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                                                                                                      Department of the Treasury
                                                                                                      Internal Revenue Service
Instructions for Form 1023

(Rev. January 2020)
Application for Recognition of Exemption Under Section 501(c)(3) of the Internal 
Revenue Code

Section references are to the Internal Revenue Contents                               Page How To Get Forms and 
Code unless otherwise noted.
                                               Revenue Code Section                        Publications
Contents                          Page         508(e)                                  27
Future Developments                            Appendix C: Glossary of Terms           29  Internet.  You can access the IRS website 
What's New                                     Appendix D: National Taxonomy of            24 hours a day, 7 days a week, at IRS.gov 
Overview of Organizations                      Exempt Entities (NTEE)                      to do the following.
Described in Section 501(c)                    Codes                                   37  • Download forms, instructions, and 
(3)                                            Index                                   40  publications.
General Instructions                                                                       • Order IRS products online.
                                               Note.   Keep a copy of the completed        • Research your tax questions online.
Answers                                        Form 1023 for your permanent records.       • Search publications by topic or 
Purpose of Form               
                                                                                           keyword.
What To File                                                                                 Use the online Internal Revenue Code, 
                                                                                           •
When To File                                   Future Developments                         regulations, or other official guidance.
Filing Assistance                              For the latest information about            • View Internal Revenue Bulletins (IRBs) 
Signature Requirements                         developments related to Form 1023 and       published since 1995.
Authorized Representative                      its instructions, such as legislation       • Sign up at IRS.gov/Charities-Non-
Public Inspection                              enacted after they were published, go to    Profits to receive local and national tax 
Foreign Organizations                          IRS.gov/Form1023.                           news by email.
Specific Instructions                          Reminder                                    Tax forms and publications.   You can 
Part I. Identification of Applicant                                                        download or print all of the forms and 
Part II. Organizational Structure              Don't include social security numbers 
                                               on publicly disclosed forms. Because        publications you may need at IRS.gov/
Part III. Required Provisions in               the IRS is required to disclose approved    FormsPubs. Otherwise, you can go to 
Your Organizing Document                                                                   IRS.gov/OrderForms to place an order 
                                               exemption applications and information 
Part IV. Your Activities                       returns, don't include social security      and have forms mailed to you. You should 
Part V. Compensation and Other                 numbers on this form. Documents subject     receive your order within 10 business 
Financial Arrangements                  10                                                 days.
                                               to disclosure include supporting 
Part VI. Financial Data                 11     information filed with the form and 
Part VII. Foundation                           correspondence with the IRS about the 
Classification                          13     filing.                                     Overview of Organizations 
Part VIII. Effective Date               15                                                 Described in Section 
Part IX. Annual Filing                         Phone Help
                                                                                           501(c)(3)
Requirement                             15     If you have questions and/or need help 
Part X. Signature                       16     completing Form 1023, please call           How To Request Recognition of 
Schedule A. Churches                    16     877-829-5500. This toll-free telephone      Tax-Exempt Status Under 
Schedule B. Schools, Colleges,                 service is available Monday through 
and Universities                        17     Friday.                                     Section 501(c)(3)
Schedule C. Hospitals and                                                                  Section 501(c)(3) describes organizations 
Medical Research                               Email Subscription                          organized and operated exclusively for 
Organizations                           18     The IRS provides a subscription-based       religious, charitable, scientific, testing for 
Schedule D. Section 509(a)(3)                  email service for tax professionals and     public safety, literary, or educational 
Supporting Organizations                20     representatives of tax-exempt               purposes, or to foster national or 
Schedule E. Effective Date              21     organizations. We send subscribers          international amateur sports competition, 
Schedule F. Low-Income                         periodic updates regarding exempt           or for the prevention of cruelty to children 
Housing                                 22     organization tax law and regulations,       or animals. Unless an exception applies, 
Schedule G. Successors to Other                available services, and other information.  an organization must file Form 1023 or 
Organizations                           22     To subscribe, visit IRS.gov/Charities.      Form 1023-EZ (if eligible) to obtain 
Schedule H. Organizations                                                                  recognition of exemption from federal 
Providing Scholarships,                                                                    income tax under section 501(c)(3). You 
Fellowships, Educational                       What's New                                  can find information about eligibility to file 
Loans, or Other Educational 
Grants to Individuals and                      Organizations requesting recognition of     Form 1023-EZ at IRS.gov/Charities.
Private Foundations                            tax-exempt status under section 501(c)(3) 
Requesting Advance                             must complete and submit their Form           Organizations not required to 
Approval of Individual Grant                   1023 (or Form 1023-EZ, if eligible)         obtain recognition of exemption.        The 
Procedures                              22     applications electronically (including      following types of organizations may be 
Appendix A: Sample Conflict of                 paying the correct user fee) using          considered tax exempt under section 
Interest Policy                         25     Pay.gov.                                    501(c)(3) without filing Form 1023 (or 
Appendix B: States With Statutory                                                          Form 1023-EZ).
Provisions Satisfying the                                                                  • Churches, including synagogues, 
Requirements of Internal                                                                   temples, and mosques.

Jan 30, 2020                                            Cat. No. 17132z

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• Integrated auxiliaries of churches and     attempting to influence legislation or if it  contribution deductions and attracting 
conventions or associations of churches.     directly or indirectly participates or        grants from private foundations. In order to 
• Any organization that has gross            intervenes in any political campaign on       be classified as a private operating 
receipts in each tax year of normally not    behalf of (or in opposition to) any           foundation, an organization must meet 
more than $5,000. For more information       candidate for elective public office. These   certain support tests. Search for “private 
on gross receipts exceptions, go to          issues are described in more detail in the    operating foundations” at IRS.gov for more 
IRS.gov/Charities.                           instructions for Part IV, lines 5 and 6.      information.
    Even though these organizations aren't                                                 Key distinctions between public chari-
required to seek recognition of exemption,   Public Charities and Private                  ties and private foundations. 
they may choose to file Form 1023 (or        Foundations                                   Foundation classification is important 
Form 1023-EZ, if eligible) to receive a                                                    because different tax rules apply to the 
determination letter stating they are        Every organization described in section       operations of each entity. For more 
recognized as exempt under section           501(c)(3) is classified as a private          information on the different rules, see 
501(c)(3) status. The determination letter   foundation unless it qualifies for one of     IRS.gov/Charities-Non-Profits/EO-
will also state whether an organization      the public charity exceptions. For some       Operational-Requirements-Private-
must file annual information returns or      organizations, the primary distinction        Foundations-and-Public-Charities.
notices and will specify whether             between a public charity and a private 
contributions to that organization are tax   foundation is its sources of financial            Foundation classification has 
deductible.                                  support.                                      TIP nothing to do with the name of the 
                                                                                               organization. Many organizations 
                                             Public charities.       The following section that aren't private foundations include the 
Requirements for Tax-Exempt                  501(c)(3) organizations are classified as     word “foundation” in their names.
Status Under Section 501(c)(3)               public charities.
                                             • Organizations that are public charities 
To qualify for exemption under section       based upon their activities (without regard   State Registration Requirements
501(c)(3), an organization must be           to their sources of support), such as 
organized and operated exclusively for       churches, schools, hospitals, medical         Tax exemption under section 501(c)(3) is 
one or more exempt purposes.                 research organizations, and cooperative       a matter of federal law. After receiving 
Organized.   An organization must be         hospital service organizations and            federal tax exemption, an organization 
organized as a corporation, a limited        agricultural research organizations           may also be required to register with one 
liability company (LLC), an                  (sections 509(a)(1) and 170(b)(1)(A)(i),      or more states where it holds assets or 
unincorporated association, or a trust.      (ii), (iii), and (ix)).                       where it will solicit contributions. The 
Its organizing document (corporate           • Organizations that normally receive         organization may also need to seek 
articles of incorporation, LLC articles of   substantial support from grants,              exemption from state taxes. The National 
organization, articles of association or     governmental units, and/or contributions      Association of State Charity Officials 
constitution of an unincorporated            from the general public (sections 509(a)(1)   (NASCO) maintains a website that 
association, or trust agreement or           and 170(b)(1)(A)(iv) and (vi)).               provides informational links to the various 
declaration of trust) must limit the         • Organizations that normally receive         states for these purposes. It can be 
organization's purpose(s) and                more than one-third of their support from     accessed at www.nasconet.org .
permanently dedicate its assets to exempt    contributions, membership fees, and 
purposes.                                    gross receipts from activities related to     General Instructions
                                             their exempt functions, and not more than 
Operated.   An organization described in     one-third of their support from gross         Social Security number. Don't enter 
section 501(c)(3) must be operated to        investment income and net unrelated           social security numbers on this form or 
further one or more of the exempt            business income (section 509(a)(2)).          any attachments because the IRS is 
purposes stated in its organizing            • Organizations that support other public     required to disclose approved exemption 
document. Certain other activities are       charities (supporting organizations)          applications and information returns. 
prohibited or restricted, including, but not (section 509(a)(3)).                          Documents subject to disclosure include 
limited to, the following activities. A      • Organizations that test for public safety   supporting information filed with the form 
section 501(c)(3) organization must:         (section 509(a)(4)).                          and correspondence with the IRS related 
• Absolutely refrain from participating in                                                 to the application.
the political campaigns of candidates for    Private foundations.    Section 501(c)(3) 
local, state, or federal office;             organizations that don’t fit into any of the  “You” and “us.”    Throughout these 
• Ensure its assets and earnings don’t       foundation classifications above are          instructions and Form 1023, the terms 
unjustly enrich board members, officers,     private foundations. Private foundations      “you” and “your” refer to the organization 
key management employees, or other           are further classified as nonoperating        that is applying for tax-exempt status. The 
insiders;                                    private foundations or private operating      terms “us” and “we” refer to the IRS.
• Not further non-exempt purposes (such      foundations (section 4942(j)(3)).             Definitions. Terms in bold type in Form 
as purposes that benefit private interests)  Nonoperating private foundations.             1023 are defined throughout these 
more than insubstantially;                   Nonoperating private foundations              instructions and in Appendix C.
• Not operate for the primary purpose of     generally accomplish their exempt 
conducting a trade or business that isn’t    purpose by making grants and don’t            Answers
related to its exempt purpose(s);            otherwise engage directly in charitable       Form 1023 asks you to answer a series of 
• Not engage in activities that are illegal  activities.                                   questions and provide information to 
or violate fundamental public policy; and                                                  assist us in determining if you meet the 
• Limit its legislative activities.          Private operating foundations.      A         requirements for tax exemption under 
                                             private operating foundation actively         section 501(c)(3). Answer questions 
Legislative and political campaign in-       conducts exempt programs. Private             completely. If you believe you previously 
tervention.  Section 501(c)(3) denies        operating foundations are subject to more     answered the question, you may refer to 
exemption to an organization if a            favorable rules than other private            your previous answer.
substantial part of its activities is        foundations in terms of charitable 

                                                                     -2-                                Instructions for Form 1023

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        Your answers must provide            Eligibility Worksheet in the Instructions for User fee amounts are listed in Rev. 
!       sufficient detail about your past,   Form 1023-EZ to determine if you're           Proc. 2020-5, updated annually. For the 
CAUTION present, and planned activities to   eligible to file Form 1023-EZ. You can visit  current Form 1023 user fee, go to Rev. 
demonstrate that you're described in         IRS.gov/Charities for more information on     Proc. 2020-5, 2020-1 I.R.B. 241, at 
section 501(c)(3). We won't be able to       application requirements.                     IRS.gov/Charities-Non-Profits/User-Fees-
recognize you as tax exempt based on a                                                     for-Tax-Exempt-and-Government-Entities-
mission statement (such as providing         Leaving a group exemption.     A              Division. You can also call 877-829-5500.
assistance to the poor) unless you also      subordinate organization under a group 
describe the activities that further         exemption can use Form 1023 to leave the      Group Exemption
accomplish your mission. We need to          group and obtain individual exemption. If     Don't use Form 1023 to apply for a group 
understand the specific activities you will  you're a subordinate organization and         exemption. We may issue to a central 
undertake to accomplish your section         wish to leave a group, you should notify      organization a group exemption that 
501(c)(3) exempt purpose(s).                 your parent organization of your intention    recognizes on a group basis the 
                                             to leave the group ruling before filing Form  exemption of subordinate organizations 
Financial data. Financial data, whether      1023.                                         on whose behalf the central organization 
budgeted or actual, should be consistent                                                   has applied. See Pub. 557 for information 
with other information presented in your     Application for Reinstatement                 on how to apply for a group exemption.
application.                                 of Exempt Status and 
For example, if you're requesting public     Retroactive Reinstatement                     What To File
charity classification under one of the      If your tax-exempt status was                 All applicants, unless otherwise noted, 
public support tests, your financial data    automatically revoked for failure to file a   must complete Parts I through X of Form 
should show contributions from the public    return or notice 3 consecutive years, you     1023, plus any required schedules and 
or receipts from providing exempt            must apply to have your tax-exempt status     attachments.
services. Budgeted financial data should     reinstated. You must complete and submit      The following organizations must 
be prepared based upon your current          Form 1023, including Schedule E (or, if       complete additional schedules to Form 
plans. We recognize that your actual         eligible, Form 1023-EZ), and pay the          1023.
financial results may vary from the          appropriate user fee.
budgeted amounts.
                                               If your application is approved, your                                    THEN you 
Past, present, and planned activities.       date of reinstatement will generally be the                                must 
Many items on Form 1023 are written in       filing date of the application, unless you                                 complete 
the present tense; however, base your        qualify for reinstatement of exemption        IF you’re                    Schedule 
answers on your past, present, and           retroactive to your date of automatic 
planned activities.                          revocation. See Rev. Proc. 2014-11,           A church           
Language and currency requirements.          2014-03 I.R.B. 411 for details, including     A school, college, or 
Prepare Form 1023 and attachments in         additional requirements for retroactive       university          
English. Provide an English translation if   reinstatement.
                                                                                           A hospital or medical 
the articles of organization, bylaws, or any Requesting Expedited Review                   research organization  
other attachments are in any other 
language.                                    We generally review applications for          A section 509(a)(3) 
                                             exemption in the order we receive them.       supporting 
Report financial information in U.S.         We only expedite processing of an             organization         
dollars (specify the conversion rate used).  application where a written request 
Combine amounts from within and outside      presents a compelling reason for              Filing this application more 
the United States and report the total for   processing the application ahead of           than 27 months from your 
each on the financial statements.            others. This does not mean your               date of formation and/or 
                                             application will be immediately approved      applying for reinstatement 
Purpose of Form                              or denied. Circumstances generally            of tax-exempt status after 
                                             warranting expedited processing include       being automatically 
Completed Form 1023 required to ap-                                                        revoked            
                                             the following.
ply for recognition of section 501(c)(3) 
exemption.   Use Form 1023, including        • A grant to the applicant is pending and     A low-income housing 
                                             the failure to secure the grant may have an 
the appropriate user fee, to apply for                                                     organization         
                                             adverse impact on the organization's 
recognition of exemption from federal                                                      A successor to other 
                                             ability to continue operations.
income tax under section 501(c)(3). If                                                     organizations        
approved, we will issue a determination      • The purpose of the newly created 
                                             organization is to provide disaster relief to 
letter that describes your tax-exempt                                                      An organization providing 
                                             victims of emergencies such as floods and 
status and your qualification to receive                                                   scholarships, fellowships, 
                                             hurricanes.
tax-deductible charitable contributions.                                                   educational loans, or other 
The determination letter will also show      • An IRS error has caused delays in           educational grants to 
                                             review of the application.
your specific foundation classification                                                    individuals and/or a private 
(described earlier) and annual filing        User Fee                                      foundation requesting 
requirements.                                The law requires payment of a user fee        approval of individual grant 
        Form 1023-EZ. You may be             with each application. You must pay this      procedures           
TIP     eligible to file Form 1023-EZ,       fee through Pay.gov when you file Form 
        Streamlined Application for          1023.
Recognition of Exemption Under Section         Payments can be made directly from 
501(c)(3) of the Internal Revenue Code,      your bank account or by credit or debit       Attachments To Form 1023
which is a streamlined version of Form       card. You won't be able to submit Form        A complete application will include one or 
1023. Complete the Form 1023-EZ              1023 without paying the correct fee.          more documents in addition to Form 1023. 

