Instructions for Form 1023

Agency decision

Ask Donna

What actually matters in this document.

Text

(Rev. December 2024)

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

Revenue Code

Section references are to the Internal Revenue

Code unless otherwise noted.

Contents

Page

Future Developments . . . . . . . . . . . . 1

Overview of Organizations

Described in Section 501(c)

(3) . . . . . . . . . . . . . . . . . . . . . 1

General Instructions . . . . . . . . . . . . . 2

Answers . . . . . . . . . . . . . . . . . . . . 3

Purpose of Form . . . . . . . . . . . . . . . 3

What To File . . . . . . . . . . . . . . . . . . 3

When To File . . . . . . . . . . . . . . . . . 4

Filing Assistance . . . . . . . . . . . . . . . 4

Signature Requirements . . . . . . . . . . 4

Authorized Representative . . . . . . . . 4

Public Inspection . . . . . . . . . . . . . . . 5

Foreign Organizations . . . . . . . . . . . 5

Specific Instructions . . . . . . . . . . . . . 6

Part I. Identification of Applicant . . . . . 6

Part II. Organizational Structure . . . . . 6

Part III. Required Provisions in

Your Organizing Document . . . . . 7

Part IV. Your Activities . . . . . . . . . . . . 8

Part V. Compensation and Other

Financial Arrangements . . . . . . 10

Part VI. Financial Data . . . . . . . . . . 11

Part VII. Foundation

Classification . . . . . . . . . . . . . 14

Part VIII. Effective Date . . . . . . . . . . 15

Part IX. Annual Filing

Requirement . . . . . . . . . . . . . 15

Part X. Signature . . . . . . . . . . . . . . 16

Schedule A. Churches . . . . . . . . . . 16

Schedule B. Schools, Colleges,

and Universities . . . . . . . . . . . 17

Schedule C. Hospitals and

Medical Research

Organizations . . . . . . . . . . . . . 18

Schedule D. Section 509(a)(3)

Supporting Organizations . . . . . 20

Schedule E. Effective Date . . . . . . . 22

Schedule F. Low-Income Housing . . . 23

Schedule G. Successors to Other

Organizations . . . . . . . . . . . . . 23

Schedule H. Organizations

Providing Scholarships,

Fellowships, Educational

Loans, or Other Educational

Grants to Individuals and

Private Foundations

Requesting Advance Approval

of Individual Grant

Procedures . . . . . . . . . . . . . . 23

Appendix A: Sample Conflict of

Interest Policy . . . . . . . . . . . . . 26

Appendix B: States With Statutory

Provisions Satisfying the

Requirements of Internal

Revenue Code Section

508(e) . . . . . . . . . . . . . . . . . . 28

Jan 7, 2025

Contents

Page

Appendix C: Glossary of Terms . . . . 30

Appendix D: National Taxonomy of

Exempt Entities (NTEE)

Codes . . . . . . . . . . . . . . . . . 38

Index . . . . . . . . . . . . . . . . . . . . . 41

Note. Keep a copy of the completed Form

1023 for your permanent records.

Future Developments

For the latest information about

developments related to Form 1023 and

its instructions, such as legislation

enacted after they were published, go to

IRS.gov/Form1023.

What's New

Organizations requesting recognition of

tax-exempt status under section 501(c)(3)

must complete and submit their Form

1023 (or Form 1023-EZ, if eligible)

applications electronically (including

paying the correct user fee) using Pay.gov.

Continuous-use form and instructions.

Form 1023 and these instructions have

been converted from an annual reversion

to continuous use. Use these instructions

for tax year 2024 and subsequent years

until a superseding revision is issued.

Reminder

Don't include social security numbers

on publicly disclosed forms. Because

the IRS is required to disclose approved

exemption applications and information

returns, don't include social security

numbers on this form. Documents subject

to disclosure include supporting

information filed with the form and

correspondence with the IRS about the

filing.

Phone Help

If you have questions and/or need help

completing Form 1023, please call

877-829-5500. This toll-free telephone

service is available Monday through

Friday.

Email Subscription

The IRS provides a subscription-based

email service for tax professionals and

representatives of tax-exempt

organizations. We send subscribers

periodic updates regarding exempt

organization tax law and regulations,

available services, and other information.

To subscribe, visit IRS.gov/Charities.

How To Get Forms and

Publications

Internet. You can access the IRS website

24 hours a day, 7 days a week, at IRS.gov

to do the following.

• Download forms, instructions, and

publications.

• Order IRS products online.

• Research your tax questions online.

• Search publications by topic or

keyword.

• Use the online Internal Revenue Code,

regulations, or other official guidance.

• View Internal Revenue Bulletins (IRBs)

published since 1995.

• Sign up at IRS.gov/Charities-NonProfits to receive local and national tax

news by email.

Tax forms and publications. You can

download or print all of the forms and

publications you may need at IRS.gov/

FormsPubs. Otherwise, you can go to

IRS.gov/OrderForms to place an order and

have forms mailed to you. You should

receive your order within 10 business

days.

Overview of Organizations

Described in Section

501(c)(3)

How To Request Recognition of

Tax-Exempt Status Under

Section 501(c)(3)

Section 501(c)(3) describes organizations

organized and operated exclusively for

religious, charitable, scientific, testing for

public safety, literary, or educational

purposes, or to foster national or

international amateur sports competition,

or for the prevention of cruelty to children

or animals. Unless an exception applies,

an organization must file Form 1023 or

Form 1023-EZ (if eligible) to obtain

recognition of exemption from federal

income tax under section 501(c)(3). You

can find information about eligibility to file

Form 1023-EZ at IRS.gov/Charities.

Organizations not required to

obtain recognition of exemption. The

following types of organizations may be

considered tax exempt under section

501(c)(3) without filing Form 1023 (or

Form 1023-EZ).

Instructions for Form 1023 (Rev. 12-2024) Catalog Number 17132z

Department of the Treasury Internal Revenue Service www.irs.gov

• Churches, including synagogues,

temples, and mosques.

• Integrated auxiliaries of churches and

conventions or associations of churches.

• Any organization that has gross

receipts in each tax year of normally not

more than $5,000. For more information

on gross receipts exceptions, go to

IRS.gov/Charities.

Even though these organizations aren't

required to seek recognition of exemption,

they may choose to file Form 1023 (or

Form 1023-EZ, if eligible) to receive a

determination letter stating they are

recognized as exempt under section

501(c)(3) status. The determination letter

will also state whether an organization

must file annual information returns or

notices and will specify whether

contributions to that organization are tax

deductible.

Requirements for Tax-Exempt

Status Under Section 501(c)(3)

To qualify for exemption under section

501(c)(3), an organization must be

organized and operated exclusively for

one or more exempt purposes.

Organized. An organization must be

organized as a corporation, a limited

liability company (LLC), an

unincorporated association, or a trust.

Its organizing document (corporate

articles of incorporation, LLC articles of

organization, articles of association or

constitution of an unincorporated

association, or trust agreement or

declaration of trust) must limit the

organization's purpose(s) and

permanently dedicate its assets to exempt

purposes.

Operated. An organization described in

section 501(c)(3) must be operated to

further one or more of the exempt

purposes stated in its organizing

document. Certain other activities are

prohibited or restricted, including, but not

limited to, the following activities. A section

501(c)(3) organization must:

• Absolutely refrain from participating in

the political campaigns of candidates for

local, state, or federal office;

• Ensure its assets and earnings don’t

unjustly enrich board members, officers,

key management employees, or other

insiders;

• Not further non-exempt purposes (such

as purposes that benefit private interests)

more than insubstantially;

• Not operate for the primary purpose of

conducting a trade or business that isn’t

related to its exempt purpose(s);

• Not engage in activities that are illegal

or violate fundamental public policy; and

• Limit its legislative activities.

Legislative and political campaign intervention. Section 501(c)(3) denies

exemption to an organization if a

substantial part of its activities is

attempting to influence legislation or if it

directly or indirectly participates or

intervenes in any political campaign on

behalf of (or in opposition to) any

candidate for elective public office. These

issues are described in more detail in the

instructions for Part IV, lines 5 and 6.

Public Charities and Private

Foundations

Every organization described in section

501(c)(3) is classified as a private

foundation unless it qualifies for one of

the public charity exceptions. For some

organizations, the primary distinction

between a public charity and a private

foundation is its sources of financial

support.

