b. List your assets and their fair through this policy. such CHNA.
market value and the portion of your Answer “Yes” if the hospital facility
assets directly devoted to medical Line 7. Answer “Yes” if you have a formal conducted a complying CHNA in the
research and stop here. program of medical training and research. current tax year or in either of the 2
If you answer “Yes,” describe your immediately preceding tax years or if the
Line 2. Answer “Yes” if you’re a program, including the programs you offer, hospital facility intends to conduct a
cooperative hospital service organization the scope of such programs, and affiliation CHNA before the end of its first 3-year
and describe the services you provide to with other hospitals or medical care period.
your member hospitals and the exempt providers with which you carry on the
status of your membership and stop here. medical training or research programs. Line 10b. A financial assistance policy
(FAP), sometimes referred to as a charity
Line 3. Answer “Yes” if all the doctors in Line 8. Answer “Yes” if you have a formal care policy, is a policy describing how an
your community are eligible for staff program of community educational organization will provide financial
privileges at your facility. You must answer programs and describe your programs, assistance at its hospital(s) and other
“Yes” even if staff privileges at your including the types of programs offered, facilities, if any. Financial assistance
facilities are limited by capacity, provided the scope of the programs, and affiliation includes free or discounted health
that all qualified medical professionals in with other hospitals or medical care services provided to persons who meet
your community may seek and would be providers with whom you offer community the organization’s criteria for financial
considered for eligibility. educational programs. assistance and are unable to pay for all or
Answer “No” if not all the doctors in Line 9. Answer “Yes” if you have a board a portion of the services. Financial
your community are eligible for staff of directors that is representative of the assistance doesn’t include:
privileges at your facility. community you serve or if an organization • Bad debt or uncollectible charges that
If you answer “No,” describe in detail described under section 501(c)(3) with a the organization recorded as revenue but
how you limit eligibility for staff privileges community board exercises rights or wrote off due to a patient’s failure to pay or
at your facility. Include details of your powers over you. the cost of providing such care to such
eligibility criteria and selection procedures Answer “Yes” if you’re subject to a state patients;
for your courtesy staff of doctors. corporate practice of medicine law that • The difference between the cost of care
Line 4. Answer “Yes” if you admit all requires your governing board to be provided under Medicaid or other
patients in your community who can pay composed solely of physicians licensed to means-tested government programs or
for themselves or through some form of practice medicine in the state. under Medicare and the revenue derived
therefrom;
third-party reimbursement (for example, Line 9a. List each board member by • Self-pay or prompt pay discounts; or
private health insurance, Medicare, or name and describe that person’s • Contractual adjustments with any
Medicaid). relationship to you. Also, for each board third-party payors.
Answer “No” if you limit admission for member, describe if and how that Answer “Yes” if the hospital facility has
these individuals in any way and describe individual represents the community. adopted a written financial assistance
your admission policy in detail, including Generally, hospital employees and staff policy and a written policy relating to
how and why you restrict patient physicians aren’t individuals considered to emergency medical care, as required by
admission. be community representatives. If you section 501(r)(4).
Line 5. Answer “Yes” if you offer operate under a parent organization
emergency medical or hospital care at whose board of directors isn’t comprised Line 10c. Under section 501(r)(5), the
your facility on a 24-hour basis, 7 days a of a majority of individuals who are maximum amounts that can be charged to
week. representative of the community you FAP-eligible individuals for emergency or
serve, provide the requested information other medically necessary care are the
Line 5a. Answer “Yes” if the reason you for your parent organization's board of amounts generally billed to individuals
don’t maintain a full-time emergency room directors as well. who have insurance covering such care.
is either because you’re a specialty Answer “Yes” if the hospital facility:
hospital where emergency care would be Line 10. Section 501(r). Answer “Yes” if
inappropriate for the services you provide you operate a facility that is required by a 1. Limits or will limit any charges to
or another emergency medical care facility state to be licensed, registered, or FAP-eligible individuals to whom the
that provides such services is located so similarly recognized as a hospital. hospital facility provided emergency or
near to you as to make such services as Organizations that respond “Yes” to this other medically necessary services to not
you might provide duplicative. question are required to meet additional more than the amounts generally billed to
requirements described in section 501(r) individuals who had insurance covering
Line 6. Answer “Yes” if you provide free to be considered a hospital exempt from such care; and
or low-cost medical or hospital care taxation by section 501(c). 2. Prohibits, or upon beginning
services. If you answer “Yes,” describe operations will prohibit, the use of gross
your policy and to whom you provide Line 10a. A community health needs
these services. Include details on how assessment (CHNA) is an assessment of charges, as described in section 501(r)(5).
the significant health needs of the
community. To meet the requirements of