Instructions for Form 1023                                     -3-

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Pay.gov can accommodate only one             • Pub. 526, Charitable Contributions.            Additional information needed.        If we 
uploaded file. Before submitting Form        • Pub. 557, Tax-Exempt Status for Your           can’t make a determination without more 
1023, consolidate your attachments into a    Organization.                                    information, we’ll write or call you. 
single PDF file. Combine your                • Pub. 598, Tax on Unrelated Business            Examples of the types of questions we 
attachments in the following order.          Income of Exempt Organizations.                  may ask you are available at IRS.gov/
• Organizing document (required).            • Pub. 1771, Charitable Contributions            Charities-Non-Profits/Charitable-
• Amendments to your organizing              Substantiation and Disclosure                    Organizations/Exempt-Organization-
document in chronological order (required    Requirements.                                    Sample-Questions. If the additional 
if applicable).                              • Pub. 1828, Tax Guide for Churches and          information you provide shows that you 
• Bylaws or other rules of operation and     Religious Organizations.                         meet the requirements for exemption, we'll 
amendments (if adopted).                     • Pub. 3079, Tax-Exempt Organizations            send you a determination letter stating that 
• Form 2848, Power of Attorney and           and Gaming.                                      you're exempt under section 501(c)(3). If 
Declaration of Representative (if            • Pub. 3833, Disaster Relief: Providing          we determine that you don't qualify for 
applicable).                                 Assistance Through Charitable                    exemption, we will send you a letter that 
• Form 8821, Tax Information                 Organizations.                                   explains our position and your appeal 
Authorization (if applicable).               • Pub. 4220, Applying for 501(c)(3)              rights.
• Supplemental responses (if your            Tax-Exempt Status.
response won't fit in the provided text      • Pub. 4221-PC, Compliance Guide for             Annual Return or Notice While 
field) and any additional information you    501(c)(3) Public Charities.                      Your Application Is Pending
want to provide to support your request      • Pub. 4221-PF, Compliance Guide for             Unless you qualify for an exception from 
(optional).                                  501(c)(3) Private Foundations.                   the requirement to file an annual return or 
• Expedite request (optional).                                                                notice, your filing obligations begin as 
  Put your name and EIN on each page         Signature Requirements                           soon as you were formed. If you have an 
of your supplemental response and            An officer, director, trustee, or other official information return or tax return due while 
identify the part and line number to which   who is authorized to sign for the                your Form 1023 is pending, complete the 
the information relates.                     organization must digitally sign Form 1023       return, mark the “Application Pending” box 
                                             at the end of Part X. The signature must         in the heading, Item B, and submit the 
When To File                                 be accompanied by the title or authority of      return as indicated in those instructions.
                                             the signer and the date.
Generally, if you file Form 1023 within 27                                                      If you’re eligible to file a Form 990-N, 
months after the end of the month in which                                                    e-Postcard, call 877-829-5500 and 
you were legally formed, and we approve      Authorized Representative                        request to be set up to allow filing of Form 
your application, the effective date of your Form 2848.   Upload a completed Form             990-N (note, it takes the IRS up to 6 
exempt status will be your legal date of     2848 if you want to authorize a                  weeks to update its records before you 
formation.                                   representative to represent you regarding        can file your Form 990-N).
  If you don’t file Form 1023 within 27      your application. An individual authorized         You can find information on return filing 
months, the effective date of your exempt    by Form 2848 may not sign the application        requirements and exceptions in Pubs. 557 
status will be the date you filed Form       unless that person is also an officer,           and 598 and in the instructions to the 
1023. For exceptions and special rules,      director, trustee, or other official who is      annual returns listed in Figure 1.
see Part VIII. Effective Date and            authorized to sign the application.
                                                                                                      You may also be required to file 
Schedule E.                                           A Centralized Authorization File        TIP     other returns, such as 
                                                      (CAF) number isn’t required to be 
How to File                                  CAUTION! listed on Form 2848.                            employment tax returns or benefit 
                                                                                              plan returns, which aren't discussed here.
As of January 31, 2020, the IRS requires 
that Form 1023 applications for              Form 8821.   Upload a completed Form                     If a Form 990-series return is due 
recognition of exemption be submitted        8821 if you want to authorize us to discuss        !     while your application is pending, 
electronically online at Pay.gov. The IRS    your application with the person you have        CAUTION complete and submit the return 
will provide a 90-day grace period during    appointed on that form.                          according to Form 990-series form's 
which it will continue to accept paper         Form 8821 doesn’t authorize your               instructions.
versions of Form 1023. To submit Form        appointee to advocate your position with 
1023, you must:                              respect to the federal tax laws; to execute 
  1. Register for an account on              waivers, consents, or closing agreements;        Public Inspection
Pay.gov.                                     or to otherwise represent you before the         Information available for public in-
                                             IRS. If you want to authorize an individual      spection. If we approve exempt status 
  2. Enter "1023" in the search box and      to represent you, use Form 2848.                 under section 501(c)(3), the following 
select Form 1023.
  3. Complete the form.                      After You Submit Form 1023                       information that will be open for public 
                                                                                              inspection includes the following.
                                             Unless we approve a request for                  • Your complete Form 1023 and any 
Filing Assistance                            expedited processing, we will assign and         supporting documents.
For help in completing this form or general  work your application in the order we            • All correspondence between you and 
questions relating to an exempt              received it.                                     the IRS concerning Form 1023, including 
organization, you may access information     No additional information needed.        If      Form 2848.
on our website at IRS.gov/EO.                our review shows that you meet the               • Your determination letter.
  You may find the following publications    requirements for tax-exempt status under         • Annual information returns (Forms 990, 
available on IRS.gov helpful.                section 501(c)(3), we’ll send you a              990-EZ, or 990-PF).
                                             determination letter stating that you’re         • Schedule A, included with Forms 990 or 
• Pub. 517, Social Security and Other        exempt under section 501(c)(3) and               990-EZ.
Information for Members of the Clergy and    identifying your foundation classification.      • Schedule B, included with Forms 990 or 
Religious Workers.                                                                            990-EZ, excluding the names and 

                                                               -4-                                         Instructions for Form 1023

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addresses of contributors and other         Figure 1. 990 Series Forms Filed by Exempt Organizations
identifying information about contributors.
• Schedule B, included with Form 
990-PF, including names, addresses, and     Type of Annual Return                        Who Should File
other identifying information about 
contributors.
• Exempt Organization Business Income       Form 990, Return of Organization             Section 501(c)(3) public charities 
Tax Return (Form 990-T).
                                            Exempt from Income Tax
  Information not available for public 
inspection.  The following items won’t be   Form 990-EZ, Short Form Return of            Section 501(c)(3) public charities whose 
open for public inspection.                 Organization Exempt from Income Tax          gross receipts during the year were less 
• Any information relating to a trade                                                    than $200,000 and total assets at the 
secret, patent, style of work, or apparatus                                              end of the year were less than $500,000 
that, if released, would adversely affect 
you (we must approve withholding this       Form 990-PF, Return of Private               Private foundations, including private 
information).                               Foundation                                   operating foundations, regardless of 
• Any other information that would                                                       financial status
adversely affect national defense (we 
must approve withholding this               Form 990-T, Exempt Organization              Public charities and private foundations 
information).                               Business Income Tax Return                   that have gross unrelated business 
• User fee payment information.                                                          income of $1,000 or more
• Contributors' names and addresses 
and identifying information about           Form 990-N Electronic Notice                 Most small public charities with gross 
contributors included with Forms 990 or     (e-Postcard) for Tax-Exempt                  receipts of $50,000 or less can file a 
990-EZ and the Schedule B filed with        Organizations Not Required to File Form      Form 990-N, if they choose not to file a 
these forms.                                990 or Form 990-EZ                           Form 990 or Form 990–EZ instead.
  When applying for tax-exempt status, 
you must clearly identify any information 
that isn’t open for public inspection by    posted. To date, the IRS hasn’t approved     U.S. sources are normally $50,000 or less 
marking it as “NOT SUBJECT TO PUBLIC        any third-party websites for posting.        and it hasn’t conducted significant activity 
INSPECTION” and include an explanation                                                   in the United States. See the Instructions 
                                            See Pub. 557 for additional information 
of why you’re asking for the information to                                              for Form 990 and Form 990-EZ, and the 
                                            on public inspection requirements.
be withheld. We will decide whether to                                                   Instructions for Form 990-PF for further 
withhold the identified information from                                                 information. A foreign organization that is 
public inspection.                          Foreign Organizations                        subject to unrelated business income tax 
                                            Foreign organizations are those that were    must file Form 990-T.
Making documents available for public       created in countries other than the United 
inspection.  Both you and the IRS must      States, its territories, or its possessions. Canadian Organizations
make the information that is subject to     Foreign organizations may apply for          Canadian organizations that have 
disclosure available for public inspection. tax-exempt status on income earned in the    received a Notification of Registration from 
The public may request a copy of the        United States in the same way that           the Canada Revenue Agency (formerly 
information available for public inspection domestic organizations apply for exempt      Canada Customs and Revenue Agency), 
from us by submitting Form 4506-A. The      status. See Language and currency            and whose registrations haven’t been 
public may also request inspection of the   requirements, above.                         revoked (“Canadian registered charities”), 
information or a copy of the information 
directly from you.                          If you’re a foreign organization applying    are automatically recognized in the U.S. 
  You may post the documents required       for exempt status, you must complete all     as section 501(c)(3) organizations and 
to be available for public inspection on    required parts of Form 1023. However,        aren’t required to file Form 1023. 
your own website. Information returns and   see the special rules below for certain      Canadian registered charities are also 
your exemption application materials must   Canadian organizations.                      presumed to be private foundations. If 
                                                                                         you’re a Canadian registered charity and 
be posted exactly as filed with the IRS.           Contributions by U.S. residents to    want to be listed as a section 501(c)(3) 
You may only delete the information that    TIP    foreign organizations generally       organization on IRS.gov or request 
isn’t open for public inspection.                  aren’t deductible. Tax treaties       classification as a public charity rather 
  If you post the documents on your         between the U.S. and certain foreign         than a private foundation, mail or fax the 
website, you can give any person            countries provide specific limited           information below to:
requesting copies the website where the     exceptions.
documents may be found, but you don’t                                                      Internal Revenue Service
need to provide copies of the information.  Annual returns for foreign organiza-           Exempt Organization Determinations
However, even if these documents are        tions. A foreign organization that obtains     Room 6403
posted on your website, you must still      exemption as a public charity must file an     P.O. Box 2508
allow public inspection without charge at   information return annually (Form 990 or       Cincinnati, OH 45201
your main office during regular business    Form 990-EZ). A foreign organization that      (855) 204-6184
hours.                                      is a private foundation must file Form 
  Documents aren’t considered available     990-PF annually. However, a foreign          No user fee is required.
for public inspection on a website if the   organization, other than a private           • A letter stating the organization’s 
otherwise disclosable information is edited foundation or a section 509(a)(3)            request (listing as a section 501(c)(3) 
or subject to editing by a third party when supporting organization, may file Form       organization on IRS.gov or classification 
                                            990-N (e-Postcard) instead of Form 990 or    as a public charity).
                                            Form 990-EZ when its gross receipts from 

Instructions for Form 1023                              -5-

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• The legal name and complete mailing         For a foreign address, enter your             or trustees, check the box provided to add 
address of the organization.                  province or state and foreign postal code     more officer, director, and/or trustee 
• The organization’s EIN.                     where indicated.                              information.
• The month its tax year ends.                                                              The person who is signing Form 1023 
                                              Line 2. Employer Identification Num-
• The organization’s date of formation.                                                     must be listed within the first five entries of 
                                              ber (EIN).  You must have your own EIN. 
• A contact name and telephone number.                                                      line 9.
                                              Enter the 9-digit EIN the IRS assigned to 
• The public charity status it is requesting 
                                              you. If you don’t have an EIN, you must 
(if applicable) and information 
                                              apply for one before submitting your 
demonstrating how it meets the                                                              Part II. Organizational 
                                              application. You can find out how to apply 
requirements of that status (see Part VII,                                                  Structure
                                              for an EIN by visiting IRS.gov and search 
line 1, and related questions and                                                           You must be a corporation, limited liability 
                                              for “apply for an EIN.” You may apply for 
schedules).                                                                                 company, unincorporated association, or 
                                              an EIN online or by fax or mail. 
• This penalty of perjury statement:                                                        trust to be tax exempt under section 
                                              International applicants may call 
I declare under the penalties of perjury                                                    501(c)(3). Sole proprietorships, 
                                              267-941-1099 (toll call).
that I have examined this request,                                                          partnerships, or loosely affiliated groups of 
including the accompanying documents,                 Don’t apply for an EIN more than      individuals aren’t eligible.
and to the best of my knowledge and           TIP     once. If you’re unsure of your EIN 
belief, the request contains all the relevant         or whether you have one, call         Line 1. Type of organization and copy 
facts relating to the request, and such       877-829-5500 for assistance.                  of organizing document.     Select your 
                                                                                            type of organization, and before 
facts are true, correct, and complete.
• The signature of an officer, director,              Don’t use the EIN of a related or     submitting the form, upload a copy of your 
                                                                                            organizing document (including any 
trustee, or other authorized person.          !       other organization.                   amendments) as part of the required 
• A copy of the organization’s Notification   CAUTION
                                                                                            attachment.
of Registration.
• Form 8833, Treaty-Based Return              Line 3. Month tax year ends.     Select the   Corporation. A corporation is an entity 
Position Disclosure Under Section 6114 or     month your tax year (annual accounting        organized under a federal or state statute, 
7701(b).                                      period) ends. Your tax year (annual           or a statue of federally recognized Indian 
                                              accounting period) is the 12-month period     tribal or Alaskan native government.
                                              on which your annual financial records are 
Organizations Created in U.S.                 based.                                        Copy of organizing document 
                                                                                            (articles of incorporation and any 
Territories and Possessions                           Check your bylaws or other rules      amendments). A corporation’s 
Organizations created in possessions and      TIP     of operation for consistency with     organizing document is its “articles of 
territories of the U.S. are generally treated         the tax year (annual accounting       incorporation. ” If you formed under state 
as domestic organizations. If you were        period) you enter here.                       statute, your articles of incorporation (and 
created in a U.S. possession or territory,                                                  any amendments) must show 
you must complete all required parts of       Line 4. Person to contact.    Enter the       certification of filing. This means your 
Form 1023 to apply for exempt status          name and title of the person you want us      articles show evidence that on a specific 
under section 501(c)(3).                      to contact if we need more information.       date they were filed with and approved by 
                                              The person to contact may be an officer,      an appropriate state authority. The 
  Charitable contributions to you are         director, trustee, or other individual who is document must be an exact copy of what 
deductible by donors if you qualify for       permitted to speak with us according to       is on file with your state.
exempt status under section 501(c)(3).        your bylaws or other rules of operation. 
  Annual filing requirements for an           Your person to contact may also be an         If you don’t have a copy of your articles 
organization created in a U.S. territory or   authorized representative, such as an         of incorporation showing evidence of 
possession are similar to those outlined      attorney, certified public accountant, or     having been filed and approved by an 
above for foreign organizations (see Rev.     enrolled agent, for whom you’re submitting    appropriate state official, you may submit 
Proc. 2011-15 at IRS.gov/irb/                 a completed Form 2848 with the Form           a substitute copy of your articles of 
2011-03.pdf).                                 1023.                                         incorporation. This substitute copy may be 
                                                                                            handwritten, typed, printed, or otherwise 
                                              Line 5. Provide a daytime telephone           reproduced. It must be accompanied by a 
                                              number for the contact listed on line 4.      declaration, signed by an officer 
Specific Instructions                                                                       authorized to sign for you, that it is a 
                                              Line 6. You may provide a fax number for 
Part I. Identification of                     the contact listed on line 4.                 complete and correct copy of the articles 
                                                                                            of incorporation and that it contains all the 
Applicant                                     Line 7. Pay.gov will populate this field      powers, principles, purposes, functions, 
                                              with the current user fee for filing Form     and other provisions by which you 
Line 1a. Enter your complete name             1023.                                         currently govern yourself.
exactly as it appears in your organizing 
document, including amendments.               Line 8. Enter your complete website           Limited liability company.  A limited 
                                              address if you have one. Also, list any       liability company (LLC) that files its own 
Line 1b. If you have an “in care of” name,    websites maintained on your behalf. The       exemption application is treated as a 
enter it here; otherwise, leave this space    information on your website should be         corporation rather than a partnership.
blank.                                        consistent with the information in your 
Line 1c-i. Enter your complete address        Form 1023.                                    Copy of organizing document 
                                                                                            (articles of organization and operating 
where all correspondence will be sent. If     Line 9. Officers, directors, and trust-       agreement (if adopted) and any 
mail isn’t delivered to your street address   ees. Enter the full names, titles, and        amendments).   Instead of articles of 
and you have a P.O. box, list your P.O.       mailing addresses of your officers,           organization, an LLC’s organizing 
box information instead of your street        directors, and/or trustees. You may use       document is its state-approved “articles 
address.                                      the organization’s address for mailing. If    of organization.” If it has adopted an 
                                              you have more than five officers, directors,  “operating agreement,” then this 

                                                               -6-                                      Instructions for Form 1023

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document is also part of its organizing      accurate copy of the signed and dated         • Took over 25% or more of the fair 
document. If you formed under state          original. Your declaration should clearly     market value of the net assets of another 
statute, your articles of organization (and  indicate the original date that it was        organization, or
any amendments) must show certificate        signed. For trusts created by a will, include • Were established upon the conversion 
of filing. This means your articles show     a copy of the death certificate or a          of an organization from for-profit to 
evidence that on a specific date they were   statement indicating the date of death,       non-profit status.
filed with and approved by an appropriate    and a copy of the relevant portions of the      If you’re a successor organization, 
state authority. The document must be an     will.                                         complete Schedule G, Successors to 
exact copy of what is on file with your                                                    Other Organizations.
                                                      If your trust agreement continues 
state. If you don’t have a copy of your 
                                                      to provide for distributions for 
articles of organization showing evidence    CAUTION!                                             Your predecessor organization 
                                                      non-charitable interests, you won’t 
of having been filed and approved by an                                                    TIP    may have been either a 
                                             qualify for tax-exempt status.
appropriate state official, you may submit                                                        tax-exempt or non-exempt 
                                                                                           organization.
a substitute copy of your articles of        Line 2. Formation date. The date you 
organization. This substitute copy may be    enter should be consistent with your 
handwritten, typed, printed, or otherwise    organizing document.                          Part III. Required 
                                             •
reproduced. It must be accompanied by a        If you’re a corporation, enter the date     Provisions in Your 
declaration, signed by an officer            that your articles of incorporation were 
authorized to sign for you, that it is a     filed and approved by the appropriate         Organizing Document
complete and correct copy of the articles    authority.                                    Line 1. Purpose clause. Your 
                                             •
of organization and that it contains all the   If you’re an LLC, enter the date that the   organizing document must limit your 
powers, principles, purposes, functions,     appropriate authority filed your articles of  purposes to those described in section 
and other provisions by which you            organization or other organizing              501(c)(3). Those purposes are charitable, 
currently govern yourself.                   document.                                     religious, educational, scientific, literary, 
       If you are an LLC and want to be      • If you’re an unincorporated association,    testing for public safety, fostering national 
TIP    treated as a disregarded entity by    enter the date that your organizing           or international amateur sports 
       a tax-exempt member, don’t file       document was adopted by the signatures        competition, and preventing cruelty to 
an exemption application.                    of at least two individuals.                  children or animals.
                                             • If you’re a trust (other than a trust 
Unincorporated association.    An            formed by a will), enter the date your trust    The generally accepted legal definition 
unincorporated association formed            was funded. If your trust agreement           of “charitable” includes relief of the poor, 
under state law must have at least two       provided for any non-charitable interests,    the distressed, or the underprivileged; 
members who have signed a written            enter the date that non-charitable interests  advancement of religion; advancement of 
document that creates an entity with a       expired. If you were formed by a will, enter  education or science; erecting or 
specifically defined purpose.                the date of death or the date any             maintaining public buildings, monuments, 
                                             non-charitable interests expired.             or works; lessening the burdens of 
Copy of organizing document                                                                government; lessening neighborhood 
(articles of association or constitution     Line 3. State of formation.   Enter the       tensions; eliminating prejudice and 
and any amendments).       Your organizing   jurisdiction (for instance, the state or the  discrimination; defending human and civil 
document must include the name of the        federally recognized tribal government)       rights secured by law; and combating 
organization, its purpose, the date the      under the laws of which you were              community deterioration and juvenile 
document was adopted, and the                incorporated or otherwise formed. This        delinquency. Therefore, the phrase “relief 
signatures of at least two individuals. If   may not be the place in which you’re          of the poor” in your organizing document 
your copy doesn’t contain the proper         physically located. For example, if you’re    properly limits your purposes.
signatures and date of adoption, you may     physically located in New York, but             Limiting your purposes by reference to 
submit a written declaration that states     incorporated under Massachusetts law,         section 501(c)(3) generally will be 
your copy is a complete and accurate         enter Massachusetts.                          sufficient to meet the organizational test 
copy of the signed and dated original.         For purposes of completing this             under section 501(c)(3). Your organizing 
Your declaration should clearly indicate     application, you’re formed under the laws     document may also sufficiently limit your 
the original date of adoption.               of a foreign country if you’re not formed     purpose by reference to a specific 
       Bylaws may be considered an           under the laws of the United States, its      charitable purpose such as “relief of the 
TIP    organizing document only if they      territories and possessions, federally        elderly within the meaning of section 
       include the required elements         recognized Indian tribal or Alaska native     501(c)(3).”
listed above.                                governments, or the District of Columbia.       However, purposes listed in your 
                                             Line 4.  Bylaws“ ” are generally the          organizing document broader than those 
Trust. A trust may be formed by a trust      internal rules and regulations of an          listed in section 501(c)(3) may cause you 
agreement or declaration of trust. A trust   organization. If you have bylaws, upload a    to fail the organizational test. In that case, 
may also be formed through a will.           current copy (including any amendments).      you will need to amend your organizing 
Generally, a trust must be funded with       Bylaws don’t need to be signed unless         document before applying. A reference to 
property, such as money, real estate, or     they are your organizing document as          section 501(c)(3) won’t ensure that your 
personal property.                           described in the instructions for line 1      purposes are limited to those described in 
Copy of organizing document (trust           above.                                        section 501(c)(3) if other provisions 
                                                                                           describing your purposes include one or 
agreement/declaration of trust or will       Line 5. Successor organization.      You      more non-exempt purposes. The following 
and any amendments).       Your trust        are a “successor” if you:                     is an example of an acceptable purpose 
agreement (and any amendments) must          • Took over activities previously             clause.
be signed by at least one trustee. If your   conducted by another organization,
trust agreement copy isn’t signed, you 
may submit a written declaration that 
states your copy is a complete and 