Public charities. The following section

501(c)(3) organizations are classified as

public charities.

• Organizations that are public charities

based upon their activities (without regard

to their sources of support), such as

churches, schools, hospitals, medical

research organizations, and cooperative

hospital service organizations and

agricultural research organizations

(sections 509(a)(1) and 170(b)(1)(A)(i),

(ii), (iii), and (ix)).

• Organizations that normally receive

substantial support from grants,

governmental units, and/or contributions

from the general public (sections 509(a)(1)

and 170(b)(1)(A)(iv) and (vi)).

• Organizations that normally receive

more than one-third of their support from

contributions, membership fees, and gross

receipts from activities related to their

exempt functions, and not more than

one-third of their support from gross

investment income and net unrelated

business income (section 509(a)(2)).

• Organizations that support other public

charities (supporting organizations)

(section 509(a)(3)).

• Organizations that test for public safety

(section 509(a)(4)).

Private foundations. Section 501(c)(3)

organizations that don’t fit into any of the

foundation classifications above are

private foundations. Private foundations

are further classified as nonoperating

private foundations or private operating

foundations (section 4942(j)(3)).

Nonoperating private foundations.

Nonoperating private foundations

generally accomplish their exempt

purpose by making grants and don’t

otherwise engage directly in charitable

activities.

Private operating foundations. A

private operating foundation actively

conducts exempt programs. Private

operating foundations are subject to more

favorable rules than other private

foundations in terms of charitable

contribution deductions and attracting

grants from private foundations. In order to

be classified as a private operating

foundation, an organization must meet

certain support tests. Search for “private

operating foundations” at IRS.gov for more

information.

Key distinctions between public charities and private foundations.

Foundation classification is important

because different tax rules apply to the

operations of each entity. For more

information on the different rules, see

IRS.gov/Charities-Non-Profits/EOOperational-Requirements-PrivateFoundations-and-Public-Charities.

Foundation classification has

TIP nothing to do with the name of the

organization. Many organizations

that aren't private foundations include the

word “foundation” in their names.

State Registration Requirements

Tax exemption under section 501(c)(3) is a

matter of federal law. After receiving

federal tax exemption, an organization

may also be required to register with one

or more states where it holds assets or

where it will solicit contributions. The

organization may also need to seek

exemption from state taxes. The National

Association of State Charity Officials

(NASCO) maintains a website that

provides informational links to the various

states for these purposes. It can be

accessed at nasconet.org.

General Instructions

Social Security number. Don't enter

social security numbers on this form or

any attachments because the IRS is

required to disclose approved exemption

applications and information returns.

Documents subject to disclosure include

supporting information filed with the form

and correspondence with the IRS related

to the application.

“You” and “us.” Throughout these

instructions and Form 1023, the terms

“you” and “your” refer to the organization

that is applying for tax-exempt status. The

terms “us” and “we” refer to the IRS.

Definitions. Terms in bold type in Form

1023 are defined throughout these

instructions and in Appendix C.

Instructions for Form 1023

Answers

Form 1023 asks you to answer a series of

questions and provide information to

assist us in determining if you meet the

requirements for tax exemption under

section 501(c)(3). Answer questions

completely. If you believe you previously

answered the question, you may refer to

your previous answer.

Your answers must provide

sufficient detail about your past,

CAUTION present, and planned activities to

demonstrate that you're described in

section 501(c)(3). We won't be able to

recognize you as tax exempt based on a

mission statement (such as providing

assistance to the poor) unless you also

describe the activities that further

accomplish your mission. We need to

understand the specific activities you will

undertake to accomplish your section

501(c)(3) exempt purpose(s).

Financial data. Financial data, whether

budgeted or actual, should be consistent

with other information presented in your

application.

For example, if you're requesting public

charity classification under one of the

public support tests, your financial data

should show contributions from the public

or receipts from providing exempt

services. Budgeted financial data should

be prepared based upon your current

plans. We recognize that your actual

financial results may vary from the

budgeted amounts.

Past, present, and planned activities.

Many items on Form 1023 are written in

the present tense; however, base your

answers on your past, present, and

planned activities.

Language and currency requirements.

Prepare Form 1023 and attachments in

English. Provide an English translation if

the articles of organization, bylaws, or any

other attachments are in any other

language.

Report financial information in U.S.

dollars (specify the conversion rate used).

Combine amounts from within and outside

the United States and report the total for

each on the financial statements.

Purpose of Form

Completed Form 1023 required to apply for recognition of section 501(c)(3)

exemption. Use Form 1023, including the

appropriate user fee, to apply for

recognition of exemption from federal

income tax under section 501(c)(3). If

approved, we will issue a determination

letter that describes your tax-exempt

status and your qualification to receive

tax-deductible charitable contributions.

The determination letter will also show

Instructions for Form 1023

your specific foundation classification

(described earlier) and annual filing

requirements.

Form 1023-EZ. You may be

TIP eligible to file Form 1023-EZ,

Streamlined Application for

Recognition of Exemption Under Section

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

which is a streamlined version of Form

1023. Complete the Form 1023-EZ

Eligibility Worksheet in the Instructions for

Form 1023-EZ to determine if you're

eligible to file Form 1023-EZ. You can visit

IRS.gov/Charities for more information on

application requirements.

Leaving a group exemption. A

subordinate organization under a group

exemption can use Form 1023 to leave the

group and obtain individual exemption. If

you're a subordinate organization and

wish to leave a group, you should notify

your parent organization of your intention

to leave the group ruling before filing Form

1023.

Application for Reinstatement

of Exempt Status and

Retroactive Reinstatement

If your tax-exempt status was

automatically revoked for failure to file a

return or notice 3 consecutive years, you

must apply to have your tax-exempt status

reinstated. You must complete and submit

Form 1023, including Schedule E (or, if

eligible, Form 1023-EZ), and pay the

appropriate user fee.

If your application is approved, your

date of reinstatement will generally be the

filing date of the application, unless you

qualify for reinstatement of exemption

retroactive to your date of automatic

revocation. See Rev. Proc. 2014-11,

2014-03 I.R.B. 411 for details, including

additional requirements for retroactive

reinstatement.

User Fee

The law requires payment of a user fee

with each application. You must pay this

fee through Pay.gov when you file Form

1023.

Payments can be made directly from

your bank account or by credit or debit

card. You won't be able to submit Form

1023 without paying the correct fee.

User fee amounts are listed in Rev.

Proc. 2020-5, updated annually. For the

current Form 1023 user fee, go to Rev.

Proc. 2020-5, 2020-1 I.R.B. 241, at

IRS.gov/Charities-Non-Profits/User-Feesfor-Tax-Exempt-and-Government-EntitiesDivision. You can also call 877-829-5500.

Group Exemption

Don't use Form 1023 to apply for a group

exemption. We may issue to a central

organization, a group exemption that

recognizes, on a group basis, the

exemption of subordinate organizations on

whose behalf the central organization has

applied. See Pub. 557 for information on

how to apply for a group exemption.

What To File

All applicants, unless otherwise noted,

must complete Parts I through X of Form

1023, plus any required schedules and

attachments.

The following organizations must

complete additional schedules to Form

1023.

Requesting Expedited Review

We generally review applications for

exemption in the order we receive them.

We only expedite processing of an

application where a written request

presents a compelling reason for

processing the application ahead of

others. This does not mean your

application will be immediately approved

or denied. Circumstances generally

warranting expedited processing include

the following.

• A grant to the applicant is pending and

the failure to secure the grant may have an

adverse impact on the organization's

ability to continue operations.

• The purpose of the newly created

organization is to provide disaster relief to

victims of emergencies such as floods and

hurricanes.

• An IRS error has caused delays in

review of the application.

THEN you

must

complete

Schedule

IF you’re

A church . . . . . . . . . . .

A school, college, or

university . . . . . . . . . .

A hospital or medical

research organization

. .

A section 509(a)(3)

supporting

organization . . . . . . . .

Filing this application more

than 27 months from your

date of formation and/or

applying for reinstatement

of tax-exempt status after

being automatically

revoked . . . . . . . . . . .

A low-income housing

organization . . . . . . . .

A successor to other

organizations . . . . . . . .