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  The hospital facility may check “Yes” if     (excluding income you receive from an         returns and return information are 
it charged more than the amounts               activity substantially related to the         confidential, as required by section 6103. 
generally billed to individuals who had        charitable, educational, or other section     However, certain returns and return 
insurance covering such care to an             501(c)(3) purpose that’s the basis for your   information of tax-exempt organizations 
individual if:                                 exemption under section 501(a)) from the      and trusts are subject to public disclosure 
• The charge in excess of the amounts          United States or any state or its political   and inspection, as provided by section 
generally billed (AGB) wasn’t made or          subdivision or from direct or indirect        6104.
requested as a pre-condition of providing      contributions from the general public. If 
medically necessary care to the                “No,” explain your sources of support.        The time needed to complete and file 
FAP-eligible individual;                                                                     this form will vary depending on individual 
                                               Line 2. Answer “Yes” if your bylaws or 
• As of the time of the charge, the                                                          circumstances. The estimated burden for 
                                               other organizational documents indicate 
FAP-eligible individual hadn’t submitted a                                                   tax-exempt organizations filing this form is 
                                               that you are organized and operated 
complete FAP application and hadn’t                                                          approved under OMB control number 
                                               exclusively to receive, hold, invest, and 
otherwise been determined by the hospital                                                    1545-0047 and is included in the 
                                               administer property and to make 
facility to be FAP eligible for care; and                                                    estimates shown in the instructions for 
                                               expenditures to or for the benefit of a 
• If the individual subsequently submits a                                                   their information return.
                                               college or university described in sections 
complete FAP application and is                                                              If you have comments concerning the 
                                               509(a)(1) and 170(b)(1)(A)(ii).
determined to be FAP eligible for care, the                                                  accuracy of these time estimates or 
hospital facility refunds any amount that      Line 3. Answer “Yes” if the college or        suggestions for making this form simpler, 
exceeds the amount he or she is                university is an agency or instrumentality    we would be happy to hear from you. You 
determined to be personally responsible        of a state or political subdivision thereof,  can send us comments from IRS.gov/
for paying as a FAP-eligible individual,       or is it owned or operated by a state or      FormComments. Or you can write to:
unless such excess amount is less than         political subdivision thereof, or by an 
$5.                                            agency or instrumentality of one or more      Internal Revenue Service
                                               states or political subdivisions. List the    Tax Forms and Publications Division
Line 10d. Answer “Yes” if the hospital         name and EIN of the college or university.    1111 Constitution Ave. NW, IR-6526
facility has, or will have at the beginning of 
operation, either a separate written billing                                                 Washington, DC 20224
and collections policy, or include in a        Schedule P. An 
written FAP:                                   Agricultural Research                         Do not send Form 8940 to this address.
• A description of any actions that the 
hospital facility (or other authorized party)  Organization Described in 
may take related to obtaining payment of a     Sections 509(a)(1) and 
bill for medical care, including, but not      170(b)(1)(A)(ix)
limited to, any extraordinary collection 
actions (ECAs);                                Line 1. Explain in detail how you are 
• The process and time frames the              operated in conjunction with a land grant 
hospital facility (or other authorized party)  college or university or a non-land grant 
uses in taking those actions (including, but   college of agriculture (as defined in 
not limited to, the reasonable efforts it will section 1404 of the Agricultural Research, 
make to determine whether an individual        Extension, and Teaching Policy Act of 
is FAP eligible before engaging in ECAs);      1977).
and                                            Line 2. Explain in detail your agricultural 
• The office, department, committee, or        research program and how contributions 
other body with the final authority or         to such program will be spent.
responsibility for determining that the 
hospital facility has made reasonable          Paperwork Reduction Act Notice.         We 
efforts to determine whether an individual     ask for the information on this form to carry 
is FAP eligible and may therefore engage       out the Internal Revenue laws of the 
in ECAs against the individual.                United States. If you want your 
                                               organization to be recognized as tax 
Schedule O. An                                 exempt by the IRS, you are required to 
Organization Operated for                      give us the information. We need it to 
                                               determine whether the organization meets 
the Benefit of a College or                    the legal requirements for your requested 
University Owned or                            miscellaneous determination.
Operated by a                                  You are not required to provide the 
Governmental Unit, as                          information requested on a form that is 
                                               subject to the Paperwork Reduction Act 
Described in Sections                          unless the form displays a valid OMB 
509(a)(1) and 170(b)(1)(A)                     control number. Books or records relating 
                                               to a form or its instructions must be 
(iv)                                           retained as long as their contents may 
Line 1. Answer “Yes” if you normally           become material in the administration of 
receive a substantial part of your support     any Internal Revenue law. Generally, tax 

                                                       -18-                                 Instructions for Form 8940 (Rev. 04-2023)

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