Instructions for Form 1023                                    -7-

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The organization is organized                  Upon the dissolution of this                • Where is the activity conducted?
exclusively for charitable,                    organization, assets shall be               • What percentage of your total time is 
                                                                                           allocated to the activity? (Combined time 
religious, educational, and                    distributed for one or more                 percentages should add up to 100%.)
scientific purposes under                      exempt purposes within the                  • How is the activity funded (for example, 
section 501(c)(3) of the Internal              meaning of section 501(c)(3) of             donations, fees, etc.) and what 
Revenue Code, or                               the Internal Revenue Code, or               percentage of your overall expenses is 
corresponding sections of any                  corresponding section of any                allocable to this activity?
future federal tax code.                       future federal tax code, or shall           • How does the activity further your 
                                               be distributed to the federal               exempt purposes?
                                               government, or to a state or                Line 2. National Taxonomy of Exempt 
See Pub. 557 for further information           local government, for a public              Entities (NTEE) code.      An NTEE code is 
and examples of how to limit your              purpose.                                    a three-character series of letters and 
purposes.
                                                                                           numbers that generally describes a type of 
Line 2. Dissolution clause. Your                                                           organization. Enter the code that best 
organizing document must provide for           See Pub. 557 for further information        describes your organization from the list of 
the permanent dedication of your assets      and examples of acceptable language for       NTEE codes, located in Appendix D. For 
to a section 501(c)(3) purpose. This         dedication of assets in your organizing       more information and more detailed 
means that if you dissolve your              document.                                     definitions of these codes developed by 
organization in the future, your assets                                                    the National Center for Charitable 
must be distributed for an exempt purpose    Part IV. Your Activities                      Statistics (NCCS), visit the Urban Institute 
described in section 501(c)(3), or to the                                                  NCCS website at www.nccs.urban.org.
federal government, or to a state or local   Reminder
government, for a public purpose. In         Answer all questions in this part as they             NTEE codes are also used for 
certain states, you may rely on state law to pertain to your past, present, and future     TIP     purposes other than identification 
establish the permanent dedication of        activities.                                           of organizations described in 
                                                                                           section 501(3)(c). Therefore, all codes in 
assets for exempt purposes. This is based    Line 1. Describe completely and in detail     the list don't necessarily correspond to a 
on Rev. Proc. 82-2, 1982-1 C.B. 367. For     your past, present, and planned activities.   section 501(c)(3) purpose.
additional information, search “Operation    Don’t refer to or repeat the purposes in 
of state law” at IRS.gov.                    your organizing document or speculate         Line 3. If programs are limited to specific 
Foreign organizations may be able to         about potential future programs. Your         individuals, describe how you select or 
rely upon the applicable laws of their       narrative description of activities should be identify those individuals. If programs are 
jurisdiction in a similar manner. If relying thorough and accurate because we              available only for members, describe 
on a foreign law, you must provide a copy    determine whether you qualify for section     membership criteria, any membership 
of the applicable law with an English        501(c)(3) exempt status based on the          dues, any different membership levels, 
translation.                                 information in your application. You should   and the benefit each membership level 
Naming a specific organization to            describe either actual or planned             receives.
receive your assets upon dissolution will    activities. For example, if you plan to 
be acceptable only if your organizing        further educational purposes by operating     Line 4.  Describe any business or family 
document requires that the specific          an afterschool homework club, you would       relationship between individuals who 
organization to be exempt under section      describe that activity rather than cite that  receive goods, services, or funds through 
501(c)(3) at the time your dissolution takes you will further educational purposes. If     your programs and any officers, directors, 
place and provides for a qualified           you were also contemplating offering          trustees, or highest compensated 
alternative recipient if the named           scholarships in the future, but currently     employees or independent contractors.
organization isn’t exempt under section      have no plans to do so, then the                For purposes of this form, “highest 
501(c)(3) at that time.                      scholarship activity would be speculative,    compensated” employees or independent 
If your organizing document states that      and you should not describe it.               contractors are persons to whom you pay 
your assets would be distributed to            Some organizations (such as credit          over $100,000 of compensation, 
members or private individuals or for any    counseling organizations (see Part IV,        including compensation from related 
purpose other than those provided in         line 8), childcare organizations (see Part    organizations.
section 501(c)(3), you must amend your       IV, line 12), agricultural research           Line 5. You participate in a political 
organizing document to remove such           organizations (see Part VII, line 1), or      campaign if you promote or oppose the 
statements.                                  cooperative hospital service organizations    candidacy of an individual for public office. 
The following is an example of an            (see Schedule C)) must meet specific          Candidate debates and nonpartisan voter 
acceptable dissolution clause.               operational requirements to qualify for       education and registration may be 
                                             exemption under section 501(c)(3). If         permitted. See Rev. Rul. 2007-41, 
                                             you’re such an organization, be certain to    2007-25 I.R.B. 1421 at IRS.gov/irb/
                                             include an explanation in your activity       2007-25_I.R.B. 1421 and Pub. 1828 for 
                                             description of how activities you conduct     more information and examples.
                                             (or don’t conduct, if the specific 
                                             operational requirement limits permissible            Organizations described in 
                                             activities) satisfy those specific              !     section 501(c)(3) are prohibited 
                                             operational requirements.                     CAUTION from supporting or opposing 
                                                                                           candidates for public office in any political 
                                               For each past, present, or planned          campaign. If you answer “Yes,” you aren’t 
                                             activity, include information that answers    qualified for tax exemption under section 
                                             the following questions.                      501(c)(3) and should reconsider whether 
                                             • What is the activity?                       the filing of application Form 1023 is 
                                             • Who conducts the activity?                  appropriate for you. See Pub 557 for a 

                                                         -8-                                        Instructions for Form 1023

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description of other code sections under             Churches and private foundations     being associated with terrorism on 
which you may qualify.                         !     aren’t eligible to make this section OFAC’s Specially Designed Nationals and 
                                             CAUTION 501(h) election.                     Blocked Persons List (OFAC SDN List). 
Line 6. You are attempting to influence                                                   Information about OFAC sanction 
legislation if you directly contact or urge  Line 7. Intellectual property includes       programs and the OFAC SDN List are 
the public to contact members of a           the following;                               available at www.treasury.gov/ofac.
legislative body for the purpose of          • Patents (for inventions);
proposing, supporting, or opposing           • Copyrights (for literary and artistic      Line 10.  A “foreign country” is a 
legislation. You are also attempting to      works such as novels, poems, plays, films,   country other than the U.S., its territories 
influence legislation if you advocate the    musical works, drawings, paintings,          and possessions, and the District of 
adoption or rejection of legislation. If you photographs, sculptures, architectural       Columbia.
answer “Yes,” your explanation should        designs, performances, recordings, film,     Line 10a–c.  See instructions for lines 9g–
include the percentage of your total time    and radio or television programs);           i.
and total funds spent on such legislative    • Trade names, trademarks, and service 
activities.                                  marks (for symbols, names, images, and       Line 11.  You are a sponsoring 
Organizations described in section           designs); and                                organization of a donor-advised fund if 
501(c)(3) are prohibited from engaging in    • Formulas, know-how, and trade              you establish separate accounts that you 
a substantial amount of legislative          secrets.                                     own or control for a donor whereby the 
                                                                                          donor or donor-advisor may make 
activities. Whether you’re engaged in        Line 8. These activities involve the         recommendations about the investments 
substantial legislative activities depends   education of the consumer on budgeting,      of or distributions from the account. See 
on all of the facts and circumstances.       personal finance, financial literacy,        Pub. 557 for more information on the 
For this purpose, “legislation” includes     mortgage foreclosure assistance, or other    definitions of sponsoring organizations 
action by Congress, a state legislature, a   consumer credit areas. These activities      and donor-advised funds.
local council, or a similar governing body,  may also involve assisting the consumer 
with respect to acts, bills, resolutions or  in consolidating debt and negotiating                You can't sponsor a 
similar items (such as legislative           between debtors and creditors to lower         !     donor-advised fund if you're a 
confirmation of appointive offices).         interest rates and waive late and over-limit CAUTION private foundation.
Legislation also includes action by the      fees. If you answer “Yes,” you may be 
public in a referendum, ballot initiative,   subject to the requirements of section       Line 12.  A “school” is an educational 
constitutional amendment, or similar         501(q). Search “501(q)” on IRS.gov for       organization whose primary function is the 
procedure. Legislation generally doesn’t     information on these requirements and        presentation of formal instruction and 
include actions by executive, judicial, or   whether they apply to you.                   which normally maintains a regular faculty 
                                                                                          and curriculum and that normally has a 
administrative bodies.                       Line 9. A “relationship” between you         regularly enrolled body of pupils or 
Organizations may involve themselves         and the recipient organization includes the  students in attendance at the place where 
in issues of public policy without being     following situations.                        its educational activities are regularly 
engaged in legislative activity. For         • You control the recipient organization,    carried on. A school may include the 
example, organizations may conduct           or it controls you through common            following.
educational meetings, prepare and            officers, directors, or trustees, or through • Primary, secondary, preparatory, or 
distribute educational materials, or         authority to approve budgets or              high school.
otherwise consider public policy issues.     expenditures.                                • College or university.
Similarly, an organization may appear        • You and the recipient organization were    • Trade or technical school.
before a governmental body at its request    created at approximately the same time       • Nursery or pre-school.
to offer testimony about a decision that     and by the same persons.                     • School that you operate as an activity, 
may affect the organization’s existence.     • You and the recipient organization         such as a school that is operated as an 
        A private foundation isn’t allowed   operated in a coordinated manner with        activity of a museum, historical society, or 
TIP     to engage in any activities to       respect to facilities, programs, employees,  church.
        influence legislation.               or other activities.
                                             • Persons who exercise substantial                   If you're a nursery or pre-school 
Line 6a. Form 5768. Most public              influence over you also exercise               TIP   that doesn't meet the description 
charities are eligible to elect to make      substantial influence over the recipient             of a school, answer “No,” to 
expenditures to influence legislation by     organization.                                line 12.
filing Form 5768, Election/Revocation of     Line 9b. Answer “Yes,” if you make                   If you’re a nursery, pre-school, or 
Election by an Eligible Section 501(c)(3)    grants, loans, or other distributions (such    TIP   child care organization that 
Organization To Make Expenditures To         as goods) to a foreign organization.                 doesn’t meet the description of a 
Influence Legislation. By filing Form 5768,                                               school, you may still further an educational 
your legislative activities will be measured Line 9g–i. The Office of Foreign Assets      purpose if substantially all the care you 
solely by an expenditure limit under         Control (OFAC) of the U.S. Department of     provide is for the purpose of enabling 
section 501(h) rather than by whether the    the Treasury administers and enforces        individuals to be gainfully employed and 
legislative activity is considered           economic and trade sanctions based on        your services are available to the general 
substantial. Form 5768 describes the         U.S. foreign policy and national security    public (section 501(k)).
types of organizations that are eligible to  goals against certain governments, 
make an election. You must file Form         entities, and individuals, as directed in      If you’re a school, or if you operate a 
5768 by mailing it to the address on the     Executive Orders. As part of the             school as an activity (even if it is a 
form. For a discussion of influencing        comprehensive and sustained campaign         secondary activity), complete Schedule B. 
legislation and the requirements of section  against terrorist financing, all U.S.        See Pub. 557 for additional information.
501(h), see Pub 557.                         persons, including U.S.–based charities, 
                                             are prohibited from dealing with persons     Line 13.  “Hospital” or “medical care” 
                                             (individuals and entities) identified as     includes the treatment of any physical or 

Instructions for Form 1023                                       -9-

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mental disability or condition, whether as    support. Fundraising may be conducted          “Yes,” if you will or you do have highest 
an inpatient or outpatient. A hospital        by your employees or volunteers, through       compensated employees or highest 
includes the following.                       an agent, or through an independent            compensated independent contractors.
• Hospitals and rehabilitation institutions,  contractor. Check all the boxes that apply.    For purposes of this form, “highest 
outpatient clinics, or community mental         For purposes of this application,            compensated” employees or independent 
health or drug treatment centers if the       “bingo” is a game of chance played with        contractors are persons to whom you pay 
principal purpose or function is the          cards that generally are printed with five     over $100,000 of compensation, 
providing of medical or hospital care or      rows of five squares each on which             including compensation from related 
medical education or research.                participants place markers to form a           organizations.
• Medical research organizations if the       pre-selected pattern to win the game.          For information on determining if an 
principal purpose or function is the          “Other (non-bingo) gaming activities”          individual is an employee or an 
continuous active conduct of medical          include pull-tabs, raffles, keno,              independent contractor, see Pub. 15-A, 
research in conjunction with a hospital.      split-the-pot, and other games of chance.      Employer’s Supplemental Tax Guide.
  If you provide “hospital or medical 
                                                  Gaming doesn’t further an 
care,” or you’re a medical research                                                          Line 1e.  Similarly situated “
                                              TIP exempt purpose under section 
organization, complete Schedule C.                                                           organizations” means tax-exempt or 
                                                  501(c)(3). Except to the extent 
  See Pub. 557 for additional                 that an exception may apply, your revenue      taxable organizations of comparable size, 
information.                                  from gaming activities will be subject to      purpose, and resources. Adjustments due 
Line 14. “Low-income housing” refers          unrelated business income tax. See             to geographic area and other specified 
to rental or ownership housing provided to    Pub. 3079 for further information about        conditions are appropriate, but you should 
persons based on financial need. If you       gaming.                                        document the adjustments. You should 
                                                                                             document the sources(s) of comparable 
provide low-income housing, complete                                                         compensation data, both taxable and 
Schedule F.                                                                                  non-taxable, and retain copies in your 
                                              Part V. Compensation and 
Line 15. Answer “Yes,” if you pay money                                                      permanent records.
to an individual as a scholarship,            Other Financial 
                                                                                             Line 1g.  “Reasonable compensation” 
fellowship, or education loan; for travel,    Arrangements                                   is the amount that would ordinarily be paid 
study, or other similar purposes. Also,       Reminder.  Answer all questions in this        for like services by like organizations 
answer “Yes,” if you pay such amounts on      part as they pertain to your past, present,    under like circumstance as of the date the 
behalf of an individual to a school or a      and future activities.                         compensation arrangement is made. 
tuition or educational savings program.                                                      Establishing and documenting your 
Complete Schedule H—Section I.                  For purposes of Part V, compensation 
                                              includes:                                      decisions about compensation is 
  Travel, study, or other similar purposes      Salary or wages;                             important because excess compensation 
include payments made to enhance a            •                                              (including cash and other benefits that 
literary, artistic, musical, scientific,      • Deferred compensation;
teaching or other similar capacity, skill, or • Retirement benefits, whether in the          aren’t accounted for as reasonable 
                                              form of a qualified or non-qualified           compensation for services) may result in 
talent of the individual recipient. These     employee plan (pensions or annuities);         excise taxes on both the individual and 
payments include, for example, amounts          Fringe benefits (personal vehicle,           you, and may jeopardize your tax 
paid to:                                      •                                              exemption.
                                              meals, lodging, personal and family 
• Vocational high school students to be       educational benefits, low-interest loans,      Line 2. A conflict of interest arises when a 
used to purchase basic tools;                 payment of personal travel, entertainment,     person in a position of authority over an 
• Teachers to induce them to teach in a       or other expense, athletic or country club     organization, such as a director, officer, or 
public school system in an economically       membership, and personal use of your           manager, may benefit personally from a 
depressed area; and                           property); and                                 decision he or she could make. A sample 
• A scientific researcher to underwrite         Bonuses.                                     Conflict of Interest Policy is included as 
that individual’s research project.           •
  Educational grants don’t include              Example. An organization could               Appendix A. This sample conflict of 
amounts you pay to an individual as           compensate a director as follows:              interest policy doesn’t prescribe any 
                                                                                             specific requirements. Therefore, 
compensation, such as payments made to                                                       organizations should use a conflict of 
a consultant for personal services or to      Wages                                          interest policy that best fits their 
produce a report for you.                      Director                              $2,500  organizations.
  Educational grants don’t include              Compensation . . .                           Adoption of a conflict of interest policy 
amounts paid to another organization that      Salary as Chief Executive                     isn’t required to obtain tax-exempt status. 
distributes your funds as a scholarship to     Officer . . . . . . . . . . . . . . . 40,000  However, by adopting the sample policy or 
an individual if you have no role in the                                                     a similar policy, you will be choosing to put 
selection process.                            Deferred retirement . . . . . .        2,000
                                                                                             in place procedures that will help your 
                                              Health insurance policy . . .          5,000
        If you're a “private foundation”                                                     officers, directors, and trustees recognize 
                                              Use of a vehicle . . . . . . . .        5,000  situations that could present potential or 
  !     as described in Part VII, you must    Total Compensation                     $54,500 actual conflicts of interest so that you can 
CAUTION obtain advance approval of your 
grant-making procedures. You can use                                                         take steps to reduce the risk that those in 
Schedule H—Section II, to request                                                            positions of authority over you may 
advance approval as part of this              Make sure the information you provide in       receive an inappropriate benefit.
application process. You can complete         Part V is consistent with the information              The sample conflict of interest 
Section II when you complete Part VII.        you enter in Part VI. Financial Data.          TIP     policy in Appendix A includes 
Foundation Classification.                    Line 1. Compensation.  Check “Yes,” if                 items marked “Hospital insert–for 
                                              you do or you will compensate your             hospitals that complete Schedule C” that 
Line 16. “Fundraising”includes efforts        officers, directors, or trustees. Also, check  are intended to be adopted by hospitals.
to raise funds through appeals for financial 