An organization providing

scholarships, fellowships,

educational loans, or other

educational grants to

individuals and/or a private

foundation requesting

approval of individual grant

procedures . . . . . . . . .

Generally, if you file Form 1023 within 27

months after the end of the month in which

you were legally formed, and we approve

your application, the effective date of your

exempt status will be your legal date of

formation.

If you don’t file Form 1023 within 27

months, the effective date of your exempt

status will be the date you filed Form 1023.

For exceptions and special rules, see Part

VIII. Effective Date and Schedule E.

How to File

As of January 31, 2020, the IRS requires

that Form 1023 applications for

recognition of exemption be submitted

electronically online at Pay.gov. The IRS

will provide a 90-day grace period during

which it will continue to accept paper

versions of Form 1023. To submit Form

1023, you must:

1. Register for an account on Pay.gov.

2. Enter "1023" in the search box and

select Form 1023.

3. Complete the form.

Filing Assistance

Attachments To Form 1023

A complete application will include one or

more documents in addition to Form 1023.

Pay.gov can accommodate only one

uploaded file. Before submitting Form

1023, consolidate your attachments into a

single PDF file. Combine your attachments

in the following order.

• Organizing document (required).

• Amendments to your organizing

document in chronological order (required

if applicable).

• Bylaws or other rules of operation and

amendments (if adopted).

• Form 2848, Power of Attorney and

Declaration of Representative (if

applicable).

• Form 8821, Tax Information

Authorization (if applicable).

• Supplemental responses (if your

response won't fit in the provided text field)

and any additional information you want to

provide to support your request (optional).

• Expedite request (optional).

Put your name and EIN on each page

of your supplemental response and

identify the part and line number to which

the information relates.

When To File

For help in completing this form or general

questions relating to an exempt

organization, you may access information

on our website at IRS.gov/EO.

You may find the following publications

available on IRS.gov helpful.

• Pub. 517, Social Security and Other

Information for Members of the Clergy and

Religious Workers.

• Pub. 526, Charitable Contributions.

• Pub. 557, Tax-Exempt Status for Your

Organization.

• Pub. 598, Tax on Unrelated Business

Income of Exempt Organizations.

• Pub. 1771, Charitable Contributions

Substantiation and Disclosure

Requirements.

• Pub. 1828, Tax Guide for Churches and

Religious Organizations.

• Pub. 3079, Tax-Exempt Organizations

and Gaming.

• Pub. 3833, Disaster Relief: Providing

Assistance Through Charitable

Organizations.

• Pub. 4220, Applying for 501(c)(3)

Tax-Exempt Status.

• Pub. 4221-PC, Compliance Guide for

501(c)(3) Public Charities.

• Pub. 4221-PF, Compliance Guide for

501(c)(3) Private Foundations.

Signature Requirements

An officer, director, trustee, or other official

who is authorized to sign for the

organization must digitally sign Form 1023

at the end of Part X. The signature must

be accompanied by the title or authority of

the signer and the date.

Authorized Representative

Form 2848. Upload a completed Form

2848 if you want to authorize a

representative to represent you regarding

your application. An individual authorized

by Form 2848 may not sign the application

unless that person is also an officer,

director, trustee, or other official who is

authorized to sign the application.

A Centralized Authorization File

(CAF) number isn’t required to be

CAUTION listed on Form 2848.

Form 8821. Upload a completed Form

8821 if you want to authorize us to discuss

your application with the person you have

appointed on that form.

Form 8821 doesn’t authorize your

appointee to advocate your position with

respect to the federal tax laws; to execute

waivers, consents, or closing agreements;

or to otherwise represent you before the

IRS. If you want to authorize an individual

to represent you, use Form 2848.

After You Submit Form 1023

Unless we approve a request for

expedited processing, we will assign and

work your application in the order we

received it.

No additional information needed. If

our review shows that you meet the

requirements for tax-exempt status under

section 501(c)(3), we will send you a

determination letter stating that you’re

exempt under section 501(c)(3) and

identifying your foundation classification.

Additional information needed. If we

can’t make a determination without more

information, we will write or call you.

Examples of the types of questions we

may ask you are available at IRS.gov/

Charities-Non-Profits/CharitableOrganizations/Exempt-OrganizationSample-Questions. If the additional

information you provide shows that you

meet the requirements for exemption, we

will send you a determination letter stating

that you're exempt under section 501(c)

(3). If we determine that you don't qualify

for exemption, we will send you a letter

that explains our position and your appeal

rights.

Annual Return or Notice While

Your Application Is Pending

Unless you qualify for an exception from

the requirement to file an annual return or

notice, your filing obligations begin as

soon as you were formed. If you have an

information return or tax return due while

your Form 1023 is pending, complete the

return, mark the “Application Pending” box

in the heading, Item B, and submit the

return as indicated in those instructions.

If you’re eligible to file a Form 990-N,

e-Postcard, call 877-829-5500 and

Instructions for Form 1023

request to be set up to allow filing of Form

990-N .

Figure 1. 990 Series Forms Filed by Exempt Organizations

Note. It takes the IRS up to 6 weeks to

update its records before you can file your

Form 990-N.

Type of Annual Return

You can find information on return filing

requirements and exceptions in Pubs. 557

and 598 and in the instructions to the

annual returns listed in Figure 1.

Form 990, Return of Organization

Exempt from Income Tax

Section 501(c)(3) public charities

Form 990-EZ, Short Form Return of

Organization Exempt from Income Tax

Section 501(c)(3) public charities whose

gross receipts during the year were less

than $200,000 and total assets at the

end of the year were less than $500,000

Form 990-PF, Return of Private

Foundation

Private foundations, including private

operating foundations, regardless of

financial status

Form 990-T, Exempt Organization

Business Income Tax Return

Public charities and private foundations

that have gross unrelated business

income of $1,000 or more

Form 990-N Electronic Notice

(e-Postcard) for Tax-Exempt

Organizations Not Required to File Form

990 or Form 990-EZ

Most small public charities with gross

receipts of $50,000 or less can file a

Form 990-N, if they choose not to file a

Form 990 or Form 990–EZ instead.

marking it as “NOT SUBJECT TO PUBLIC

INSPECTION” and include an explanation

of why you’re asking for the information to

be withheld. We will decide whether to

withhold the identified information from

public inspection.

See Pub. 557 for additional information

on public inspection requirements.

You may also be required to file

TIP other returns, such as

employment tax returns or benefit

plan returns, which aren't discussed here.

If a Form 990-series return is due

while your application is pending,

CAUTION complete and submit the return

according to Form 990-series form's

instructions.

Public Inspection

Information available for public inspection. If we approve exempt status under

section 501(c)(3), the following information

that will be open for public inspection

includes the following.

• Your complete Form 1023 and any

supporting documents.

• All correspondence between you and

the IRS concerning Form 1023, including

Form 2848.

• Your determination letter.

• Annual information returns (Forms 990,

990-EZ, or 990-PF).

• Schedule A, included with Forms 990 or

990-EZ.

• Schedule B, included with Forms 990 or

990-EZ, excluding the names and

addresses of contributors and other

identifying information about contributors.

• Schedule B, included with Form 990-PF,

including names, addresses, and other

identifying information about contributors.

• Exempt Organization Business Income

Tax Return (Form 990-T).

Information not available for public

inspection. The following items won’t be

open for public inspection.

• Any information relating to a trade

secret, patent, style of work, or apparatus

that, if released, would adversely affect

you (we must approve withholding this

information).

• Any other information that would

adversely affect national defense (we must

approve withholding this information).

• User fee payment information.

• Contributors' names and addresses

and identifying information about

contributors included with Forms 990 or

990-EZ and the Schedule B filed with

these forms.

When applying for tax-exempt status,

you must clearly identify any information

that isn’t open for public inspection by

Instructions for Form 1023

Making documents available for public

inspection. Both you and the IRS must

make the information that is subject to

disclosure available for public inspection.

The public may request a copy of the

information available for public inspection

from us by submitting Form 4506-A. The

public may also request inspection of the

information or a copy of the information

directly from you.

You may post the documents required

to be available for public inspection on

your own website. Information returns and

your exemption application materials must

be posted exactly as filed with the IRS.

You may only delete the information that

isn’t open for public inspection.

If you post the documents on your

website, you can give any person

requesting copies the website where the

documents may be found, but you don’t

need to provide copies of the information.