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Line 3. A fixed payment means a              Line 5. Answer “Yes,” if any of your           haven’t existed, for a total of 4 years of 
payment that is either a set dollar amount   officers, directors, or trustees:              financial information. Place financial 
or fixed through a specific formula where    • Is an officer, director, or trustee in       information for the year you’re filing this 
the amount doesn’t depend on discretion.     another organization (other than a section     application in the column marked Current 
For example, a salary of $200,000 that is    501(c)(3) organization) that has a lease,      tax year.
adjusted annually based on the increase      contract, loan, or other agreement with        Completed 5 years or more.          If 
in the Consumer Price Index is a fixed       you; or                                        you’ve existed for 5 years or more, provide 
payment.                                     • Possesses more than a 35% ownership          your actual income and expenses for your 
  A “non-fixed payment” means a              interest in any organization that has a        5 most recently completed tax years. 
payment that depends on discretion. For      lease, contract, loan, or other agreement      Place financial information for your most 
example, a bonus of up to $100,000 that is   with you. For example, answer “Yes,” if        recently completed tax year in the column 
based on an evaluation of performance by     one of your directors is an officer for a      marked Current tax year.
the governing board is a non-fixed           section 501(c)(4) organization with whom 
payment because the governing body has       you have a lease for office space, or if one           We may request financial 
discretion over whether the bonus is paid    of your directors owns more than 35% of        !       information for more than 5 years.
and on the amount of the bonus.              the voting stock of a corporation to which     CAUTION
                                             you made a loan.
Line 4. Don’t include purchases or sales                                                    A. Statement of Revenue and 
of goods and services in your normal         Line 6. “Develop” means the planning,          Expenses
course of operations that are available to   financing, construction, or provision of 
the general public under similar terms and   similar services involved in the acquisition   Preparing the statement.    Prepare the 
conditions.                                  of real property, such as land or a building.  statement using the method of accounting 
                                             For example, you should provide                you use in keeping your books and 
  Answer “Yes,” if any of your officers,     information regarding the services of a        records.
directors, or trustees:                      consultant who arranges your acquisition       Prepare the statement using the 
• Is an officer, director, or trustee of     of a facility through the issuance of          accounting period entered on Part I, line 3. 
another organization (other than a section   tax-exempt bonds.                              Enter “0” if a particular revenue or 
501(c)(3) organization) that you will 
purchase or sell goods, services, or         Line 7. “Manage” means to direct or            expense doesn’t apply to you.
assets from or to; or                        administer. For example, you would             Your financial information should reflect 
• Possesses more than 35% ownership          provide information about an organization      your activities described in this 
interest in any organization that you will   hired to administer a museum gift shop.        application.
purchase or sell goods, services, or         Line 8. A “joint venture” is a legal           Line 1. Enter the total gifts, grants, and 
assets from or to.                           agreement in which the persons jointly         contributions you receive (other than 
                                             undertake a transaction for mutual profit.     membership dues reported on line 2 and 
  Arm’s length.    An arm’s length                                                          described below). Include items of value 
                                             Generally, each person contributes assets 
standard exists where the parties have an                                                   that you receive as gifts, grants, or 
                                             and shares risks. Like a partnership, joint 
adverse (or opposing) interest. For                                                         contributions. For example, if one of your 
                                             ventures can involve any type of business 
example, a seller wants to sell his goods                                                   activities is a food drive, include the value 
                                             transaction and the persons involved can 
at the highest possible price, while a buyer                                                of the donated food on this line. Also 
                                             be individuals, groups of individuals, 
wants to buy at the lowest possible price.                                                  include on this line payments a 
                                             companies, or corporations.
These are adverse interests.                                                                governmental unit makes to enable you to 
  In negotiating with a person, an           Part VI. Financial Data                        both accomplish your exempt purpose(s) 
adverse interest is assumed if that person                                                  and to provide a service or facility directly 
is otherwise unrelated to you in the sense     Line 1. Select the option that best          to the general public.
of not being in a position to exercise       describes you to determine the years of        See the instructions for line 9 if you’re 
substantial influence over you or your       revenues and expenses you need to              uncertain whether revenue should be 
affairs. If the person is in a position to   provide.                                       included as a grant on line 1 or as gross 
exercise substantial influence over your                                                    receipts on line 9. Include unusual 
affairs, then an arm’s length standard         Completed less than 1 year.     If 
requires additional precautions to           you’ve existed for less than 1 year,           grants on line 12 and not on line 1.
eliminate the effect of the relationship.    provide projections of your likely income      Examples. 
                                             and expenses for your current year and 
  Using a conflict of interest policy,       projections of your likely income and          1. A city pays the symphony orchestra 
information about comparable                 expenses for the next 2 years based on a       to provide free music programs in the 
transactions between unrelated parties,      reasonable and good faith estimate of          public schools. The programs are open to 
and reliable methods for evaluating the      your future finances for a total of 3 years of the public. This income received from a 
transaction, are examples of precautions     financial information. Place financial         governmental unit accomplishes the 
that would help make the negotiation         information for the year you’re filing this    orchestra's exempt purpose and directly 
process equivalent to one between            application in the column marked Current       provides a service to the general public. 
unrelated persons.                           tax year.                                      This income is a grant to the symphony 
                                                                                            orchestra that should be listed on line 1.
  Fair market value.    This is the price at   Completed more than 1 year, fewer            2. The symphony orchestra sells 
which property or the right to use property  than 5 years. If you’ve existed for more       tickets to the public for its fall season. 
would change hands between a willing         than 1 year but fewer than 5 years,            Such income is gross receipts received 
buyer and a willing seller, neither being    provide your actual income and expenses        from the general public in performance of 
under any compulsion to buy, sell, or        for each completed year you’ve existed         the symphony orchestra’s exempt function 
transfer property or the right to use        and projections of your likely income and      and should be listed on line 9.
property, and both having reasonable         expenses based on a reasonable and 
knowledge of relevant facts.                 good faith estimate of your future finances    3. The public school system pays the 
                                             for your current year and each year you        orchestra to create several musical pieces 

Instructions for Form 1023                                   -11-

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Figure 2. Net Gain or Loss On Sales of Capital Assets                                            Provide an itemized list of your gross 
                                                                                               receipts in line 25, describing the sources 
                                                   Categories                                  and amounts of income. For payments by 
                                                                                               a governmental unit, list the payer, the 
                                (A) Real Estate    (B) Securities                    (C) Other purpose of the payment, and the payment 
1. Gross sales price of                                                                        amount.
   assets (other than 
   inventory) by category.                                                                     Line 10. Lines 8 and 9 will be added for 
                                                                                               you.
2. Less: Cost or other 
   basis and sales                                                                             Line 11. Enter any net gain or loss on the 
   expenses.                                                                                   sale of capital assets. Provide an itemized 
3. Gain or (loss). Subtract                                                                    list by asset category (for example, real 
   line 2 from line 1.                                                                         estate or securities) showing gross sales, 
                                                                                               cost or other basis/sales expenses, and 
4. Net gain or (loss) — Add line 3 of columns (A), (B), and (C). Enter here and                gain or loss by asset category in line 25. 
   on Form 1023, Part VI - A. Statement of Revenues and Expenses, line 11.                     You may use the format in Figure 2.
                                                                                               Line 12. Enter any “unusual grants,” 
                                                                                               which generally are any substantial 
suitable for the school system’s                provided by the governmental unit to the       contributions and bequests you received 
elementary music curriculum. This               public without charge.                         from disinterested persons that, by their 
payment by a governmental unit for the                                                         size, adversely affect your classification as 
                                                Line 7. Enter your total income from all 
music compositions is primarily for the                                                        a public charity Unusual grants. “      ” are 
                                                sources not reported on lines 1 through 6, 
school system’s own use, not for the direct                                                    unusual, unexpected, and received from 
                                                or lines 9, 11, and 12. Provide an itemized 
benefit of the public. Therefore, this                                                         an unrelated party. Provide an itemized list 
                                                list in line 25, showing each type and 
income is gross receipts received from a                                                       of any unusual grants, including the 
                                                amount of income included, and a brief 
governmental unit in performance of the                                                        amount in line 25, and explain how it was 
                                                description of each type of income.
orchestra’s exempt function that should be                                                     unusual, unexpected, and from an 
listed on line 9.                               Line 8. Lines 1 through 7 will be added 
                                                                                               unrelated party.
                                                for you.
Line 2. Enter the amount you receive                                                             For additional information about 
from members to provide support to the          Line 9. Enter income from activities that      unusual grants and a description of public 
organization. Don’t include payments from       you conduct to further your exempt             charity classifications, see Pub. 557.
members or on behalf of members to              purposes (excluding amounts listed on 
purchase admissions, merchandise,               other lines). Also, include as gross           Line 13. Lines 10 through 12 will be 
services, or use of facilities.                 receipts the income from activities            added for you.
                                                conducted:                                     Lines 14. Enter the total expenses you 
Line 3. Enter your gross income from            • Intermittently (not regularly carried on),   incur for soliciting gifts, grants, and 
dividends, interest, payments received on       such as an occasional auction;                 contributions included on line 1. Include 
securities, loans, rents, and royalties you     • With substantially all (at least 85%)        fees paid to professional fundraisers for 
hold for investment purposes.                   volunteer labor, such as a car wash;           soliciting gifts, grants, and contributions.
See Pub. 598 for additional information         • For the convenience of members, 
regarding royalties treated as unrelated        students, patients, officers, or employees,    Line 15. Enter the total amount you pay 
business income.                                such as a parking lot for a school’s           out to both individuals and organizations. 
                                                students and employees; or                     Provide an itemized list in line 25, 
Line 4. Enter your net income from              • With substantially all contributed           identifying recipients (using letter 
unrelated business activities. “Unrelated       merchandise, such as a thrift store.           designations such as A, B, C, etc.), a brief 
business income” generally is income                                                           description of the purposes or conditions 
from any trade or business activity that is       See Pub. 598 for additional information      of payments, and the amounts paid.
regularly carried on, and not related to        regarding income that isn’t from an 
your exempt purpose. Certain exceptions         unrelated trade or business.                     Colleges, universities, and other 
                                                                                               educational institutions and agencies 
and exclusions may apply.                         “Gross receipts” also includes               subject to the Family Educational Rights 
Report on line 9 income from activities         payment by a governmental unit that may        and Privacy Act (20 U.S.C. 1232g) don’t 
that aren’t related to the accomplishment       be called a “grant” but is actually payment    need to list the names of individuals to 
of your exempt purposes, but aren’t             for a service or facility for the use of the   whom they provided scholarships or other 
considered unrelated business activities.       government payer, rather than for the          financial assistance where such 
For example, report income from the sale        direct benefit of the public.                  disclosure would violate the privacy 
of merchandise by volunteers that isn’t           Example. The state government gives          provisions of the law. Instead, group each 
treated as an unrelated trade or business       a conservation group a grant to study the      type of financial aid provided, indicate the 
on line 9.                                      effects of a new sewage treatment plant        number of individuals who received the 
See Pub. 598 for additional information         on an ecologically significant woodland        aid, and specify the aggregate dollar 
regarding unrelated business income.            area. Although the payment is called a         amount.
                                                grant, it is actually gross receipts that        Maintain (but don’t submit) a list 
Line 5. Enter amounts any local tax             should be included on line 9. The payment      showing the names of recipients 
authority collects from the public on your      is by a governmental unit (state) for a        associated with each letter designation.
behalf.                                         study for its own use, not for the direct 
Line 6. Enter the value of services or          benefit of the general public. A for-profit    Line 16. Enter total payments you make 
facilities a governmental unit furnishes to     consulting company could’ve done the           to or for the benefit of your members (not 
you. Use the fair market value of the           study rather than by the tax-exempt            including any amounts listed on line 15). 
services or facilities. Don’t include the       conservation group.                            Provide an itemized list in line 25, 
value of services or facilities generally                                                      identifying recipients (using letter 

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designations), a brief description of the      Line 4. Enter the total amount of bonds or    on lines 1 through 9, for example, patents, 
purposes or condition of payments, and         notes you issued that will be repaid to you.  copyrights, or other intangible assets. 
the amounts paid.                              Provide an itemized list in line 19, that     Provide an itemized list of each asset in 
Maintain (but don’t submit) a list             shows the name of each borrower (using a      line 19.
showing the names of recipients                letter designation), the borrower’s           Line 11. Lines 1 through 10 will be added 
associated with each letter designation.       relationship to you, a brief description of   for you.
                                               the obligation, the rate of return, the due 
Line 17. Enter the total amount of                                                           Line 12. Enter the total amount of your 
                                               date, and the amount due.
compensation you pay to your officers,                                                       accounts payable to suppliers and others, 
directors, and trustees.                       Maintain (but don’t submit) a list            such as salaries payable, accrued payroll 
                                               showing the names of borrowers                taxes, and interest payable.
Line 18. Enter the total amount of             associated with each letter designation.
salaries and wages you pay to employees                                                      Line 13. Enter the total unpaid portion of 
(not reported on line 17).                     Line 5. Enter the total fair market value     grants and contributions you committed to 
                                               of corporate stocks you hold. Provide an      pay to other organizations or individuals.
Line 19. Enter your total interest             itemized list of your corporate stock 
expenses for the year. Don’t include           holdings in line 19.                          Line 14. Enter the total of your mortgages 
mortgage interest treated as an                                                              and other notes payable outstanding at 
occupancy expense on line 20.                  For stock of closely held corporations, 
                                               list the name or the corporation, a brief     the end of the current tax year/period. 
Line 20. Enter the amount you pay for the      summary of the corporation’s capital          Provide an itemized list in line 19 showing 
use of office space or other facilities, heat, structure, the number of shares held, and     each note separately, including the 
light, power and other utilities, outside      their value as carried on your books. If      lender’s name, purpose of loan, 
janitorial services, mortgage interest, real   valuation doesn’t reflect current fair market repayment terms, interest rate, and 
estate taxes, and similar expenses.            value, also include fair market value.        original amount.
Line 21. Enter the total depreciation,         For stock traded on an organized              Line 15. Enter the total amount of any 
depletion, and similar expenses you incur.     exchange or in substantial quantities over    other liabilities not reported on lines 12 
                                               the counter, list the name of the             through 14. Provide an itemized list in 
Line 22. Enter the total professional fees     corporation, a description of the stock,      line 19 of these liabilities, including the 
you pay. Professional fees are amounts         and the principal exchange on which it is     amounts you owe.
charged by individuals and entities that       traded, the number of shares held, their      Line 16. Lines 12 through 15 will be 
aren’t your employees. They include fees       value as carried on your books, and their     added for you.
for professional fundraisers (other than       fair market value.
fees listed on line 14, earlier), accounting                                                 Line 17. Under fund accounting, an 
services, legal counsel, consulting            Line 6. Enter your total amount of loans      organization segregates its assets, 
services, contract management, or any          (personal and mortgage loans) receivable.     liabilities, and net assets into separate 
independent contractors.                       Provide an itemized list in line 19 that      funds according to restrictions on the use 
                                               identifies each borrower (using a letter      of certain assets. Each fund is like a 
Line 23. Enter any expenses you didn’t         designation), the borrower’s relationship     separate entity in that it has a 
include in the lines above, such as for        to you, purpose of loan, repayment terms,     self-balancing set of accounts showing 
program services. Provide an itemized list     interest rate, and original amount of loan.   assets, liabilities, equity (fund balance), 
in line 25, showing the type and amount of     Report each loan separately, even if more     income, and expenses. If you don’t use 
each significant expense.                      than one loan was made to the same            fund accounting, report only the “net 
Line 24. Lines 14 through 23 will be           person.                                       assets” account balances, which include 
added for you.                                 Maintain (but don’t submit) a list            capital stock, paid-in capital, retained 
B. Balance Sheet                               showing the names of borrowers                earnings or accumulated income, and 
                                               associated with each letter designation.      endowment funds.
Complete the balance sheet for your most 
recently completed tax year. If you haven’t    Line 7. Enter the total book value of your    Line 18. Lines 16 and 17 will be added 
completed a full tax year, use the most        other investments. Include the total book     for you.
current information available. Be sure to      value of government securities (federal, 
enter the year-end date for the information    state, and municipal), and buildings and      Part VII. Foundation 
provided and not the date you prepare this     equipment held for investment purposes. 
application. Enter “0” if a particular asset   Provide an itemized list in line 19           Classification
or liability doesn’t apply to you.             identifying and reporting the book value of   Organizations that are exempt under 
                                               each building/item of equipment held for      section 501(c)(3) are private 
Line 1. Enter your total cash in checking      investment purposes.                          foundations unless they are:
and savings accounts, temporary cash                                                         • Churches, schools, hospitals, 
investments (money market funds, CDs,          Line 8. Enter the total book value of         governmental units, entities that undertake 
treasury bills, or other obligations that      buildings and equipment not held for          testing for public safety, organizations that 
mature in less than 1 year), and petty cash    investment purposes. This includes            have broad financial support from the 
funds.                                         facilities you own and equipment you use      general public; or
                                               in conducting your exempt activities.         • Organizations that support one or more 
Line 2. Enter your total accounts              Provide an itemized list in line 19 of these  organization(s) that are themselves 
receivable that arose from the sale of         assets held at the end of the current tax     classified as public charities.
goods and/or performance of services,          year/period, including the cost or other 
less any reserve for bad debt.                 basis.                                          Section 501(c)(3) organizations 
                                                                                             excepted from private foundation 
Line 3. Enter the amount of materials,         Line 9. Enter the total book value of land    classification are public charities. Unless 
goods, and supplies you purchased or           not held for investment purposes.             you meet one of the exceptions above, 
manufactured and held to be sold or used 
in some future period.                         Line 10. Enter the total book value of any    you’re a private foundation.
                                               other category of your assets not reported 

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    You can only select one                   functions, or a combination of these                In Part IV, line 1, include information 
TIP foundation classification.                sources, and not more than one-third of         detailing your agricultural research 
                                              your support from gross investment              program and how you will spend 
                                              income and net unrelated business               contributions to your program, including a 
Line 1.  Select the foundation                income. Typically, you would show a             description of how you’re engaged in the 
classification you’re requesting from the     substantial part of your income on Part         continuous active conduct of agricultural 
list below. The form will then take you to    VI-A. Statement of Revenues and                 research (as defined in Section 1404 of 
additional lines or parts of the application  Expenses, lines 1, 2, and 9.                    the Agricultural Research, Extension, and 
that you must complete based on your                                                          Teaching Policy Act of 1977), information 
response.                                     Under this public charity 
                                              classification, you must meet both the          showing that you’re operated in 
509(a)(1) and 170(b)(1)(A)(vi).     Select    “one-third public support test ” and the        conjunction with a land grant college or 
this classification if you normally receive a “not-more-than-one-third investment             university or a non-land grant college of 
substantial part of your support from         income and net unrelated business               agriculture (as defined in Section 1404 of 
grants from governmental units or from        income test,” lines 1 through 13. See Pub.      the Agricultural Research, Extension, and 
contributions from the general public, or a   557 for additional information about these      Teaching Policy Act of 1977), and 
combination of these sources. Typically,      tests.                                          information discussing the timing of when 
you would show a substantial part of your                                                     you will spend contributions for research.
income on Part VI-A. Statement of             509(a)(1) and 170(b)(1)(A)(i).  Select          509(a)(3). Select this classification if 
Revenue and Expenses, lines 1 and 2.          this classification if your primary purpose     you’re organized and operated to support 
Under this public charity                     is operating a church or convention or          one or more public charities described in 
classification, you must meet the one-third   association of churches. The term               section 509(a)(1) or 509(a)(2) or an 
public support test or 10% facts and          “church” includes mosques, temples,             organization that is tax exempt under 
circumstances test. See Pub. 557 for more     synagogues, etc. If you select this box,        section 501(c)(4), (5), or (6) and meets the 
information.                                  complete Schedule A.                            public support test of section 509(a)(2). 
Public support test. An organization          509(a)(1) and 170(b)(1)(A)(ii).  Select         See the instructions for Schedule D for 
must receive either:                          this classification if your primary purpose     more information about the requirements 
                                              is operating a school. If you select this       for this classification, including the 
1. At least one-third of its total support    box, complete Schedule B.                       required relationship you must have with 
from governmental agencies,                                                                   your supported organization(s). Complete 
contributions from the general public, and    If you operate a school but it isn’t your 
contributions or grants from other public     primary purpose, don’t select this              Schedule D.
charities; or                                 classification. However, you must still         509(a)(4). Select this classification if your 
                                              complete Schedule B. See Part IV, line 12.
2. At least 10% of its total support                                                          primary purpose is to test products to 
from governmental agencies,                   509(a)(1) and 170(b)(1)(A)(iii).   Select       determine their acceptability for use by the 
contributions from the general public, and    this classification if your primary purpose     general public.
contributions or grants from other public     is providing medical or hospital care or            Contributions to organizations of this 
charities; and also satisfy a facts and       medical eduction or research (performed         type aren’t deductible under section 
circumstances test.                           in association with a hospital). If you select  170(c). Also, organizations that primarily 
                                              this box, complete Schedule C.                  test for specific manufacturers don’t 
Facts and circumstances test.       Facts     A hospital includes a rehabilitation            qualify for exemption under section 501(c)
and circumstances include:                    institute, outpatient clinic, community         (3).
1. The amount of support you                  mental health clinic, drug treatment            Select my classification for me.       Select 
received from the general public,             center, or skilled nursing facility. A hospital this option if you believe you’re a public 
governmental units, or public charities;      doesn’t include convalescent homes,             charity but would like the IRS to select the 
2. Whether you have a continuous              homes for children or the aged, or              correct public charity classification (509(a)
and bona fide program for solicitation of     institutions whose principal purpose or         (1) and 170(b)(1)(A)(vi) or 509(a)(2)) for 
funds from the general public,                function is to train handicapped individuals    you.
governmental units, or public charities, or   to pursue some vocation.
                                                                                              Private foundation. Select this 
carry on activities designed to attract       Cooperative hospital service                    classification if you don’t meet one of the 
support from organizations or other           organizations described in section              exceptions listed above.
governmental units, and                       501(e) should also check this box and 
3. All other facts and circumstances,         complete Schedule C.                            Line 1a. Section 508(e) provides that a 
                                                                                              private foundation isn’t tax exempt unless 
including the public nature of your           509(a)(1) and 170(b)(1)(A)(iv).    Select       its organizing document contains 
governing board, the extent to which your     this classification if you’re organized and     specific provisions. These specific 
facilities or programs are publicly           operated exclusively to benefit a college       provisions require that you operate to 
available, the extent to which nature your    or university owned or operated by a            avoid liability for excise taxes under 
dues encourage membership, and                governmental unit. You must also normally       sections 4941(d), 4942, 4943(c), 4944, 
whether your activities are likely to appeal  receive a substantial part of your support      and 4945(d). You can also meet these 
to persons having a broad common              from a governmental unit or from                provisions by reliance on state law.
interest or purpose. For additional           contributions from the general public.
information about the 10% facts and                                                               See Pub. 557 for samples of provisions 
circumstances test, see Pub. 557 and          509(a)(1) and 170(b)(1)(A)(ix).    Select       that will meet section 508(e). Also, see 
Reg. 1.170A-9(f)(3).                          this classification if you’re an agricultural   Appendix B for a list of states that have 
                                              research organization described in section      enacted statutory provisions that satisfy 
509(a)(2). Select this classification if you  170(b)(1)(A)(ix) operated in conjunction        the requirement of section 508(e), subject 
normally receive more than one-third of       with a land grant college or university or a    to notations. Appendix B is based on Rev. 
your support from contributions,              non-land grant college of agriculture.          Rul. 75-38, 1975-1 C.B. 161.
membership fees, and gross receipts 
from activities related to your exempt 

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Line 1c. Some private foundations are         Line 2a(i). 509(a)(2). Check “Yes,” if you     amount contributed must also be more 
private operating foundations. Private        received amounts listed on lines 1, 2, and     than 2% of all the contributions you 
operating foundations make qualifying         9 of Part VI-A, Statement of Revenue and       received. A creator of a trust is treated as 
distributions directly for the active conduct Expenses, from any disqualified                a substantial contributor regardless of the 
of their educational, charitable, and         persons and identify those disqualified        amount contributed. For more information 
religious purposes. “Directly for the active  persons by letter (A, B, C, etc.) and list the regarding substantial contributors, go to 
conduct” means that you use the               amounts contributed by each. Keep, but         IRS.gov/Charities-Non-Profits/Private-
distributions yourself to carry out the       don’t submit, a list of the names of your      Foundations/Substantial-Contributor-
programs for which you’re organized and       donors with the associated letter              Private-Foundation.
operated. Grants made to assist other         designations.
                                                                                             Family members.    A “member of the 
organizations or individuals are normally 
                                              Line 2a(ii). Check “Yes,” if you received      family” includes the spouse, ancestors, 
considered indirect.
                                              amounts paid by an individual or               children, grandchildren, 
Line 1d.  If you have existed for 1 year or   organization greater than the larger of 1%     great-grandchildren, and their spouses.
more, you must provide information that       of line 10, of Part VI-A, Statement of           For additional information concerning 
demonstrates you meet the requirements        Revenues and Expenses, or $5,000 for           members of the family, go to IRS.gov/
to be classified as a private operating       any completed tax year, and identify those     Charities-Non-Profits/Charitable-
foundation, including the income test and     individuals or organizations by letter and     Organizations/Member-of-the-Family.
either the endowment test, the assets test,   list the amount(s) received from each. 
or the support test. If you have existed for  Keep, but don’t submit, a list of the names      Further information about disqualified 
less than 1 year, you must sufficiently       of your donors with the associated letter      persons, can be obtained at IRS.gov/
describe how you’re likely to meet these      designations.                                  Charities-Non-Profits/IRC-Setion-4946-
requirements and tests. You may also                                                         Definition-of-Disqualified-Person.
submit an affidavit or opinion of counsel             Don’t include disqualified persons 
                                                                                             Line 2a(iii). Use Schedule A (Form 990 
giving enough facts about your operations      !      in this list. Disqualified persons     or 990-EZ), Public Charity Status and 
and support to enable us to determine that    CAUTION should be listed in line 2(a)(i). For 
you’re likely to meet these requirements.     purposes of this application, a                Public Support, Part III, Support Schedule 
                                              “disqualified person” is any individual or     for Organizations Described in Section 
See Pub. 557 for additional information                                                      509(a)(2), and its instructions to determine 
                                              organization that is any of the following.
about private operating foundations.                                                         if you meet the public support test for your 
                                               1. A “substantial contributor” to you         most recent 5-year period.
Line 2. Confirmation of public support        (defined below).
status. If you have been in existence for 
more than 5 years, and you requested           2. An officer, director, trustee, or any 
classification as a public charity described  other individual who has similar powers or     Part VIII. Effective Date
in sections 509(a)(1) and 170(b)(1)(A)(vi),   responsibilities.                              Line 1. Use the formation date you listed 
you must confirm that you meet the public      3. An individual who owns more than           in Part II, line 2, and the date you will 
support test.                                 20% of the total combined voting power of      submit this electronic form and required 
To show that you meet the required            a corporation that is a substantial            user fee payment to determine whether 
public charity support test, complete lines   contributor.                                   you’re submitting this application within 27 
                                                                                             months from the month in which you were 
2(i) and 2(ii). Calculate your public support  4. An individual who owns more than           formed. If you’re not submitting this 
based on the accounting method you used       20% of the profits interest of a partnership   application within 27 months from your 
to complete Part VI-A, Statement of           that is a substantial contributor.             formation, complete Schedule E.
Revenues and Expenses.                         5. An individual who owns more than 
Line 2(i). 509(a)(1) and 170(b)(1)(A)         20% of the beneficiary interest of a trust or  Part IX. Annual Filing 
(vi). Check “Yes,” if you received            estate that is a substantial contributor.
                                                                                             Requirement
contributions from any person, company,        6. A member of the family of any 
or organization (other than a governmental    individual described in 1, 2, 3, 4, or 5       Most organizations must file an annual 
unit described in section 170(c)(1) or a      above.                                         return (Form 990, 990-EZ, or Form 
                                                                                             990-PF) or notice (Form 990-N, Electronic 
publicly supported organization under          7. A corporation in which any                 Notice (e-Postcard)). Exceptions to this 
section 170(b)(1)(A)(vi)), whose gifts        individuals described 1, 2, 3, 4, 5, or 6      rule include churches, certain church 
totaled more than 2% of the amount on the     above hold more than 35% of the total          affiliated organizations, and certain 
total of amounts entered on line 8 of Part    combined voting power.                         affiliates of a governmental unit. You can 
VI-A, Statement of Revenue and 
Expenses, and identify those contributors      8. A trust or estate in which any             find more detailed information about filing 
by letter (A, B, C, etc.) and list the        individuals described in 1, 2, 3, 4, 5, or 6   requirements and exceptions from the 
amount(s) contributed by each. Keep, but      above hold more than 35% of the                requirement to file in the Instructions for 
don’t submit, a list of the names of your     beneficial interests.                          Form 990.
donors with the associated letter              9. A partnership in which any                   The following are some general rules.
designations.                                 individuals described in 1, 2, 3, 4, 5, or 6   • A private foundation must file Form 
                                              above hold more than 35% of the profits        990-PF annually, regardless of its gross 
Line 2(ii). Use Schedule A (Form 990 or       interest.                                      receipts.
990-EZ) Public Charity Status and Public 
Support, Part II, Support Schedule for                                                       • Unless specifically required to file Form 
Organizations Described in Sections           Substantial contributor. A substantial         990 or Form 990-EZ (see the Instructions 
170(b)(1)(A)(iv) and 170(b)(1)(A)(vi), and    contributor is any individual or               for Form 990), most public charities that 
its instructions to determine if you met the  organization that gave more than $5,000        normally have gross receipts of $50,000 or 
public support test for your most recent      to you from the date you were formed or        less may satisfy their filing obligation with 
5-year period.                                other date that your exemption would be        Form 990-N, Electronic Notice 
                                              effective, to the end of the year in which     (e-Postcard).
                                              the contributions were received. This total 

Instructions for Form 1023                                      -15-

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        If you fail to file a required        The characteristics generally attributed to  activities conducted as part of your 
 !      information return or notice for 3    churches are:                                services further your religious purposes.
CAUTION consecutive years, your exempt        • A distinct legal existence,
                                                                                           Line 7a. Enter the average number of 
status will be automatically revoked.         • A recognized creed and form of 
                                                                                           members and non-members who attend 
                                              worship,
                                                                                           your regularly scheduled religious 
Line 1. Check “Yes,” if you’re claiming       • A definite and distinct ecclesiastical 
                                                                                           services.
you are excepted from filing a Form           government,
990-series return or notice and indicate      • A formal code of doctrine and              Line 8. An “established place of worship” 
the reason you believe you’re excepted        discipline,                                  is a place where you hold regularly 
from filing. See Pub. 557 and the             • A distinct religious history,              scheduled religious services. It may be a 
Instructions for Form 8940, Request for       • A membership not associated with any       place that you own, rent, or that is 
Miscellaneous Determination, for more         other church or denomination,                provided free for your use.
information on the requirements for the       • Ordained ministers ministering to the      Line 9. An “established congregation” or 
various filing exceptions. Provide            congregation,                                “other religious membership group” 
information regarding how you meet your       • Ordained ministers selected after          includes individuals who regularly attend 
requested exception in your narrative         completing prescribed courses of study,      and take part in the religious services of 
description of activities or as part of an    • A literature of its own,                   your organization at an established 
uploaded supplemental response.               • Established places of worship,             location. An established congregation 
                                              • Regular congregations,                     generally doesn’t include members of only 
Part X. Signature                             • Regular religious services,                one family. If you answer “No,” because 
                                              • Sunday schools for the religious           you don’t have an established 
Signature requirements.         An officer,   instruction of the young, and                congregation or other religious 
director, trustee, or other official who is   • Schools for the preparation of ministers.  membership, you may be a religious 
authorized to sign for the organization 
must sign Form 1023. The signature must       Although you don’t need to meet each of      organization that doesn’t qualify as a 
be accompanied by the title or authority of   the above criteria to be classified as a     church. If you don’t qualify as a church, 
the signer and the date.                      church, you’re generally required to have    you will need to go back to Part VII, line 1, 
                                              a congregation or other religious            to reconsider your public charity 
        The person signing Form 1023          membership group. For purposes of            classification.
 TIP    must be listed as an officer,         foundation classification under section              You may request classification as 
        director, or trustee within the first 509(a)(1) and 170(b)(1)(A)(i), the term      TIP     a church at a later date after you 
five entries of Part I, line 9.               “church” includes, without limitation,               establish a congregation or other 
                                              mosques, temples, and synagogues, and        religious membership group. For 
Upload Checklist                              certain other forms of religious             information about this option, see Form 
                                              organizations. For more information, see     8940, Request for Miscellaneous 
Documents to upload.     Check the boxes      Pub. 1828.                                   Determination Under Section 507, 509(a), 
to indicate which documents are included                                                   4940, 4942, 4945, and 6033 of the Internal 
in the file you upload with your application. The practices and rituals associated with    Revenue Code, or contact our customer 
 You must upload a copy of your               your religious beliefs or creed must not be  account service representatives at 
organizing document and any                   illegal or contrary to public policy.        877-829-5500 (toll-free).
amendments to it along with a copy of          
your bylaws, if adopted. The other listed                                                  Line 9a. Enter the total number of your 
documents are not required.                   Specific Line Items                          current members. If you have no 
 Put your name and EIN on each page           Line 1.  Describe your written creed,        members, enter zero (0).
of your supplemental response and             statement of faith, or summary of beliefs.   Line 9b.  Answer “Yes,” if you have a 
identify the part and line number to which    Line 2.  Your literature includes any        prescribed way to become a member. 
the information relates.                      writings about your beliefs, rules, or       Answer “Yes,” even if you just keep 
 Pay.gov can accommodate only one             history.                                     records of who is currently a member. 
                                                                                           Describe any actions required for 
uploaded file. Consolidate your               Line 3.  A “code of doctrine and discipline” individuals to become members.
attachments into a single PDF file, which     refers to a body of laws or rules that 
cannot exceed 15MB.                           govern behavior.                             Line 9c. Describe any rights and benefits 
 If your PDF file exceeds the 15MB limit,                                                  of members. You should include details of 
remove any items over the limit and           Line 4.  A “religious hierarchy or           any levels of membership and the rights 
contact IRS Customer Accounts Services        ecclesiastical government” refers to         and/or benefits associated with each level.
at 877-829-5500 for assistance on how to      people or institutions that exercise 
submit the removed items.                     significant influence or authority over your Line 9d.  If your members may be 
                                              church.                                      associated with another denomination or 
Schedule A. Churches                                                                       church, describe the circumstances in 
                                              Line 5.  Answer “Yes,” if you’re part of a   which your members would be members 
There is no single definition of the word     group of churches with similar beliefs and   of your church and another church.
“church” for tax purposes. When               structures, such as a convention, 
determining whether a section 501(c)(3)       association, or union of churches.           Line 9e.  See Appendix C for a 
religious organization is described as a                                                   description of the word “family.”
church (described in section 509(a)(1) and    Line 6.  A “form of worship” refers to 
170(b)(1)(A)(i)), we will consider            religious practices that express your        Line 10. Answer “Yes,” if you conduct 
characteristics generally attributed to       devotion to your creed, faith, or beliefs.   baptisms, weddings, funerals, or other 
                                                                                           religious rites.
churches and the facts and circumstances      Line 7.  Indicate the regular days and 
of each organization applying for public      times of your religious services. Describe   Line 11. A school for the religious 
charity classification as a “church.”         the order of events during your regular      instruction of the young refers to any 
                                              worship service and explain how the 