However, even if these documents are

posted on your website, you must still

allow public inspection without charge at

your main office during regular business

hours.

Documents aren’t considered available

for public inspection on a website if the

otherwise disclosable information is edited

or subject to editing by a third party when

posted. To date, the IRS hasn’t approved

any third-party websites for posting.

Who Should File

Foreign Organizations

Foreign organizations are those that were

created in countries other than the United

States, its territories, or its possessions.

Foreign organizations may apply for

tax-exempt status on income earned in the

United States in the same way that

domestic organizations apply for exempt

status. See Language and currency

requirements, earlier.

If you’re a foreign organization applying

for exempt status, you must complete all

required parts of Form 1023. However,

see the special rules below for certain

Canadian organizations.

Contributions by U.S. residents to

TIP foreign organizations generally

aren’t deductible. Tax treaties

between the U.S. and certain foreign

countries provide specific limited

exceptions.

Annual returns for foreign organizations. A foreign organization that obtains

exemption as a public charity must file an

information return annually (Form 990 or

Form 990-EZ). A foreign organization that

is a private foundation must file Form

990-PF annually. However, a foreign

organization, other than a private

foundation or a section 509(a)(3)

supporting organization, may file Form

990-N (e-Postcard) instead of Form 990 or

Form 990-EZ when its gross receipts from

U.S. sources are normally $50,000 or less

and it hasn’t conducted significant activity

in the United States. See the Instructions

for Form 990 and Form 990-EZ, and the

Instructions for Form 990-PF for further

information. A foreign organization that is

subject to unrelated business income tax

must file Form 990-T.

Canadian Organizations

Canadian organizations that have received

a Notification of Registration from the

Canada Revenue Agency (formerly

Canada Customs and Revenue Agency),

and whose registrations haven’t been

revoked (“Canadian registered charities”),

are automatically recognized in the U.S. as

section 501(c)(3) organizations and aren’t

required to file Form 1023. Canadian

registered charities are also presumed to

be private foundations. If you’re a

Canadian registered charity and want to

be listed as a section 501(c)(3)

organization on IRS.gov or request

classification as a public charity rather

than a private foundation, mail or fax the

information below to:

Internal Revenue Service

Exempt Organization Determinations

Room 6403

P.O. Box 2508

Cincinnati, OH 45201

(855) 204-6184

No user fee is required.

• A letter stating the organization’s

request (listing as a section 501(c)(3)

organization on IRS.gov or classification

as a public charity).

• The legal name and complete mailing

address of the organization.

• The organization’s EIN.

• The month its tax year ends.

• The organization’s date of formation.

• A contact name and telephone number.

• The public charity status it is requesting

(if applicable) and information

demonstrating how it meets the

requirements of that status (see Part VII,

line 1, and related questions and

schedules).

• This penalty of perjury statement:

I declare under the penalties of perjury

that I have examined this request,

including the accompanying documents,

and to the best of my knowledge and

belief, the request contains all the relevant

facts relating to the request, and such

facts are true, correct, and complete.

• The signature of an officer, director,

trustee, or other authorized person.

• A copy of the organization’s Notification

of Registration.

• Form 8833, Treaty-Based Return

Position Disclosure Under Section 6114 or

7701(b).

on which your annual financial records are

based.

Organizations Created in U.S.

Territories and Possessions

Organizations created in possessions and

territories of the U.S. are generally treated

as domestic organizations. If you were

created in a U.S. possession or territory,

you must complete all required parts of

Form 1023 to apply for exempt status

under section 501(c)(3).

Charitable contributions to you are

deductible by donors if you qualify for

exempt status under section 501(c)(3).

Annual filing requirements for an

organization created in a U.S. territory or

possession are similar to those outlined

above for foreign organizations (see Rev.

Proc. 2011-15 at IRS.gov/pub/irs-irbs/

irb11-03.pdf).

Specific Instructions

Part I. Identification of

Applicant

Line 1a. Enter your complete name

exactly as it appears in your organizing

document, including amendments.

Line 1b. If you have an “in care of” name,

enter it here; otherwise, leave this space

blank.

Line 1c-i. Enter your complete address

where all correspondence will be sent. If

mail isn’t delivered to your street address

and you have a P.O. box, list your P.O. box

information instead of your street address.

For a foreign address, enter your

province or state and foreign postal code

where indicated.

Line 2. Employer Identification Number

(EIN). You must have your own EIN.

Enter the 9-digit EIN the IRS assigned to

you. If you don’t have an EIN, you must

apply for one before submitting your

application. You can find out how to apply

for an EIN by visiting IRS.gov and search

for “apply for an EIN.” You may apply for an

EIN online or by fax or mail. International

applicants may call 267-941-1099 (toll

call).

Don’t apply for an EIN more than

TIP once. If you’re unsure of your EIN

or whether you have one, call

877-829-5500 for assistance.

Don’t use the EIN of a related or

other organization.

CAUTION

Line 3. Month tax year ends. Select the

month your tax year (annual accounting

period) ends. Your tax year (annual

accounting period) is the 12-month period

Check your bylaws or other rules

TIP of operation for consistency with

the tax year (annual accounting

period) you enter here.

Line 4. Person to contact. Enter the

name and title of the person you want us

to contact if we need more information.

The person to contact may be an officer,

director, trustee, or other individual who is

permitted to speak with us according to

your bylaws or other rules of operation.

Your person to contact may also be an

authorized representative, such as an

attorney, certified public accountant, or

enrolled agent, for whom you’re submitting

a completed Form 2848 with the Form

1023.

Line 5. Provide a daytime telephone

number for the contact listed on line 4.

Line 6. You may provide a fax number for

the contact listed on line 4.

Line 7. Pay.gov will populate this field

with the current user fee for filing Form

1023.

Line 8. Enter your complete website

address if you have one. Also, list any

websites maintained on your behalf. The

information on your website should be

consistent with the information in your

Form 1023.

Line 9. Officers, directors, and trustees. Enter the full names, titles, and

mailing addresses of your officers,

directors, and/or trustees. You may use the

organization’s address for mailing. If you

have more than five officers, directors, or

trustees, check the box provided to add

more officer, director, and/or trustee

information.

The person who is signing Form 1023

must be listed within the first five entries of

line 9.

Part II. Organizational

Structure

You must be a corporation, limited liability

company, unincorporated association, or

trust to be tax exempt under section

501(c)(3). Sole proprietorships,

partnerships, or loosely affiliated groups of

individuals aren’t eligible.

Line 1. Type of organization and copy

of organizing document. Select your

type of organization, and before submitting

the form, upload a copy of your

organizing document (including any

amendments) as part of the required

attachment.

Corporation. A corporation is an entity

organized under a federal or state statute,

or a statue of federally recognized Indian

tribal or Alaskan native government.

Instructions for Form 1023

Copy of organizing document

(articles of incorporation and any

amendments). A corporation’s

organizing document is its “articles of

incorporation.” If you formed under state

statute, your articles of incorporation (and

any amendments) must show

certification of filing. This means your

articles show evidence that on a specific

date they were filed with and approved by

an appropriate state authority. The

document must be an exact copy of what

is on file with your state.

If you don’t have a copy of your articles

of incorporation showing evidence of

having been filed and approved by an

appropriate state official, you may submit

a substitute copy of your articles of

incorporation. This substitute copy may be

handwritten, typed, printed, or otherwise

reproduced. It must be accompanied by a

declaration, signed by an officer

authorized to sign for you, that it is a

complete and correct copy of the articles

of incorporation and that it contains all the

powers, principles, purposes, functions,

and other provisions by which you

currently govern yourself.

Limited liability company. A limited

liability company (LLC) that files its own

exemption application is treated as a

corporation rather than a partnership.

Copy of organizing document

(articles of organization and operating

agreement (if adopted) and any

amendments). Instead of articles of

organization, an LLC’s organizing

document is its state-approved “articles

of organization.” If it has adopted an

“operating agreement,” then this document

is also part of its organizing document. If

you formed under state statute, your

articles of organization (and any

amendments) must show certificate of

filing. This means your articles show

evidence that on a specific date they were

filed with and approved by an appropriate

state authority. The document must be an

exact copy of what is on file with your

state. If you don’t have a copy of your

articles of organization showing evidence

of having been filed and approved by an

appropriate state official, you may submit

a substitute copy of your articles of

organization. This substitute copy may be

handwritten, typed, printed, or otherwise

reproduced. It must be accompanied by a

declaration, signed by an officer

authorized to sign for you, that it is a

complete and correct copy of the articles

of organization and that it contains all the

powers, principles, purposes, functions,

and other provisions by which you

currently govern yourself.