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regularly scheduled religious, educational    • Certification by the appropriate state      nondiscriminatory policy as to students as 
activities for youth.                         authority or successful completion of         follows.
                                              required training for qualified teachers;
Line 12. A “prescribed course of study”                                                     The M school admits students 
refers to formal or informal training. It     • Records of regular attendance by 
                                              students at your facility; and
doesn’t include self-ordination or paying a                                                 of any race, color, national 
fee for an ordination certificate without     • A lease agreement or deed for your          origin, and ethnic origin to all the 
                                              facility.
completing a course of study. Describe                                                      rights, privileges, programs, and 
the course of study completed by your           If you answer “No,” you may not meet        activities generally accorded or 
religious leaders.                            the requirements of a school and you may      made available to students at 
Line 15. Provide any additional               need to go back to Part VII, line 1, to       the school. It doesn't 
information you would like us to consider     reconsider your foundation classification if  discriminate on the basis of 
that would help us classify you as a          you requested classification as a school      race, color, national origin, and 
church.                                       under sections 509(a)(1) and 170(b)(1)(A)     ethnic origin in administration of 
                                              (ii).                                         its educational policies, 
                                                                                            admission policies, scholarship 
Schedule B. Schools,                          Line 2.  Answer “Yes,” if your primary        and loan programs, and athletic 
Colleges, and Universities                    function of the school is the presentation    and other school-administered 
                                              of formal instruction. If you answer “No,” 
                                              you may not meet the requirements for         programs.
An organization qualifies as a school (for    classification as a school and may want to 
purposes of classification under sections     go back to Part VII, line 1, to reconsider 
509(a)(1) and 170(b)(1)(A)(ii)) if all the    your foundation classification if you         Annual certification. A private school 
following applies. It:                        requested classification as a school under    must certify annually that it meets the 
                                              sections 509(a)(1) and 170(b)(1)(A)(ii).      requirements of Rev. Proc. 75-50, as 
• Presents formal instruction as its                                                        modified by Rev. Proc. 2019-22, by filing 
primary function,                             Line 3.  Answer “Yes,” if you’re a public     Schedule A (Form 990, or Form 990-EZ) 
• Has a regularly scheduled curriculum,       school and explain how you’re operated        Organization Exempt Under Section 
• Has a regular faculty of qualified          by the state or a subdivision of a state,     501(c)(3).
teachers,                                     including if you have a signed contract or 
• Has a regularly enrolled student body,      agreement with a state or local               Schools that don’t file Form 990 or 
and                                           government under which you operate and        990-EZ must make the certification by 
• Has a place where educational               receive funding. If you answer “Yes,” don’t   filing Form 5578, Annual Certification of 
activities are regularly carried on.          complete the remainder of Schedule B.         Racial Nondiscrimination for a Private 
                                                                                            School Exempt From Federal Income Tax.
The term “school” includes primary,           Line 4.  Answer “Yes,” if you were formed 
secondary, preparatory, high schools,         or substantially expanded when public         Line 7. Answer “Yes,” if your organizing 
colleges, and universities. An organization   schools in your district or county were       document or bylaws contain a 
won’t be described as a school under          desegregated by court order.                  nondiscriminatory statement as to 
                                                                                            students similar to the one shown above 
sections 509(a)(1) and 170(b)(1)(A)(ii) if it          If you're unsure whether to answer 
                                                                                            or if you adopted such a policy by 
engages in both educational and                 !      “Yes,”contact an appropriate         resolution of your governing body. State 
non-educational activities, unless the latter CAUTION  school official.
are merely incidental to the educational                                                    where your policy is located in your 
activities. Non-traditional schools such as   Line 5.  Answer “Yes,” if a state or federal  organizing document, bylaws, or if it is in 
an outdoor survival school or a yoga          administrative agency or judicial body ever   an adopted resolution. If you answered 
school may qualify. However, an               determined your organization to be racially   “No,” you must adopt a nondiscriminatory 
organization may further an educational       discriminatory. Identify the parties involved policy before submitting this application.
purpose without satisfying all the            and the forum in which the case was           Line 8. Answer “Yes,” if your brochures, 
conditions listed above that describe a       presented. Explain the reason for the         application forms, advertisements, and 
school. Such organizations may qualify as     action, the decision reached, and provide     catalogues dealing with student 
public charities based upon their sources     legal citations (if any) for the decision.    admissions, programs, and scholarships 
of support as organizations described in      Also, explain in detail any changes made      contain a statement similar to the 
sections 509(a)(1) and 170(B)(1)(A)(vi) or    in response to the action against your        following:
section 509(a)(2).                            organization or the decision reached.
                                                                                            The M school admits students of any 
Specific Line Items                                                                         race, color, and national or ethnic 
                                              Establishment of Racially 
                                                                                            origin.
Line 1. Answer “Yes,” if you have a           Nondiscriminatory Policy
regularly scheduled curriculum, a regular 
faculty of qualified teachers, a regularly    Every private school is subject to the 
enrolled student body, and facilities where   provisions of Revenue Procedure 75-50,        Line 8a.  If you answered “No” to Line 8, 
your educational activities are regularly     1975-2 C.B. 587, modified by Rev. Proc.       check the box on line 8a if you agree that 
carried on.                                   2019-22, 2019-22 I.R.B. 1260. See Pub.        all future printed materials, including 
                                              557, which sets forth the requirements of     website content, will contain a statement 
        If you answer “Yes,”you should        Rev. Proc. 75-50 under the section for        of nondiscriminatory policy as to students 
 TIP    maintain in your records evidence     Private Schools.                              similar to the one provided above.
        that you meet these factors, such 
as:                                           Publication of racially nondiscrimina-        Line 9. You must make your 
                                              tory policy. A section 501(c)(3)              nondiscriminatory policy known to all 
• A list of required courses of study,        organization that is a private school must    segments of the general community 
dates and times courses are offered, and      publish a notice of its racially              served by the school. One way to meet 
other information about how to complete                                                     this requirement is to publish your 
required courses;

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

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

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• The charge in excess of the amounts          • It isn’t controlled by disqualified  “     • Type III (“operated in connection 
generally billed (AGB) wasn’t made or          persons,” directly or indirectly. See        with” relationship; responsive to the 
requested as a pre-condition of providing      Appendix C for a definition of a             needs or demands of, and having 
medically necessary care to the                “disqualified person.”                       significant involvement in the affairs of, the 
FAP-eligible individual;                                                                    supported organization(s)): One or more 
• As of the time of the charge, the            A supporting organization can also           of your officers, directors, or trustees are 
FAP-eligible individual hadn’t submitted a     support the charitable purposes of           elected or appointed by the officers, 
complete FAP application and hadn’t            organizations that are exempt under          directors, trustees, or membership of your 
otherwise been determined by the hospital      sections 501(c)(4), (5), or (6).             supported organization(s); one or more of 
facility to be FAP eligible for the care; and,                                              your officers, directors, trustees, or other 
• If the individual subsequently submits a     Specific Line Items                          important office holders are also members 
complete FAP application and is                Line 1.  List the name, address, and EIN     of the governing body of your supported 
determined to be FAP-eligible for care, the    of each organization you support.            organization(s); or your officers, directors, 
hospital facility refunds any amount that                                                   or trustees maintain a close and 
exceeds the amount he or she is                Line 2.  Answer “Yes,” if each supported     continuous working relationship with the 
determnined to be personally responsible       organization has a letter from the IRS       officers, directors, or trustees of your 
for paying as a FAP-eligible individual,       recognizing it as a public charity under     supported organization(s).
unless such excess amount is less than         section 509(a)(1) or 509(a)(2).
                                                                                                    If you don't meet one of these 
$5.                                                    Before you file your application,     TIP    three relationship tests, you aren't 
Line 10d.  Answer “Yes,” if the hospital        TIP    use Tax Exempt Organization                  described in section 509(a)(3) and 
facility has, or will have at the beginning of         Search on IRS.gov to confirm         should review the other foundation 
operation, either a separate written billing   whether each of your supported               classification options in Part VII, line 1.
and collections policy, or include in a        organizations is currently recognized as 
written FAP:                                   exempt and is classified as a public         Line 4. Describe how your governing 
• A description of any actions that the        charity.                                     board and officers are selected, including 
hospital facility (or other authorized party)                                               where (if applicable) this information is in 
may take related to obtaining payment of a     Line 2a.   Answer “Yes,” if any supported    your governing document, bylaws, or 
bill for medical care, including, but not      organization you listed on line 1 received a other internal rules and regulations.
limited to, any extraordinary collection       letter from the IRS stating that it’s exempt 
                                                                                              Type III organizations must also 
actions (ECAs);                                under sections 501(c)(4), (5), or (6) and 
                                                                                            describe how your officers, directors, or 
• The process and time frames the              meets the public support test under 
                                                                                            trustees maintain a close and continuing 
hospital facility (or other authorized party)  section 509(a)(2). See Pub. 557 for 
                                                                                            relationship with the officers, directors, or 
uses in taking those actions (including, but   information on the public support test for 
                                                                                            trustees of your supported organization(s).
not limited to, the reasonable efforts it will section 509(a)(2).
make to determine whether an individual          If you answer “No,” describe how each      Line 5. Prohibited control by disquali-
is FAP-eligible before engaging in ECAs);      organization you support is a public charity fied person. You can’t be described in 
and                                            under section 509(a)(1) or 509(a)(2). For    section 509(a)(3) if you’re directly or 
• The office, department, committee, or        example, if you support a church or          indirectly controlled by disqualified 
other body with the final authority or         foreign organization that hasn’t received a  persons. You are controlled if disqualified 
responsibility for determining that the        determination letter recognizing it as a     persons:
hospital facility has made reasonable          public charity, you should describe how      • Can exercise 50% or more of the total 
efforts to determine whether an individual     this organization qualifies as a public      voting power of your governing body;
is FAP-eligible and may therefore engage       charity under section 509(a)(1) or 509(a)    • Have authority to affect significant 
in ECAs against the individual.                (2). See Pub. 557 for information on public  decisions, such as power over your 
                                               charities under sections 509(a)(1) and       investment decisions, or power over your 
Schedule D. Section                            509(a)(2).                                   charitable disbursement decisions; or
                                                                                            • Can exercise veto power over your 
509(a)(3) Supporting                           Line 3. Relationship test. To qualify        actions.
                                               under section 509(a)(3), you must show 
                                                                                              Although control is generally 
Organizations                                  that you meet one of three relationship 
                                                                                            demonstrated where disqualified persons 
                                               tests with your supported organization(s). 
                                                                                            have the authority over your governing 
Supporting organizations are described in      Select the option that best describes your 
                                                                                            body to require you to take an action or 
section 509(a)(3). The term “supported         relationship with your supported 
                                                                                            refrain from taking an action, indirect 
organization” refers to an organization that   organization(s).
                                                                                            control by disqualified persons will also 
a supporting organization benefits. A          • Type I (“operated, supervised, or 
                                                                                            disqualify you as a supporting 
supporting organization may support more       controlled by” relationship; comparable 
                                                                                            organization.
than one supported organization.               to a parent–subsidiary relationship): A 
                                               majority of your governing board or            See Appendix C for a description of the 
An organization qualifies as a supporting      officers are elected or appointed by the     terms “disqualified person,” “family,” 
organization (for purposes of classification   governing body, members of the               “foundation manager,” and “business 
under section 509(a)(3)) if:                   governing body, officers acting in their     relationship.”
• It is organized and at all times thereafter  official capacity, or the membership of              Public charities and foundation 
is operated exclusively for the benefit of,    your supported organization(s).               TIP    managers who otherwise are 
to perform the function of, or to carry out    • Type II (“supervised or controlled in              disqualified persons only because 
the purposes of one or more public             connection with” relationship;               they are foundation managers aren't 
charities described in section 509(a)(1) or    comparable to a brother–sister               disqualified persons for this purpose.
509(a)(2);                                     relationship): Your control or management 
• It meets one of three required               is vested in the same persons who control    Line 7. Organizational test.   If you 
relationship tests with the supported          or manage your supported                     answered “No,” you are a Type III 
organization(s); and                           organization(s).

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supporting organization, you must amend       2. Exercise a substantial degree of          gifts, grants, or contributions. See 
your organizing document to specify           direction over the policies, programs, and   Appendix C.
your supported organization(s) by name;       activities of each supported organization.
or you won’t meet the organizational test                                                  For purposes of this line, “non-exempt-use 
under section 509(a)(3) and need to           For example, N, an organization              assets” are all assets of the supporting 
reconsider your requested public charity      described in section 501(c)(3), is the       organization other than:
classification in Part VII, line 1.           parent organization of a healthcare system 
                                                                                              1. Assets described in Regulations 
                                              consisting of two hospitals (Q and R) and 
                                                                                           section 53.4942(a)(2)(c)(2)(i) through (iv), 
Line 7a. If you answered “No,” you won’t      an outpatient clinic (S), each of which is 
                                                                                           and
meet the organizational test under section    described in section 509(a)(1), and a 
509(a)(3) unless you amend your               taxable subsidiary (T). N is the sole           2. Exempt-use assets, which are 
organizing document to specify your           member of each of Q, R, and S. Under the     assets that are used (or held for use) 
supported organization(s) by name,            charter and bylaws of each of Q, R, and S,   directly in carrying out the exempt 
purpose, or class, and need to reconsider     N appoints all members of the board of       purposes of your supported organization. 
your requested public charity classification  directors of each corporation. N engages     See Regulations section 1.509(a)-4(i)(8) 
in Part VII, line 1.                          in the overall coordination and supervision  for more information.
Line 8. When responding to this question,     of the healthcare system’s exempt 
don’t include donors that are section         subsidiary corporations Q, R, and S in       Line 13a. List the total amount you 
509(a)(1), (2), or (4) organizations.         approval of their budgets, strategic         distribute(d) annually to each supported 
                                              planning, marketing, resource allocation,    organization. Also, indicate how each 
        This prohibition on contributions     securing tax-exempt bond financing, and      amount will vary from year to year.
TIP     from controlling donors only          community education. N also manages          Line 13b. List the total annual income for 
        applies to Type I and Type III        and invests assets that serve as             each supported organization. If you 
supporting organizations.                     endowments of Q, R, and S.                   distribute your income to, or for the use of, 
Line 9. Type III responsiveness test.         Line 12.  Answer “Yes,” if you conduct       a particular department or program of an 
Answer “Yes,” if, because of your             activities that the supported organization   organization, list the annual revenue of the 
relationship described in line 3, the         would otherwise need to conduct in           supported department or program.
supported organization has a significant      furtherance of its exempt purposes and       Line 13c. Answer “Yes,” if your funds are 
involvement in your investment policies,      describe the activities that you conduct.    “earmarked” for a particular program or 
making and timing of grants, and directing    Holding title to and managing assets         activity conducted by your supported 
the use of your income and assets, and        that are used (or held for use) directly in  organization.
explain how your supported organization       carrying out the exempt purposes of your      
is involved in these matters.                 supported organization (exempt-use           Schedule E. Effective Date
                                              assets) are activities that directly further 
Line 10. Type III notification require-       the exempt purposes of your supported        The questions in this schedule will help us 
ment. A Type III supporting organization      organization. Conversely, with certain       determine the effective date of exemption 
must provide the notice described in this     exceptions, fundraising, making grants       if you’re either seeking reinstatement after 
question. If you’re a Type III supporting     (whether to the supported organization or    automatic revocation or you’re filing this 
organization, you’ll be required to answer    to third parties), and investing and         application more than 27 months after the 
this question annually on your annual         managing non-exempt-use assets aren’t        end of the month in which you were legally 
information return (Schedule A of Form        activities that directly further the exempt  formed.
990 or 990-EZ).                               purposes of the supported organization.       
Lines 11–13. Type III integral part test.     See Regulations section 1.509(a)-4(i)(4)     Specific Line Items
An organization seeking classification as a   (ii) for more information.                   Line 1. Answer “Yes,” if your exempt 
Type III supporting organization must         Line 13. To satisfy the integral part test   status was automatically revoked under 
meet an integral part test, which is          as a non-functionally integrated supporting  section 6033(j)(1) for failure to file required 
satisfied by maintaining significant          organization, you must distribute at least   annual returns or notices for 3 consecutive 
involvement in the operations of one or       85% of your annual net income or 3.5%        years and you’re applying for 
more supported organizations and              of the aggregate fair market value of all    reinstatement.
providing support on which the supported      of your non-exempt-use assets (whichever        Rev. Proc. 2014-11, 2014-3 I.R.B. 411, 
organization(s) are dependent. A Type III     is greater) to your supported                at IRS.gov/irb/2014-03_IRB establishes 
supporting organization may be                organization(s). You can use Part V of       several different procedures for reinstating 
functionally integrated (lines 11–12) or      Schedule A (Form 990 or 990-EZ) to help      an organization’s exempt status 
non-functionally integrated (lines 13 and     determine your answer to this question.      depending upon its size, the number of 
13a–c) depending on the manner in which 
it meets the integral part test. Functionally          The distributable amount for the    times it’s been automatically revoked, and 
integrated Type III supporting                TIP      first tax year an organization is   the timeliness of filing for reinstatement. 
organizations are subject to fewer                     treated as a non-functionally       Review the revenue procedure to 
restrictions and requirements than            integrated Type III supporting organization  determine which section applies to you.
non-functionally integrated Type IIII         is zero.                                     Line 1a. Select the section of Rev. Proc. 
supporting organizations.                                                                  2014-11 under which you’re applying for 
Line 11. Answer “Yes,” if you’re the          For purposes of this line, “net income” has  reinstatement.
parent of all your supported organizations    the same meaning as the term “adjusted 
because you:                                  net income.” In general, “adjusted net       Section 4. Select this section if:
                                              income” is the excess of gross income,       •  You were eligible to file either Form 
1. Have the power to appoint or elect,        including gross income from any unrelated    990-EZ or Form 990-N for each of the 3 
directly or indirectly, a majority of the     trade or business, determined with certain   consecutive years that you failed to file;
officers, directors, or trustees of each      modifications, reduced by total              •  This is the first time you’ve been 
supported organization; and                   deductions. Gross income doesn’t include     automatically revoked pursuant to section 
                                                                                           6033(j)(1); and

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• You’re submitting this application no         your filing requirements in each of the 3     Schedule F. Low-Income 
later than 15 months after the later of the     years of revocation. Include a detailed 
date of your Revocation Letter or the date      explanation of all the facts and              Housing
on which the IRS posted your name on the        circumstances that led to the failure, the    To qualify for tax exemption, low-income 
Auto-Revocation List at                         discovery of the failure, and the steps you   housing must provide affordable housing 
apps.irs.gov/app/eos/.                          have taken or will take to avoid or mitigate  for a significant segment of individuals in 
  By selecting this item, you’re also           future failures to file timely returns or     your community with low incomes. Your 
attesting that your failure to file wasn’t      notices.                                      low-income housing may serve a 
intentional and you’ve put in place             Section 7. Select this section if you’re      combination of purposes, such as for 
procedures to file required returns or          seeking reinstatement with an effective       poor, frail, and elderly persons.
notices in the future.                          date of reinstatement of the date of           
        If you were classified as a private     submission of this application.               Specific Line Items
                                                                                              Line 1. The “type” of facility may be an 
TIP     foundation prior to your                Line 2. Generally, if you didn’t file Form    apartment complex, condominium, 
        automatic revocation, you weren't       1023 within 27 months of formation, the       cooperative, or private residence, etc.
eligible to file either Form 990-EZ or Form     effective date of your exempt status will be 
990-N and, therefore, aren't eligible to        the date you filed Form 1023 (submission      Line 6. Answer “Yes,” if you charge daily, 
request reinstatement under Section 4.          date). We may grant requests for an           weekly, monthly, or annual fees or 
                                                earlier effective date when there’s           maintenance charges.
        If your exempt status was               evidence to establish you acted               Line 8. Government programs include 
  !     automatically revoked more than         reasonably and in good faith, and the         federal, state, or local government 
CAUTION once, you’re not eligible for 
                                                grant of relief won’t prejudice the interests programs.
reinstatement under Section 4; however,         of the government.                             
you may apply for reinstatement under 
Section 5, Section 6, or Section 7.               Select the appropriate box to indicate 
                                                whether you accept the submission date        Schedule G. Successors 
Section 5.  Select this section if:             as the effective date of your exempt status   to Other Organizations
                                                or whether you are requesting an earlier      You should consider this schedule as a 
• You’re ineligible to file for reinstatement   effective date.                               successor organization if any of the 
under Section 4, and
• You’re submitting this application not        Line 2a. You may be eligible for              following situations pertain to you.
later than 15 months after the later of the     consideration for relief from the             • You took or will take over activities 
date of your Revocation Letter or the date      requirement that you file Form 1023 within    previously conducted by another 
on which the IRS posted your name on the        27 months of formation if you can             organization.
Auto-Revocation List at                         establish that you acted reasonably and in    • You took or will take over 25% or more 
apps.irs.gov/app/eos/.                          good faith, and that granting an extension    of the fair market value of the net assets 
  By selecting this item, you’re also           won’t prejudice the interests of the          of another organization.
attesting that you filed the required annual    government.                                   • You were established upon the 
                                                                                              conversion of an organization from 
returns, your failure to file was not             Describe in detail your reasons for filing  for-profit to non-profit status.
intentional, and you have put in place          late, how you discovered your failure to 
procedures to file required returns or          file, any reliance on professional advice or  The other organization is the 
notices in the future.                          advice from the IRS, and any other            predecessor organization. You should 
  Describe how you exercised ordinary           information you believe will support your     complete this schedule regardless of 
business care and prudence in                   request for relief. Also, you may want to     whether the predecessor (other 
determining and attempting to comply with       provide a comparison of (1) what your         organization) was exempt or not exempt 
your filing requirements in at least 1 of the   aggregate tax liability would be if you had   from federal income tax.
3 years of revocation. Include a detailed       filed this application within the 27-month    For purposes of this schedule, a 
explanation of all the facts and                period with (2) what your aggregate           “for-profit” organization is one in which 
circumstances that led to the failure, the      liability would be if you were exempt as of   persons are permitted to have an 
discovery of the failure, and the steps you     your formation date.                          ownership or partnership interest, such as 
have taken or will take to avoid or to            We may consider the following factors.      corporate stock. It includes sole 
mitigate future failures to file timely returns • You filed Form 1023 before we               proprietorships, corporations, and other 
or notices.                                     discovered your failure to file.              entities that provide for ownership 
                                                • You failed to file because of intervening   interests.
Section 6.  Select this section if you are      events beyond your control.                    
applying for reinstatement of your              • You exercised reasonable diligence,         Schedule H. Organizations 
tax-exempt status more than 15 months           but you weren’t aware of the filing           Providing Scholarships, 
from the later of the date of the Revocation    requirements. (The complexity of your 
Letter or the date on which the IRS posted      filing and experience in these matters may    Fellowships, Educational 
your name on the Auto-Revocation List at        be taken into consideration.)                 Loans, or Other 
apps.irs.gov/app/eos/.                          • You reasonably relied on written advice 
  By selecting this item, you’re also           from us.                                      Educational Grants to 
attesting that you filed the required annual    • You reasonably relied on the advice of      Individuals and Private 
returns, your failure to file wasn’t            a qualified tax professional who failed to    Foundations Requesting 
intentional, and you have put in place          file or advise you to file Form 1023.
procedures to file required returns or                                                        Advance Approval of 
notices in the future.                                                                        Individual Grant 
  Describe how you exercised ordinary                                                         Procedures
business care and prudence in 
                                                                                              Complete this schedule if you provide 
determining and attempting to comply with 
                                                                                              scholarships, fellowships, grants, loans, or 

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other distributions to individuals for     If you make educational loans,              charities-non-profit/private-foundations/
educational purposes. When answering       describe the terms of the loan (for         advance-approval-of-grant-making-
the questions on this schedule, you should example, the factors you consider in        procedures.
demonstrate how these distributions        selecting or approving loan recipients, 
                                                                                       Line 1a. Check the box for section 
further your exempt purposes.              interest rate, duration, forgiveness 
                                                                                       “4945(g)(1)” if your award qualifies as a 
                                           provision, etc.). Also, describe whether 
        If you’re a private foundation,                                                scholarship or fellowship grant that’s 
                                           any financial institutions or other lenders 
                                                                                       awarded on an objective and 
  !     you’re subject to the rules under  are involved in your program.
CAUTION section 4945 and may incur an                                                  nondiscriminatory basis and is used for 
excise tax if you make grants for the      Explain how you will publicize your         study at a school (see Schedule B for 
purpose described above without seeking    program and whether you publicize to the    what is considered a school).
advance approval of your grant-making      general public or to another group of 
                                                                                       Check the box for “4945(g)(3)” if the 
procedures (see Schedule H–Section II).    possible recipients. Include specific 
                                                                                       purpose of your award is to achieve a 
                                           information about the geographic area in 
                                                                                       specific objective, produce a report or 
Generally, distributions made to           which your program will be publicized and 
                                                                                       other similar product, or improve or 
individuals may advance educational        the means you will use, such as through 
                                                                                       enhance a literary, artistic, musical, 
purposes if selection is made:             newspaper advertisements, school district 
                                                                                       scientific, teaching, or other similar 
• In a non-discriminatory fashion in terms announcements, or community groups.
of racial preference;                                                                  capacity, skill, or talent of the recipient. 
• Based on need and/or merit; and          Line 2. Organizations that make grants to   Include your educational loan program 
• To a charitable class in terms of being  individuals must maintain adequate          under this section.
available to an open-ended group, rather   records and case histories showing the      You may check more than one box.
than to pre-selected individuals.          name and address of each recipient, 
                                           pursuant Rev. Rul. 56-304, 1956-2 C.B.              If your award qualifies as a prize 
A scholarship or fellowship is tax free to 306 but don’t provide this information as   TIP     or award that is subject to the 
the recipient only if he or she is a       part of your application.                           provisions of section 74(b) and 
candidate for a degree at an eligible                                                  your recipient is selected from the general 
educational institution and uses the                                                   public, you don’t have to request advance 
scholarship or fellowship to pay qualified Section II                                  approval of your grant-making procedures 
education expenses.                        If you requested public charity             since a prize or award isn’t subject to the 
Qualified education expenses include       classification in Part VII, line 1, don’t   advance approval procedure requirements 
tuition and fees; and course-related       complete Schedule H – Section II.           because it isn’t a grant for travel, study, or 
expenses such as books, supplies, and      Line 1. Answer “Yes,” if you’re a private   other similar purposes. See Rev. Ruls. 
equipment. Room and board, travel,         foundation and you’re requesting            77-380, 1977-2 C.B. 419; 76-460, 1976-2 
research, clerical help, and non-required  advance approval of your grant-making       C.B. 371; and 75-393, 1975-2 C.B. 451.
equipment aren’t qualified education       procedures under section 4945(g).           Line 4. Answer “Yes,” if you award 
expenses. See Pub. 970, Tax Benefits for   Answer “No,” if you’re a private foundation scholarships on a preferential basis 
Education, for additional information.     but don’t wish to request advance           because you require, as an initial 
Selection of individuals using a lottery   approval of your grant-making procedures    qualification, that the individual be an 
system generally hasn’t been approved by   under section 4945(g). If you answer “No”   employee or be related to an employee of 
the IRS.                                   the amounts you distribute as educational   a particular employer.
                                           grants provided to individuals may be 
Specific Line Items                        considered taxable expenditures under       Line 7. For purposes of this schedule, a 
                                           section 4945.                               program for children of employees of a 
Section I                                                                              particular employer includes children and 
                                           For more information about advance 
Line 1. If you conduct more than one       approval of grant-making procedures of a    family members of employees.
grant program, describe each program       private foundation, go to IRS.gov/
separately.

Instructions for Form 1023                               -23-

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Paperwork Reduction Act Notice. We ask for the information on this form to carry out the Internal Revenue laws of the United 
States. You are required to give us the information. We need it to ensure that you are complying with these laws and to allow us to 
figure and collect the right amount of tax.
You are not required to provide the information requested on a form that is subject to the Paperwork Reduction Act unless the form 
displays a valid OMB control number. Books or records relating to a form or its instructions must be retained as long as their contents 
may become material in the administration of any Internal Revenue law. Generally, tax returns and return information are confidential, 
as required by section 6103. However, certain returns and return information of tax exempt organizations and trusts are subject to 
public disclosure and inspection, as provided by section 6104.
The time needed to complete and file this form will vary depending on individual circumstances. The estimated burden for tax 
exempt organizations filing this form is approved under OMB control number 1545-0047 and is included in the estimates shown in the 
instructions for their information return.
Comments and suggestions. If you have comments concerning the accuracy of this time estimate or suggestions for making this 
form simpler, we would be happy to hear from you. You can send us comments from IRS.gov/FormComments. Or you can write to:
Internal Revenue Service
Tax Forms and Publications Division
1111 Constitution Ave. NW, IR-6526
Washington, DC 20224

                                                              -24- Instructions for Form 1023

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Appendix A: Sample Conflict of Interest Policy

Note. This Sample Conflict of       indirectly, through business,     conflict of interest is discussed  4. Violations of the Conflict 
Interest Policy is intended to      investment, or family:            and voted upon. The                of Interest Policy 
provide an example of a              a. An ownership or               remaining board or committee 
conflict of interest policy for      investment interest in any       members shall decide if a             a. If the governing board or 
organizations. The sample            entity with which the            conflict of interest exists.          committee has reasonable 
                                                                                                            cause to believe a member 
conflict of interest policy does     Organization has a               3. Procedures for Address-            has failed to disclose 
not prescribe any specific           transaction or                   ing the Conflict of Interest          actual or possible conflicts 
requirements. Therefore,             arrangement,                                                           of interest, it shall inform 
organizations should use a           b. A compensation                    a. An interested person 
                                                                          may make a presentation           the member of the basis 
conflict of interest policy that     arrangement with the                                                   for such belief and afford 
                                                                          at the governing board or 
best fits their organization.        Organization or with any                                               the member an opportunity 
                                                                          committee meeting, but 
                                     entity or individual with                                              to explain the alleged 
                                                                          after the presentation, 
Note. Items marked Hospital          which the Organization                                                 failure to disclose.
                                                                          he/she shall leave the 
insert — for hospitals that          has a transaction or                                                   b. If, after hearing the 
                                                                          meeting during the 
complete Schedule C are              arrangement, or                                                        member's response and 
                                                                          discussion of, and the vote 
intended to be adopted by            c. A potential ownership or                                            after making further 
                                                                          on, the transaction or 
hospitals.                           investment interest in, or                                             investigation as warranted 
                                                                          arrangement involving the 
Article I                            compensation                                                           by the circumstances, the 
                                                                          possible conflict of 
                                     arrangement with, any                                                  governing board or 
                                                                          interest.
Purpose                              entity or individual with                                              committee determines the 
The purpose of the conflict of       which the Organization is            b. The chairperson of the 
                                                                          governing board or                member has failed to 
interest policy is to protect this   negotiating a transaction                                              disclose an actual or 
                                                                          committee shall, if 
tax-exempt organization's            or arrangement.                                                        possible conflict of 
                                                                          appropriate, appoint a 
(Organization) interest when it      d. Compensation includes                                               interest, it shall take 
                                                                          disinterested person or 
is contemplating entering into       direct and indirect                                                    appropriate disciplinary 
                                                                          committee to investigate 
a transaction or arrangement         remuneration as well as                                                and corrective action.
                                                                          alternatives to the 
that might benefit the private       gifts or favors that aren’t 
                                                                          proposed transaction or 
interest of an officer or director   insubstantial. A financial                                          Article IV
                                                                          arrangement.
of the Organization or might         interest isn’t necessarily a                                        Records of Proceedings
result in a possible excess          conflict of interest. Under          c. After exercising due 
                                                                          diligence, the governing 
benefit transaction. This policy     Article III, Section 2, a                                           The minutes of the governing 
                                                                          board or committee shall 
is intended to supplement but        person who has a financial                                          board and all committees with 
                                                                          determine whether the 
not replace any applicable           interest may have a                                                 board delegated powers shall 
                                                                          Organization can obtain, 
state and federal laws               conflict of interest only if                                        contain:
                                                                          with reasonable efforts, a 
governing conflict of interest       the appropriate governing                                           a. The names of the persons 
                                                                          more advantageous 
applicable to nonprofit and          board or committee                                                  who disclosed or otherwise 
                                                                          transaction or arrangement 
charitable organizations.            decides that a conflict of                                          were found to have a financial 
                                                                          from a person or entity that 
                                     interest exists.
Article II                                                                would not give rise to a       interest in connection with an 
                                    Article III                           conflict of interest.          actual or possible conflict of 
Definitions                                                               d. If a more advantageous      interest, the nature of the 
                                    Procedures                            transaction or arrangement     financial interest, any action 
1. Interested Person   Any                                                isn’t reasonably possible      taken to determine whether a 
director, principal officer, or     1. Duty to Disclose  In 
member of a committee with          connection with any actual or         under circumstances not        conflict of interest was present, 
governing board delegated           possible conflict of interest, an     producing a conflict of        and the governing board's or 
powers, who has a direct or         interested person must                interest, the governing        committee's decision as to 
indirect financial interest, as     disclose the existence of the         board or committee shall       whether a conflict of interest in 
defined below, is an interested     financial interest and be given       determine by a majority        fact existed.
person.                             the opportunity to disclose all       vote of the disinterested      b. The names of the persons 
                                    material facts to the directors       directors whether the          who were present for 
 [Hospital insert – for             and members of committees             transaction or arrangement     discussions and votes relating 
hospitals that complete             with governing board                  is in the Organization best    to the transaction or 
Schedule C. If a person is an       delegated powers considering          interest, for its own benefit, arrangement, the content of 
interested person with respect      the proposed transaction or           and whether it is fair and     the discussion, including any 
to any entity in the health care    arrangement.                          reasonable. In conformity      alternatives to the proposed 
                                                                          with the above                 transaction or arrangement, 
system of which the                 2. Determining Whether a              determination, it shall        and a record of any votes 
organization is a part, he or       Conflict of Interest Exists           make its decision as to        taken in connection with the 
she is an interested person         After disclosure of the financial     whether to enter into the      proceedings.
with respect to all entities in the interest and all material facts,      transaction or 
health care system.]                and after any discussion with         arrangement.
2. Financial Interest  A            the interested person, he/she 
person has a financial interest     shall leave the governing 
if the person has, directly or      board or committee meeting 
                                    while the determination of a 

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Article V                        prohibited from providing             b. Has read and               b. Whether partnerships, 
                                 information to any committee          understands the policy,       joint ventures, and 
Compensation                     regarding compensation.               c. Has agreed to comply       arrangements with 
a. A voting member of the         [Hospital insert-for                 with the policy, and          management 
governing board who receives     hospitals that complete               d. Understands the            organizations conform to 
compensation, directly or        Schedule C Physicians who             Organization is charitable    the Organization's written 
indirectly, from the             receive compensation from the         and in order to maintain its  policies, are properly 
Organization for services is     Organization, whether directly        federal tax exemption it      recorded, reflect 
precluded from voting on         or indirectly or as employees         must engage primarily in      reasonable investment or 
matters pertaining to that       or independent contractors,           activities that accomplish    payments for goods and 
member's compensation.           are precluded from                    one or more of its            services, further charitable 
                                 membership on any committee           tax-exempt purposes.          purposes and don't result 
                                                                                                     in inurement, 
b. A voting member of any        whose jurisdiction includes       Periodic Reviews                  impermissible private 
committee whose jurisdiction     compensation matters. No 
includes compensation            physician, either individually or To ensure the Organization        benefit, or in an excess 
matters and who receives         collectively, is prohibited from  operates in a manner              benefit transaction.
compensation, directly or        providing information to any      consistent with charitable 
indirectly, from the             committee regarding physician     purposes, and doesn't engage     Article VIII
Organization for services is     compensation.]                    in activities that could         Use of Outside Experts
precluded from voting on                                           jeopardize its tax-exempt 
matters pertaining to that       Article VI                        status, periodic reviews shall   When conducting the periodic 
member's compensation.                                             be conducted. The periodic       reviews, as provided for in 
                                 Annual Statements                 reviews shall, at a minimum,     Article VII, the Organization 
c. No voting member of the       Each director, principal officer, include the following subjects:  may, but need not, use outside 
                                                                                                    advisors. If outside experts are 
governing board or any           and member of a committee             a. Whether compensation      used, their use shall not relieve 
committee whose jurisdiction     with governing board                  arrangements and benefits    the governing board of its 
includes compensation            delegated powers shall                are reasonable, based on     responsibility for ensuring 
matters and who receives         annually sign a statement             competent survey             periodic reviews are 
indirectly, from the 
compensation, directly or        which affirms such person:            information, and the result  conducted.
Organization, either              a. Has received a copy of            of arm's length bargaining.
individually or collectively, is  the conflict of interest 
                                  policy,

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Appendix B: States With Statutory Provisions Satisfying the Requirements of 
              Internal Revenue Code Section 508(e)
              The following states have adopted legislation satisfying the requirements of Section 508(e) relating to 
              private foundation governing instruments. Information derived from Revenue Ruling 75-38, 1975-1 
              C.B. 161.

ALABAMA — except where otherwise provided by a decree of a court of competent jurisdiction or by a provision in the 
private foundation's governing instrument, which in either case has been entered or made after October 1, 1971, and 
expressly limits the applicability of state law. 
ALASKA — except for such private foundations that expressly provide in their governing instruments that the applicable 
sections of Alaska law don't apply to them.
ARKANSAS — except for such private foundations which expressly provide in their governing instruments that the 
applicable sections of Arkansas law don't apply to them and except in the case of trusts where otherwise provided by decree 
of a court of competent jurisdiction.
CALIFORNIA — except where otherwise provided by a court of competent jurisdiction. 
COLORADO — with respect to trusts that are private foundations except where otherwise provided by a court of competent 
jurisdiction. 
CONNECTICUT — except where otherwise provided by a court of competent jurisdiction. 
DELAWARE — except for such private foundations, which expressly provide in their governing instruments that the 
applicable sections of Delaware law don't apply to them. 
DISTRICT OF COLUMBIA — except for such corporations, which expressly provide in their governing instruments that the 
applicable sections of District of Columbia law don't apply to them and except in the case of trusts where otherwise provided 
by a court of competent jurisdiction. (For purposes of this statute, corporations include corporations organized under any Act 
of Congress applicable to the District of Columbia as well as corporations organized under the laws of the District of 
Columbia.) 
FLORIDA — except for such trusts that file a proper election not to be subject to the applicable provisions of Florida law and 
for such corporations as to which a court of competent jurisdiction has otherwise determined.
GEORGIA — except for such private foundations that file a proper election not to be subject to such law.
HAWAII — no exceptions.
IDAHO — except for such private foundations that expressly provide in their governing instruments that the applicable 
sections of Idaho law don't apply to them.
ILLINOIS — except for such corporations that have express provisions to the contrary in their articles of incorporation and 
except for trusts where it is otherwise provided by a court of competent jurisdiction. 
INDIANA — except where otherwise determined by a court of competent jurisdiction with respect to private foundations 
organized before January 1, 1970.
IOWA — except for such private foundations which expressly provide in their governing instruments that the applicable 
sections of Iowa law don't apply to them.
KANSAS — except where otherwise provided by a court of competent jurisdiction. 
KENTUCKY — except, with respect to corporations in existence on July 1, 1972, to the extent that such a corporation 
provides to the contrary by amendment to its articles of incorporation adopted after July 1, 1972, and, with respect to trusts in 
existence on July 1, 1972, where action is properly commenced on or before December 31, 1972, in a court of competent 
jurisdiction to excuse the trust from compliance with the requirements of section 508(e) of the Code.
LOUISIANA — except for such private foundations that expressly provide in their governing instruments that the applicable 
sections of Louisiana law don't apply to them. 
MAINE — except where otherwise provided by a court of competent jurisdiction. 
MARYLAND — except where otherwise provided by a court of competent jurisdiction. 
MASSACHUSETTS — except where otherwise provided by a court of competent jurisdiction. 
MICHIGAN — with respect to trusts that are private foundations except for such private foundations which file a notice of 
inconsistency under Michigan law. 