Instructions for Form 1023

If you are an LLC and want to be

TIP treated as a disregarded entity by

a tax-exempt member, don’t file an

exemption application.

Unincorporated association. An

unincorporated association formed

under state law must have at least two

members who have signed a written

document that creates an entity with a

specifically defined purpose.

Copy of organizing document

(articles of association or constitution

and any amendments). Your organizing

document must include the name of the

organization, its purpose, the date the

document was adopted, and the

signatures of at least two individuals. If

your copy doesn’t contain the proper

signatures and date of adoption, you may

submit a written declaration that states

your copy is a complete and accurate

copy of the signed and dated original. Your

declaration should clearly indicate the

original date of adoption.

Bylaws may be considered an

TIP organizing document only if they

include the required elements

listed above.

Trust. A trust may be formed by a trust

agreement or declaration of trust. A trust

may also be formed through a will.

Generally, a trust must be funded with

property, such as money, real estate, or

personal property.

Copy of organizing document (trust

agreement/declaration of trust or will

and any amendments). Your trust

agreement (and any amendments) must

be signed by at least one trustee. If your

trust agreement copy isn’t signed, you

may submit a written declaration that

states your copy is a complete and

accurate copy of the signed and dated

original. Your declaration should clearly

indicate the original date that it was

signed. For trusts created by a will, include

a copy of the death certificate or a

statement indicating the date of death,

and a copy of the relevant portions of the

will.

If your trust agreement continues

to provide for distributions for

CAUTION non-charitable interests, you won’t

qualify for tax-exempt status.

Line 2. Formation date. The date you

enter should be consistent with your

organizing document.

• If you’re a corporation, enter the date

that your articles of incorporation were

filed and approved by the appropriate

authority.

• If you’re an LLC, enter the date that the

appropriate authority filed your articles of

organization or other organizing

document.

• If you’re an unincorporated association,

enter the date that your organizing

document was adopted by the signatures

of at least two individuals.

• If you’re a trust (other than a trust

formed by a will), enter the date your trust

was funded. If your trust agreement

provided for any non-charitable interests,

enter the date that non-charitable interests

expired. If you were formed by a will, enter

the date of death or the date any

non-charitable interests expired.

Line 3. State of formation. Enter the

jurisdiction (for instance, the state or the

federally recognized tribal government)

under the laws of which you were

incorporated or otherwise formed. This

may not be the place in which you’re

physically located. For example, if you’re

physically located in New York, but

incorporated under Massachusetts law,

enter Massachusetts.

For purposes of completing this

application, you’re formed under the laws

of a foreign country if you’re not formed

under the laws of the United States, its

territories and possessions, federally

recognized Indian tribal or Alaska native

governments, or the District of Columbia.

Line 4. “Bylaws” are generally the

internal rules and regulations of an

organization. If you have bylaws, upload a

current copy (including any amendments).

Bylaws don’t need to be signed unless

they are your organizing document as

described in the instructions for line 1

above.

Line 5. Successor organization. You

are a “successor” if you:

• Took over activities previously

conducted by another organization,

• Took over 25% or more of the fair

market value of the net assets of another

organization, or

• Were established upon the conversion

of an organization from for-profit to

non-profit status.

If you’re a successor organization,

complete Schedule G, Successors to

Other Organizations.

Your predecessor organization

TIP may have been either a

tax-exempt or non-exempt

organization.

Part III. Required

Provisions in Your

Organizing Document

Line 1. Purpose clause. Your

organizing document must limit your

purposes to those described in section

501(c)(3). Those purposes are charitable,

religious, educational, scientific, literary,

testing for public safety, fostering national

or international amateur sports

competition, and preventing cruelty to

children or animals.

The generally accepted legal definition

of “charitable” includes relief of the poor,

the distressed, or the underprivileged;

advancement of religion; advancement of

education or science; erecting or

maintaining public buildings, monuments,

or works; lessening the burdens of

government; lessening neighborhood

tensions; eliminating prejudice and

discrimination; defending human and civil

rights secured by law; and combating

community deterioration and juvenile

delinquency. Therefore, the phrase “relief

of the poor” in your organizing document

properly limits your purposes.

Limiting your purposes by reference to

section 501(c)(3) generally will be

sufficient to meet the organizational test

under section 501(c)(3). Your organizing

document may also sufficiently limit your

purpose by reference to a specific

charitable purpose such as “relief of the

elderly within the meaning of section

501(c)(3).”

However, purposes listed in your

organizing document broader than those

listed in section 501(c)(3) may cause you

to fail the organizational test. In that case,

you will need to amend your organizing

document before applying. A reference to

section 501(c)(3) won’t ensure that your

purposes are limited to those described in

section 501(c)(3) if other provisions

describing your purposes include one or

more non-exempt purposes. The following

is an example of an acceptable purpose

clause.

The organization is organized

exclusively for charitable,

religious, educational, and

scientific purposes under

section 501(c)(3) of the Internal

Revenue Code, or

corresponding sections of any

future federal tax code.

See Pub. 557 for further information

and examples of how to limit your

purposes.

Line 2. Dissolution clause. Your

organizing document must provide for

the permanent dedication of your assets to

a section 501(c)(3) purpose. This means

that if you dissolve your organization in the

future, your assets must be distributed for

an exempt purpose described in section

501(c)(3), or to the federal government, or

to a state or local government, for a public

purpose. In certain states, you may rely on

state law to establish the permanent

dedication of assets for exempt purposes.

This is based on Rev. Proc. 82-2, 1982-1

C.B. 367. For additional information,

search “Operation of state law” at IRS.gov.

Foreign organizations may be able to

rely upon the applicable laws of their

jurisdiction in a similar manner. If relying

on a foreign law, you must provide a copy

of the applicable law with an English

translation.

Naming a specific organization to

receive your assets upon dissolution will

be acceptable only if your organizing

document requires that the specific

organization to be exempt under section

501(c)(3) at the time your dissolution takes

place and provides for a qualified

alternative recipient if the named

organization isn’t exempt under section

501(c)(3) at that time.

If your organizing document states that

your assets would be distributed to

members or private individuals or for any

purpose other than those provided in

section 501(c)(3), you must amend your

organizing document to remove such

statements.

The following is an example of an

acceptable dissolution clause.

Upon the dissolution of this

organization, assets shall be

distributed for one or more

exempt purposes within the

meaning of section 501(c)(3) of

the Internal Revenue Code, or

corresponding section of any

future federal tax code, or shall

be distributed to the federal

government, or to a state or

local government, for a public

purpose.

See Pub. 557 for further information

and examples of acceptable language for

dedication of assets in your organizing

document.

Part IV. Your Activities

Reminder

Answer all questions in this part as they

pertain to your past, present, and future

activities.

Line 1. Describe completely and in detail

your past, present, and planned activities.

Don’t refer to or repeat the purposes in

your organizing document or speculate

about potential future programs. Your

narrative description of activities should be

thorough and accurate because we

determine whether you qualify for section

501(c)(3) exempt status based on the

information in your application. You should

describe either actual or planned

activities. For example, if you plan to

further educational purposes by operating

an afterschool homework club, you would

describe that activity rather than cite that

you will further educational purposes. If

you were also contemplating offering

scholarships in the future, but currently

have no plans to do so, then the

scholarship activity would be speculative,

and you should not describe it.

Some organizations (such as credit

counseling organizations (see Part IV,

line 8), childcare organizations (see Part

IV, line 12), agricultural research

organizations (see Part VII, line 1), or

cooperative hospital service organizations

(see Schedule C)) must meet specific

operational requirements to qualify for

exemption under section 501(c)(3). If

you’re such an organization, be certain to

include an explanation in your activity

description of how activities you conduct

(or don’t conduct, if the specific

operational requirement limits permissible

activities) satisfy those specific

operational requirements.

For each past, present, or planned

activity, include information that answers

the following questions.

• What is the activity?

• Who conducts the activity?

• Where is the activity conducted?

• What percentage of your total time is

allocated to the activity? (Combined time

percentages should add up to 100%.)

• How is the activity funded (for example,

donations, fees, etc.) and what

percentage of your overall expenses is

allocable to this activity?

• How does the activity further your

exempt purposes?

Line 2. National Taxonomy of Exempt

Entities (NTEE) code. An NTEE code is

a three-character series of letters and

numbers that generally describes a type of

organization. Enter the code that best

describes your organization from the list of

NTEE codes, located in Appendix D. For

more information and more detailed

definitions of these codes developed by

the National Center for Charitable

Statistics (NCCS), visit the Urban Institute

NCCS website at nccs.urban.org.

NTEE codes are also used for

TIP purposes other than identification

of organizations described in

section 501(c)(3). Therefore, all codes in

the list don't necessarily correspond to a

section 501(c)(3) purpose.

Line 3. If programs are limited to specific

individuals, describe how you select or

identify those individuals. If programs are

available only for members, describe

membership criteria, any membership

dues, any different membership levels,

and the benefit each membership level

receives.

Line 4. Describe any business or family

relationship between individuals who

receive goods, services, or funds through

your programs and any officers, directors,

Instructions for Form 1023

trustees, or highest compensated

employees or independent contractors.

For purposes of this form, “highest

compensated” employees or independent

contractors are persons to whom you pay

over $100,000 of compensation,

including compensation from related

organizations.

Line 5. You participate in a political

campaign if you promote or oppose the

candidacy of an individual for public office.

Candidate debates and nonpartisan voter

education and registration may be

permitted. See Rev. Rul. 2007-41,

2007-25 I.R.B. 1421 at IRS.gov/irb/

2007-25_I.R.B. 1421 and Pub. 1828 for

more information and examples.

Organizations described in

section 501(c)(3) are prohibited

CAUTION from supporting or opposing

candidates for public office in any political

campaign. If you answer “Yes,” you aren’t

qualified for tax exemption under section

501(c)(3) and should reconsider whether

the filing of application Form 1023 is

appropriate for you. See Pub. 557 for a

description of other code sections under

which you may qualify.

Line 6. You are attempting to influence

legislation if you directly contact or urge

the public to contact members of a

legislative body for the purpose of

proposing, supporting, or opposing

legislation. You are also attempting to

influence legislation if you advocate the

adoption or rejection of legislation. If you

answer “Yes,” your explanation should

include the percentage of your total time

and total funds spent on such legislative

activities.

Organizations described in section

501(c)(3) are prohibited from engaging in

a substantial amount of legislative

activities. Whether you’re engaged in

substantial legislative activities depends

on all of the facts and circumstances.

For this purpose, “legislation” includes

action by Congress, a state legislature, a

local council, or a similar governing body,

with respect to acts, bills, resolutions or

Categories

(A) Real Estate

(B) Securities

1. Gross sales price of

assets (other than

inventory) by category.

2. Less: Cost or other

basis and sales

expenses.

3. Gain or (loss). Subtract

line 2 from line 1.

4. Net gain or (loss) — Add line 3 of columns (A), (B), and (C). Enter here and

on Form 1023, Part VI - A. Statement of Revenues and Expenses, line 11.

receipts on line 9. Include unusual

grants on line 12 and not on line 1.

Examples.

1. A city pays the symphony orchestra

to provide free music programs in the

public schools. The programs are open to

the public. This income received from a

governmental unit accomplishes the

orchestra's exempt purpose and directly

provides a service to the general public.

This income is a grant to the symphony

orchestra that should be listed on line 1.

2. The symphony orchestra sells

tickets to the public for its fall season.

Such income is gross receipts received

from the general public in performance of

the symphony orchestra’s exempt function

and should be listed on line 9.

3. The public school system pays the

orchestra to create several musical pieces

suitable for the school system’s

elementary music curriculum. This

payment by a governmental unit for the

music compositions is primarily for the

school system’s own use, not for the direct

benefit of the public. Therefore, this

income is gross receipts received from a

governmental unit in performance of the

orchestra’s exempt function that should be

listed on line 9.

Line 2. Enter the amount you receive

from members to provide support to the

organization. Don’t include payments from

members or on behalf of members to

purchase admissions, merchandise,

services, or use of facilities.

Line 3. Enter your gross income from

dividends, interest, payments received on

securities, loans, rents, and royalties you

hold for investment purposes.

See Pub. 598 for additional information

regarding royalties treated as unrelated

business income.

Line 4. Enter your net income from

unrelated business activities. “Unrelated

business income” generally is income

from any trade or business activity that is

regularly carried on, and not related to

your exempt purpose. Certain exceptions

and exclusions may apply.

Report on line 9 income from activities

that aren’t related to the accomplishment

of your exempt purposes, but aren’t

considered unrelated business activities.

For example, report income from the sale

of merchandise by volunteers that isn’t

treated as an unrelated trade or business

on line 9.

See Pub. 598 for additional information

regarding unrelated business income.

Line 5. Enter amounts any local tax

authority collects from the public on your

behalf.

Line 6. Enter the value of services or

facilities a governmental unit furnishes to

you. Use the fair market value of the

services or facilities. Don’t include the

value of services or facilities generally

provided by the governmental unit to the

public without charge.

Line 7. Enter your total income from all

sources not reported on lines 1 through 6,

or lines 9, 11, and 12. Provide an itemized

list in line 25, showing each type and

amount of income included, and a brief

description of each type of income.

Line 8. Lines 1 through 7 will be added

for you.

Line 9. Enter income from activities that

you conduct to further your exempt

purposes (excluding amounts listed on

other lines). Also, include as gross

receipts the income from activities

conducted:

• Intermittently (not regularly carried on),

such as an occasional auction;

• With substantially all (at least 85%)

volunteer labor, such as a car wash;

• For the convenience of members,

students, patients, officers, or employees,

such as a parking lot for a school’s

students and employees; or

• With substantially all contributed

merchandise, such as a thrift store.

See Pub. 598 for additional information

regarding income that isn’t from an

unrelated trade or business.

“Gross receipts” also includes

payment by a governmental unit that may

be called a “grant” but is actually payment

for a service or facility for the use of the

government payer, rather than for the

direct benefit of the public.

Example. The state government gives

a conservation group a grant to study the

effects of a new sewage treatment plant

on an ecologically significant woodland

area. Although the payment is called a

grant, it is actually gross receipts that

should be included on line 9. The payment

is by a governmental unit (state) for a

study for its own use, not for the direct

benefit of the general public. A for-profit

consulting company could’ve done the

study rather than by the tax-exempt

conservation group.

Provide an itemized list of your gross

receipts in line 25, describing the sources

and amounts of income. For payments by

a governmental unit, list the payer, the

purpose of the payment, and the payment

amount.

Line 10. Lines 8 and 9 will be added for

you.

Line 11. Enter any net gain or loss on the

sale of capital assets. Provide an itemized

list by asset category (for example, real

estate or securities) showing gross sales,

cost or other basis/sales expenses, and

gain or loss by asset category in line 25.

You may use the format in Figure 2.

Line 12. Enter any “unusual grants,”

which generally are any substantial

contributions and bequests you received

from disinterested persons that, by their

size, adversely affect your classification as

a public charity. “Unusual grants” are

unusual, unexpected, and received from

an unrelated party. Provide an itemized list

of any unusual grants, including the

amount in line 25, and explain how it was

unusual, unexpected, and from an

unrelated party.

For additional information about

unusual grants and a description of public

charity classifications, see Pub. 557.

Line 13. Lines 10 through 12 will be

added for you.

Lines 14. Enter the total expenses you

incur for soliciting gifts, grants, and

contributions included on line 1. Include

fees paid to professional fundraisers for

soliciting gifts, grants, and contributions.

Line 15. Enter the total amount you pay

out to both individuals and organizations.

Provide an itemized list in line 25,

identifying recipients (using letter

designations such as A, B, C, etc.), a brief

Instructions for Form 1023

description of the purposes or conditions

of payments, and the amounts paid.

Colleges, universities, and other

educational institutions and agencies

subject to the Family Educational Rights

and Privacy Act (20 U.S.C. 1232g) don’t

need to list the names of individuals to

whom they provided scholarships or other

financial assistance where such disclosure

would violate the privacy provisions of the

law. Instead, group each type of financial

aid provided, indicate the number of

individuals who received the aid, and

specify the aggregate dollar amount.