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MINNESOTA — except for private foundations that have been held by a court of competent jurisdiction not to be affected by 
such state statute. 
MISSISSIPPI — except where otherwise provided by a court of competent jurisdiction. 
MISSOURI — except for private foundations that have been held by a court of competent jurisdiction not to be affected by 
such state statute. 
MONTANA — except in the case of trusts where otherwise provided by court decree entered after March 28, 1974, and 
except in the case of a corporation that has an express provision to the contrary in its articles of incorporation.
NEBRASKA — except for such trusts that effectively elect to be excluded from the applicable sections of Nebraska law, for 
such corporations which have governing instruments expressly providing to the contrary, and except as a court of competent 
jurisdiction has otherwise determined in any given case. 
NEVADA — no exceptions. 
NEW HAMPSHIRE — except where it is otherwise provided by a court of competent jurisdiction. 
NEW JERSEY — except for such private foundations that expressly provide in their governing instruments that the 
applicable sections of New Jersey law don't apply to them. 
NEW YORK — except where such law conflicts with any mandatory direction of an instrument by which assets were 
transferred prior to June 1, 1971, and such conflicting direction hasn’t been removed legally. 
NORTH CAROLINA — except for such private foundations which expressly provide in their governing instruments that the 
applicable sections of North Carolina law don't apply to them and except for trusts that have their governing instruments 
reformed by a decree of the Superior Court of North Carolina. 
NORTH DAKOTA — with respect to trusts that are private foundations except where otherwise provided by a court of 
competent jurisdiction.
OHIO — except in the case of trusts where it is provided otherwise by a court of competent jurisdiction and except in the 
case of corporations in existence on September 17, 1971, which expressly adopt contrary provisions in their governing 
instruments after September 17, 1971. 
OKLAHOMA — except for such private foundations that file a proper election not to be subject to such law.
OREGON — no exceptions.
PENNSYLVANIA — except where otherwise provided by a court of competent jurisdiction. 
RHODE ISLAND — except where otherwise provided by a court of competent jurisdiction. 
SOUTH CAROLINA — except for private foundations that expressly provide in their governing instruments that the 
applicable sections of South Carolina law don't apply to them. 
SOUTH DAKOTA — except where otherwise provided by a court of competent jurisdiction. 
TENNESSEE — except where otherwise provided by a court of competent jurisdiction. 
TEXAS — except for such private foundations that a proper election not to be subject to such law. 
UTAH — with respect to trusts that are private foundations except where otherwise provided by a court of competent 
jurisdiction.
VERMONT — except where otherwise provided by a court of competent jurisdiction. 
VIRGINIA — except for private foundations whose governing instruments contain express provisions to the contrary or that 
have filed a proper election not to be subject to such law. 
WASHINGTON — except for such private foundations that expressly provide in their governing instruments that the 
applicable sections of Washington law don't apply to them. 
WEST VIRGINIA — with respect to trusts that are private foundations except for such trusts which provide in their governing 
instruments that the applicable sections of West Virginia law don't apply to them. 
WISCONSIN — except as may otherwise be provided by decree of a court of competent jurisdiction. 
WYOMING — except where otherwise provided by a court of competent jurisdiction. 

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Appendix C: Glossary of Terms

Adjusted net income (for Schedule D) Adjusted net income includes: gross income from any unrelated trade or 
                                     business; gross income from functionally related businesses; interest 
                                     payments received on loans; amounts received or accrued as repayments 
                                     of amounts taken as qualifying distributions for any tax year; amounts 
                                     received or accrued from the sale or other disposition of property to the 
                                     extent acquisition of the property was treated as a qualifying distribution 
                                     for any tax year; any amounts set aside for a specific project to the extent 
                                     the full set-aside was not necessary for the project; interest on 
                                     government obligations normally excluded under section 103; net 
                                     short-term capital gains on sale or other disposition of property; and 
                                     income received from an estate if the estate is considered terminated for 
                                     income tax purposes because of a prolonged administration period. 
                                      
                                     It doesn't include: gifts, grants, and contributions received; long-term 
                                     capital gains or losses; net section 1231 gains; capital gain dividends; the 
                                     excess of fair market value over adjusted basis of property distributed to 
                                     the U.S. or a possession or political subdivision, a state or its political 
                                     subdivision, a charitable trust, or corporation for public purposes; or 
                                     income received from an estate during the administration period.
                                      
                                     In computing adjusted net income, deduct the following: ordinary and 
                                     necessary expenses paid or incurred for the production or collection of 
                                     gross income, or for the management, conservation, or collection of gross 
                                     income (includes operating expenses such as compensation of officers, 
                                     employee wages and salaries, interest, rent, and taxes); straight-line 
                                     depreciation and depletion (not percentage depletion); and expenses and 
                                     interest paid or incurred to carry tax-exempt obligations. Don't deduct net 
                                     short-term capital losses for the year in which they occur (these losses 
                                     cannot be carried back or carried over to earlier or later tax years); the 
                                     excess of expenses for property used for exempt purposes over the 
                                     income received from the property; charitable contributions made by you; 
                                     net operating losses; and special deductions for corporations.
                                      
Arm's length                         A transaction between parties having adverse (or opposing) interests 
                                     where none of the participants are in a position to exercise substantial 
                                     influence over the transaction because of business or family 
                                     relationship(s) with more than one of the parties.
                                      
Authorized representative            An individual eligible to practice before the IRS who holds a power of 
                                     attorney (Form 2848 or other similar documents) that authorizes him or 
                                     her to represent the organizations in tax matters, including the application 
                                     for tax-exempt status.
                                      
Bingo                                A game of chance played with cards that are generally printed with 5 rows 
                                     of 5 squares each, on which participants place markers to form a 
                                     pre-selected pattern to win the game. Bingo is gambling.
                                      
Business relationship                Employment and contractual relationships, and common ownership of a 
                                     business where any officers, directors, or trustees, individually or together, 
                                     possess more than a 35% ownership interest in common. Ownership 
                                     means voting power in a corporation, profits interest in a partnership, or 
                                     beneficial interest in a trust.
                                      
Bylaws                               The internal rules and regulations of an organization.
                                      
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Certification of filing            Evidence that, on a specific date, articles of incorporation (for a 
                                   corporation) or articles of organization (for a limited liability company) 
                                   were accepted for filing by appropriate state authority resulting in the 
                                   creation of a state-law entity.
                                    
Community                          The local or regional geographic area to be served by an organization.
                                    
Compensation                       All forms of income from working, including salary or wages; deferred 
                                   compensation; retirement benefits, whether in the form of a qualified or 
                                   non-qualified employee plan (for example, pensions or annuities); fringe 
                                   benefits (for example, personal vehicle, meals, lodging, personal and 
                                   family educational benefits, low interest-loans, payment of personal travel, 
                                   entertainment, or other expenses, athletic or country club membership, 
                                   and personal use of your property); and bonuses.
                                    
Conflict of interest policy        A set of procedures to identify potential conflicts of interest and to reduce 
                                   the likelihood that persons in a position of authority over an organization 
                                   may use that authority to receive an inappropriate benefit. A conflict of 
                                   interest may arise when a person in a position of authority over an 
                                   organization, such as a director, officer, or manager, may benefit 
                                   personally from a decision he or she could make. 
                                    
Controlled by disqualified persons See the definition of a disqualified person below. A section 509(a)(3) 
                                   supporting organization, may not be controlled directly or indirectly by 
                                   disqualified persons (other than the organization’s officers, directors or 
                                   trustees). An organization is controlled by disqualified persons if 
                                   disqualified persons can exercise 50% or more of the total voting power 
                                   held by the organization’s governing body. For this purpose, controlled 
                                   includes the authority to affect significant decisions, such as power over 
                                   investment decisions, or charitable disbursement decisions, as well as the 
                                   power to veto such decision. Control may be direct or indirect. 
                                    
Corporation                        An entity organized under a federal or state corporation law (including the 
                                   statutes of a federally recognized Indian tribal or Alaskan native 
                                   government). 
                                    
Develop                            The planning, financing, construction, or provision of similar services 
                                   involved in the acquisition of real property, such as land or a building.
                                    
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Disqualified person Any individual or organization that is any of the following relationships.
                       
                      a. A substantial contributor to you (see Substantial contributor).
                       
                      b. An officer, director, trustee, or any other individual who has similar 
                      powers or responsibilities. 
                       
                      c. An individual who owns more than 20% of the total combined voting 
                      power of a corporation that is a substantial contributor to you.
                       
                      d. An individual who owns more than 20% of the profits interest of a 
                      partnership that is a substantial contributor to you.
                       
                      e. An individual who owns more than 20% of the beneficial interest of a 
                      trust or estate that is a substantial contributor to you.
                       
                      f. A member of the family of any individual described in a, b, c, d, or e 
                      above.
                       
                      g. A corporation in which any individuals described in a, b, c, d, e, or f 
                      above hold more than 35% of the total combined voting power.
                       
                      h. A trust or estate in which any individuals described in a, b, c, d, e, or 
                      f above hold more than 35% of the beneficial interests.
                       
                      i. A partnership in which any individuals described a, b, c, d, e, or f 
                      above hold more than 35% of the profits interest.
                     
Earmark             Donations or other contributions given to an organization on the condition 
                    or understanding that they will be used to assist particular individuals or 
                    specific identified groups.
                     
Expenses            Financial burdens or outlays, costs (of doing business), and business 
                    outlays chargeable against revenues. For purposes of this form, expenses 
                    mean direct and indirect expenses.
                     
Fair market value   The price at which property, or the right to use property, would change 
                    hands between a willing buyer and a willing seller, neither being under any 
                    compulsion to buy, sell, or transfer property or the right to use property, 
                    and both having reasonable knowledge of relevant facts.
                     
Family              Includes an individual's spouse, ancestors, children, grandchildren, 
                    great-grandchildren, siblings (whether by whole or half-blood), and the 
                    spouses of children, grandchildren, great-grandchildren, and siblings.
                     
Foreign country     A country other than the United States, its territories and possessions, and 
                    the District of Columbia.
                     
For-profit          A business entity whose activities are conducted or maintained to make a 
                    profit (for example, revenues greater than expenses) for its private 
                    shareholders or owners.
                     
Foundation manager  Officers, directors, or trustees, or an individual having powers or 
                    responsibilities similar to those of a foundation's officers, directors, or 
                    trustees.
                     
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Fundraising             The organized activity of raising funds, whether by volunteers, employees, 
                        or paid independent contractors.
                         
Gaming                  The term gaming includes activities such as Bingo, Beano, lotteries, 
                        pull-tabs, pari-mutuel betting, Calcutta wagering, pickle jars, punch 
                        boards, tip boards, tip jars, certain video games, 21, raffles, keno, 
                        split-the-pot, and other games of chance.
                         
Gross investment income As defined in section 509, gross investment income means the gross 
                        amount of income from interest, dividends, payments with respect to 
                        securities loans, rents, and royalties; but not including any such income to 
                        the extent included in computing the tax imposed by section 511.
                         
Gross receipts          For purposes of Part VI-A. Statement of Revenues and Expenses, gross 
                        receipts include monies earned from activities related to an organization’s 
                        charitable or other section 501(c)(3) activities, such as selling admissions 
                        or merchandise, performing services, or furnishing facilities.
                         
Hospital                Hospital or medical care includes the treatment of any physical or mental 
                        disability or condition, whether on an inpatient or outpatient basis. A 
                        hospital includes the following.
                           
                          a. Hospitals and rehabilitation institutions, outpatient clinics, or 
                          community mental health or drug treatment centers if the principal 
                          purpose or function is the providing of medical or hospital care or 
                          medical education or research.
                           
                          b. Medical research organizations, if the principal purpose or function 
                          is the continuous active conduct of medical research in conjunction 
                          with a hospital. 
                         
Influence legislation   The act of directly contacting or urging the public to contact members of a 
                        legislative body for the purpose of proposing, supporting, or opposing 
                        legislation. Attempting to influence legislation includes advocating the 
                        adoption or rejection of legislation.
                         
Intellectual property   A type of property (distinct from real or personal property) including the 
                        following.
                           
                          a. Patents (for inventions).
                           
                          b. Copyrights (for literary and artistic works such as novels, poems, 
                          plays, films, musical works, drawings, paintings, photographs, 
                          sculptures, architectural designs, performances, recordings, film, and 
                          radio or television programs).
                           
                          c. Trade names, trademarks, and service marks (for symbols, names, 
                          images, and designs).
                           
                          d. Formulas, know-how, and trade secrets.
                         
Joint venture           A legal agreement in which the parties jointly undertake a transaction for 
                        mutual profit. Generally, each person contributes assets and shares risks. 
                        Like a partnership, joint ventures can involve any type of business 
                        transaction and the “persons” involved can be individuals, groups of 
                        individuals, companies, or corporations.
                         
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Limited liability company       A limited liability company (LLC) is a business entity organized in the 
                                United States under state law. Generally, an LLC may be classified for 
                                federal income tax purposes as a partnership, corporation, or an entity 
                                disregarded as separate from its owner by applying the rules in Regulation 
                                section 301.7701-3. However, an LLC that has been determined to be, or 
                                claims to be, exempt from taxation under section 501(a) is treated as 
                                having made an election to be classified as a corporation under 
                                Regulation section 301.7701-3(c)(1)(v). 
                                 
Low-income housing              Rental or ownership housing provided to persons based on financial need.
                                 
Mailing address                 Address where correspondence is received.
                                 
Manage                          Manage means to direct or administer.
                                 
Medical care                    The treatment of any physical or mental disability or condition, whether on 
                                an inpatient or outpatient basis.
                                 
Medical research organization   An organization whose principal purpose or function is the continuous 
                                active conduct of medical research in conjunction with a hospital.
                                 
Net income (for Schedule D)     See Adjusted net income.
                                 
Non-fixed payment               A non-fixed payment means a payment that depends on discretion. For 
                                example, a bonus of up to $100,000 that is based on an evaluation of 
                                performance by the governing board is a non-fixed payment because the 
                                governing body has discretion over whether the bonus is paid and the 
                                amount of the bonus.
                                 
Organizing document             The organizing document depends on the form of the organization. For a 
                                corporation, the document is the articles of incorporation. For an LLC, the 
                                document is the articles of organization. For an unincorporated 
                                association, the document is the articles of association or constitution. The 
                                organizing document of a trust is the trust agreement.
                                 
Political campaign intervention An organization participates in a political campaign, if it promotes or 
                                opposes, through political literature, brochures, pamphlets, hosting or 
                                participating in events, etc., the candidacy of an individual for public office. 
                                Debates and nonpartisan voter education aren’t considered political.
                                 
Predecessor                     An organization whose activities or assets were taken over by another 
                                organization.
                                 
Private foundation              An organization that is exempt under section 501(c)(3) is a private 
                                foundation unless it is a church, school, hospital, governmental unit, entity 
                                that undertakes testing for public safety, organization that has broad 
                                financial support from the general public, or organization that supports one 
                                or more other organizations that are themselves classified as public 
                                charities.
                                 
Private operating foundation    A type of private foundation that makes qualifying distributions directly for 
                                the active conduct of its educational, charitable, and religious purposes. 
                                “Directly for the active conduct” means that the distributions are used by 
                                the foundation itself to carry out the programs for which it is organized and 
                                operated. Grants made to assist other organizations or individuals are 
                                normally considered indirect.
                                 
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Public charity          An organization that is exempt under section 501(c)(3) is excepted from 
                        private foundation status because it is described in section 509(a)(1) 
                        (which cross references sections 170(b)(1)(i) through (vi), and (ix)), 509(a)
                        (2), 509(a)(3), or 509(a)(4).
                         
Reasonable compensation Reasonable compensation is the amount that would ordinarily be paid for 
                        like services by like organizations under like circumstances as of the date 
                        the compensation arrangement is made. Reasonable compensation is 
                        important because excessive benefits in the form of compensation to 
                        disqualified persons may result in the imposition of excise taxes and 
                        jeopardize the organization's tax-exempt status.
                         
Related                 The family or business relationships between persons.
                         
Relationship            A relationship may exist between one organization and another in the 
                        following situations.
                         
                          a. One organization controls the other through common officers, 
                          directors, or trustees, or through authority to approve budgets or 
                          expenditures.
                           
                          b. Both organizations were created at approximately the same time 
                          and by the same persons.
                           
                          c. The organizations operate in a coordinated manner with respect to 
                          facilities, programs, employees, or other activities.
                           
                          d. The same persons exercise substantial influence over both 
                          organizations. 
                         
Revenue                 Revenue means gross revenue amounts.
                         
Revenue Procedure       An official statement of a procedure published in the IRS Internal Revenue 
                        Bulletin (previously the Cumulative Bulletin) that either affects the rights or 
                        duties of taxpayers or other members of the public under the Internal 
                        Revenue Code and related statutes, treaties, and regulations or, although 
                        not necessarily affecting the rights and duties of the public, should be a 
                        matter of public knowledge. 
                         
Revenue Ruling          An official interpretation by the IRS of the Internal Revenue laws and 
                        related statutes, treaties, and regulations, that has been published in the 
                        IRS Internal Revenue Bulletin (previously the Cumulative Bulletin). 
                        Revenue Rulings are issued only by the Office of Associate Chief Counsel 
                        and are published for the information and guidance of taxpayers, IRS 
                        officials, and others concerned.
                         
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School                     A school is an educational organization whose primary function is the 
                           presentation of formal instruction and that normally maintains a regular 
                           faculty and curriculum and normally has a regularly enrolled body of pupils 
                           or students in attendance at the place where its educational activities are 
                           regularly carried on. A school may include the following.
                              
                             a. Primary, secondary, preparatory, or high school.
                              
                             b. College or university.
                              
                             c. Trade or technical school. 
                              
                             d. Nursery or preschool.
                              
                             e. School that you operate as an activity, such as school that is 
                             operated as an activity of a museum, historical society, or church.
                              
Similarly situated         Similarly situated organizations means tax-exempt or taxable 
                           organizations of a comparable size, purpose, and resources.
                            
Substantial contributor    An individual or organization that contributed more than $5,000 to an 
                           organization from the date it was formed or other date that its exemption 
                           would be effective, to the end of the year in which the contributions were 
                           received. This total amount contributed must also be more than 2% of all 
                           the contributions the organization received. A creator of a trust is treated 
                           as a substantial contributor regardless of the amount contributed.
                            
Successor                  An organization that took over: 
                              
                             a. More than a negligible amount of the activities that were previously 
                             conducted by another organization, 
                              
                             b. 25% or more of the fair market value of the net assets of another 
                             organization, or
                              
                             c. Was established upon the conversion of an organization from 
                             for-profit to non-profit status. 
                            
Trust                      A trust is an entity that may be formed by a trust agreement or declaration 
                           of trust. A trust may also be formed through a will. 
                            
Unincorporated association An unincorporated association formed under state law must have at least 
                           two members who have signed a written document for a specifically 
                           defined purpose.
                            
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