Maintain (but don’t submit) a list

showing the names of recipients

associated with each letter designation.

Line 16. Enter total payments you make

to or for the benefit of your members (not

including any amounts listed on line 15).

Provide an itemized list in line 25,

identifying recipients (using letter

designations), a brief description of the

purposes or condition of payments, and

the amounts paid.

Maintain (but don’t submit) a list

showing the names of recipients

associated with each letter designation.

Line 17. Enter the total amount of

compensation you pay to your officers,

directors, and trustees.

Line 18. Enter the total amount of

salaries and wages you pay to employees

(not reported on line 17).

Line 19. Enter your total interest

expenses for the year. Don’t include

mortgage interest treated as an

occupancy expense on line 20.

Line 20. Enter the amount you pay for the

use of office space or other facilities, heat,

light, power and other utilities, outside

janitorial services, mortgage interest, real

estate taxes, and similar expenses.

Line 21. Enter the total depreciation,

depletion, and similar expenses you incur.

Line 22. Enter the total professional fees

you pay. Professional fees are amounts

charged by individuals and entities that

aren’t your employees. They include fees

for professional fundraisers (other than

fees listed on line 14, earlier), accounting

services, legal counsel, consulting

services, contract management, or any

independent contractors.

Line 23. Enter any expenses you didn’t

include in the lines above, such as for

program services. Provide an itemized list

in line 25, showing the type and amount of

each significant expense.

Line 24. Lines 14 through 23 will be

added for you.

Instructions for Form 1023

B. Balance Sheet

Complete the balance sheet for your most

recently completed tax year. If you haven’t

completed a full tax year, use the most

current information available. Be sure to

enter the year-end date for the information

provided and not the date you prepare this

application. Enter “0” if a particular asset

or liability doesn’t apply to you.

Line 1. Enter your total cash in checking

and savings accounts, temporary cash

investments (money market funds, CDs,

treasury bills, or other obligations that

mature in less than 1 year), and petty cash

funds.

Line 2. Enter your total accounts

receivable that arose from the sale of

goods and/or performance of services,

less any reserve for bad debt.

Line 3. Enter the amount of materials,

goods, and supplies you purchased or

manufactured and held to be sold or used

in some future period.

Line 4. Enter the total amount of bonds or

notes you issued that will be repaid to you.

Provide an itemized list in line 19, that

shows the name of each borrower (using a

letter designation), the borrower’s

relationship to you, a brief description of

the obligation, the rate of return, the due

date, and the amount due.

Maintain (but don’t submit) a list

showing the names of borrowers

associated with each letter designation.

Line 5. Enter the total fair market value

of corporate stocks you hold. Provide an

itemized list of your corporate stock

holdings in line 19.

For stock of closely held corporations,

list the name or the corporation, a brief

summary of the corporation’s capital

structure, the number of shares held, and

their value as carried on your books. If

valuation doesn’t reflect current fair market

value, also include fair market value.

For stock traded on an organized

exchange or in substantial quantities over

the counter, list the name of the

corporation, a description of the stock, and

the principal exchange on which it is

traded, the number of shares held, their

value as carried on your books, and their

fair market value.

Line 6. Enter your total amount of loans

(personal and mortgage loans) receivable.

Provide an itemized list in line 19 that

identifies each borrower (using a letter

designation), the borrower’s relationship to

you, purpose of loan, repayment terms,

interest rate, and original amount of loan.

Report each loan separately, even if more

than one loan was made to the same

person.

Maintain (but don’t submit) a list

showing the names of borrowers

associated with each letter designation.

Line 7. Enter the total book value of your

other investments. Include the total book

value of government securities (federal,

state, and municipal), and buildings and

equipment held for investment purposes.

Provide an itemized list in line 19

identifying and reporting the book value of

each building/item of equipment held for

investment purposes.

Line 8. Enter the total book value of

buildings and equipment not held for

investment purposes. This includes

facilities you own and equipment you use

in conducting your exempt activities.

Provide an itemized list in line 19 of these

assets held at the end of the current tax

year/period, including the cost or other

basis.

Line 9. Enter the total book value of land

not held for investment purposes.

Line 10. Enter the total book value of any

other category of your assets not reported

on lines 1 through 9, for example, patents,

copyrights, or other intangible assets.

Provide an itemized list of each asset in

line 19.

Line 11. Lines 1 through 10 will be added

for you.

Line 12. Enter the total amount of your

accounts payable to suppliers and others,

such as salaries payable, accrued payroll

taxes, and interest payable.

Line 13. Enter the total unpaid portion of

grants and contributions you committed to

pay to other organizations or individuals.

Line 14. Enter the total of your mortgages

and other notes payable outstanding at the

end of the current tax year/period. Provide

an itemized list in line 19 showing each

note separately, including the lender’s

name, purpose of loan, repayment terms,

interest rate, and original amount.

Line 15. Enter the total amount of any

other liabilities not reported on lines 12

through 14. Provide an itemized list in

line 19 of these liabilities, including the

amounts you owe.

Line 16. Lines 12 through 15 will be

added for you.

Line 17. Under fund accounting, an

organization segregates its assets,

liabilities, and net assets into separate

funds according to restrictions on the use

of certain assets. Each fund is like a

separate entity in that it has a

self-balancing set of accounts showing

assets, liabilities, equity (fund balance),

income, and expenses. If you don’t use

fund accounting, report only the “net

assets” account balances, which include

capital stock, paid-in capital, retained

earnings or accumulated income, and

endowment funds.

Line 18. Lines 16 and 17 will be added

for you.

Part VII. Foundation

Classification

Organizations that are exempt under

section 501(c)(3) are private

foundations unless they are:

• Churches, schools, hospitals,

governmental units, entities that undertake

testing for public safety, organizations that

have broad financial support from the

general public; or

• Organizations that support one or more

organization(s) that are themselves

classified as public charities.

Section 501(c)(3) organizations

excepted from private foundation

classification are public charities. Unless

you meet one of the exceptions above,

you’re a private foundation.

You can only select one

TIP foundation classification.

Line 1. Select the foundation

classification you’re requesting from the

list below. The form will then take you to

additional lines or parts of the application

that you must complete based on your

response.

509(a)(1) and 170(b)(1)(A)(vi). Select

this classification if you normally receive a

substantial part of your support from

grants from governmental units or from

contributions from the general public, or a

combination of these sources. Typically,

you would show a substantial part of your

income on Part VI-A. Statement of

Revenue and Expenses, lines 1 and 2.

Under this public charity

classification, you must meet the one-third

public support test or 10% facts and

circumstances test. See Pub. 557 for more

information.

Public support test. An organization

must receive either:

1. At least one-third of its total support

from governmental agencies, contributions

from the general public, and contributions

or grants from other public charities; or

2. At least 10% of its total support

from governmental agencies, contributions

from the general public, and contributions

or grants from other public charities; and

also satisfy a facts and circumstances

test.

Facts and circumstances test. Facts

and circumstances include:

1. The amount of support you

received from the general public,

governmental units, or public charities;

2. Whether you have a continuous

and bona fide program for solicitation of

funds from the general public,

governmental units, or public charities, or

carry on activities designed to attract

support from organizations or other

governmental units, and

3. All other facts and circumstances,

including the public nature of your

governing board, the extent to which your

facilities or programs are publicly

available, the extent to which nature your

dues encourage membership, and

whether your activities are likely to appeal

to persons having a broad common

interest or purpose. For additional

information about the 10% facts and

circumstances test, see Pub. 557 and

Reg. 1.170A-9(f)(3).

509(a)(2). Select this classification if you

normally receive more than one-third of

your support from contributions,

membership fees, and gross receipts

from activities related to your exempt

functions, or a combination of these

sources, and not more than one-third of

your support from gross investment

income and net unrelated business

income. Typically, you would show a

substantial part of your income on Part

VI-A. Statement of Revenues and

Expenses, lines 1, 2, and 9.

Under this public charity

classification, you must meet both the

“one-third public support test ” and the

“not-more-than-one-third investment

income and net unrelated business

income test,” lines 1 through 13. See Pub.

557 for additional information about these

tests.

509(a)(1) and 170(b)(1)(A)(i). Select

this classification if your primary purpose

is operating a church or convention or

association of churches. The term

“church” includes mosques, temples,

synagogues, etc. If you select this box,

complete Schedule A.

509(a)(1) and 170(b)(1)(A)(ii). Select

this classification if your primary purpose

is operating a school. If you select this

box, complete Schedule B.

If you operate a school but it isn’t your

primary purpose, don’t select this

classification. However, you must still

complete Schedule B. See Part IV, line 12.

509(a)(1) and 170(b)(1)(A)(iii). Select

this classification if your primary purpose

is providing medical or hospital care or

medical eduction or research (performed

in association with a hospital). If you select

this box, complete Schedule C.

A hospital includes a rehabilitation

institute, outpatient clinic, community

mental health clinic, drug treatment center,

or skilled nursing facility. A hospital doesn’t

include convalescent homes, homes for

children or the aged, or institutions whose

principal purpose or function is to train

handicapped individuals to pursue some

vocation.

Cooperative hospital service

organizations described in section

501(e) should also check this box and

complete Schedule C.

509(a)(1) and 170(b)(1)(A)(iv). Select

this classification if you’re organized and

operated exclusively to benefit a college or

university owned or operated by a

governmental unit. You must also normally

receive a substantial part of your support

from a governmental unit or from

contributions from the general public.

509(a)(1) and 170(b)(1)(A)(ix). Select

this classification if you’re an agricultural

research organization described in section

170(b)(1)(A)(ix) operated in conjunction

with a land grant college or university or a

non-land grant college of agriculture.

In Part IV, line 1, include information

detailing your agricultural research

program and how you will spend

contributions to your program, including a

description of how you’re engaged in the

continuous active conduct of agricultural

research (as defined in Section 1404 of

the Agricultural Research, Extension, and

Teaching Policy Act of 1977), information

showing that you’re operated in

conjunction with a land grant college or

university or a non-land grant college of

agriculture (as defined in Section 1404 of

the Agricultural Research, Extension, and

Teaching Policy Act of 1977), and

information discussing the timing of when

you will spend contributions for research.

509(a)(3). Select this classification if

you’re organized and operated to support

one or more public charities described in

section 509(a)(1) or 509(a)(2) or an

organization that is tax exempt under

section 501(c)(4), (5), or (6) and meets the

public support test of section 509(a)(2).

See the instructions for Schedule D for

more information about the requirements

for this classification, including the

required relationship you must have with

your supported organization(s). Complete

Schedule D.

509(a)(4). Select this classification if your

primary purpose is to test products to

determine their acceptability for use by the

general public.

Contributions to organizations of this

type aren’t deductible under section

170(c). Also, organizations that primarily

test for specific manufacturers don’t

qualify for exemption under section 501(c)

(3).

Select my classification for me. Select

this option if you believe you’re a public

charity but would like the IRS to select the

correct public charity classification (509(a)

Instructions for Form 1023

(1) and 170(b)(1)(A)(vi) or 509(a)(2)) for

you.

Private foundation. Select this

classification if you don’t meet one of the

exceptions listed above.

Line 1a. Section 508(e) provides that a

private foundation isn’t tax exempt unless

its organizing document contains

specific provisions. These specific

provisions require that you operate to

avoid liability for excise taxes under

sections 4941(d), 4942, 4943(c), 4944,

and 4945(d). You can also meet these

provisions by reliance on state law.

See Pub. 557 for samples of provisions

that will meet section 508(e). Also, see

Appendix B for a list of states that have

enacted statutory provisions that satisfy

the requirement of section 508(e), subject

to notations. Appendix B is based on Rev.

Rul. 75-38, 1975-1 C.B. 161.

Line 1c. Some private foundations are

private operating foundations. Private

operating foundations make qualifying

distributions directly for the active conduct

of their educational, charitable, and

religious purposes. “Directly for the active

conduct” means that you use the

distributions yourself to carry out the

programs for which you’re organized and

operated. Grants made to assist other

organizations or individuals are normally

considered indirect.

Line 1d. If you have existed for 1 year or

more, you must provide information that

demonstrates you meet the requirements

to be classified as a private operating

foundation, including the income test and

either the endowment test, the assets test,

or the support test. If you have existed for

less than 1 year, you must sufficiently

describe how you’re likely to meet these

requirements and tests. You may also

submit an affidavit or opinion of counsel

giving enough facts about your operations

and support to enable us to determine that

you’re likely to meet these requirements.

See Pub. 557 for additional information

about private operating foundations.

Line 2. Confirmation of public support

status. If you have been in existence for

more than 5 years, and you requested

classification as a public charity described

in sections 509(a)(1) and 170(b)(1)(A)(vi),

you must confirm that you meet the public

support test.

To show that you meet the required

public charity support test, complete lines

2(i) and 2(ii). Calculate your public support

based on the accounting method you used

to complete Part VI-A, Statement of

Revenues and Expenses.

Line 2(i). 509(a)(1) and 170(b)(1)(A)

(vi). Check “Yes,” if you received

contributions from any person, company,

or organization (other than a governmental

Instructions for Form 1023

unit described in section 170(c)(1) or a

publicly supported organization under

section 170(b)(1)(A)(vi)), whose gifts

totaled more than 2% of the amount on the

total of amounts entered on line 8 of Part

VI-A, Statement of Revenue and

Expenses, and identify those contributors

by letter (A, B, C, etc.) and list the

amount(s) contributed by each. Keep, but

don’t submit, a list of the names of your

donors with the associated letter

designations.

Line 2(ii). Use Schedule A (Form 990 or

990-EZ) Public Charity Status and Public

Support, Part II, Support Schedule for

Organizations Described in Sections

170(b)(1)(A)(iv) and 170(b)(1)(A)(vi), and

its instructions to determine if you met the

public support test for your most recent

5-year period.

Line 2a(i). 509(a)(2). Check “Yes,” if you

received amounts listed on lines 1, 2, and

9 of Part VI-A, Statement of Revenue and

Expenses, from any disqualified

persons and identify those disqualified

persons by letter (A, B, C, etc.) and list the

amounts contributed by each. Keep, but

don’t submit, a list of the names of your

donors with the associated letter

designations.

Line 2a(ii). Check “Yes,” if you received

amounts paid by an individual or

organization greater than the larger of 1%

of line 10, of Part VI-A, Statement of

Revenues and Expenses, or $5,000 for

any completed tax year, and identify those

individuals or organizations by letter and

list the amount(s) received from each.

Keep, but don’t submit, a list of the names

of your donors with the associated letter

designations.

Don’t include disqualified persons

in this list. Disqualified persons

CAUTION should be listed in line 2(a)(i). For

purposes of this application, a

“disqualified person” is any individual or

organization that is any of the following.

1. A “substantial contributor” to you

(defined below).

2. An officer, director, trustee, or any

other individual who has similar powers or

responsibilities.

3. An individual who owns more than

20% of the total combined voting power of

a corporation that is a substantial

contributor.

4. An individual who owns more than

20% of the profits interest of a partnership

that is a substantial contributor.

5. An individual who owns more than

20% of the beneficiary interest of a trust or

estate that is a substantial contributor.

6. A member of the family of any

individual described in 1, 2, 3, 4, or 5

above.

7. A corporation in which any

individuals described 1, 2, 3, 4, 5, or 6

above hold more than 35% of the total

combined voting power.

8. A trust or estate in which any

individuals described in 1, 2, 3, 4, 5, or 6

above hold more than 35% of the

beneficial interests.

9. A partnership in which any

individuals described in 1, 2, 3, 4, 5, or 6

above hold more than 35% of the profits

interest.

Substantial contributor. A substantial

contributor is any individual or

organization that gave more than $5,000

to you from the date you were formed or

other date that your exemption would be

effective, to the end of the year in which

the contributions were received. This total

amount contributed must also be more

than 2% of all the contributions you

received. A creator of a trust is treated as

a substantial contributor regardless of the

amount contributed. For more information

regarding substantial contributors, go to

IRS.gov/Charities-Non-Profits/PrivateFoundations/Substantial-ContributorPrivate-Foundation.

Family members. A “member of the

family” includes the spouse, ancestors,

children, grandchildren,

great-grandchildren, and their spouses.

For additional information concerning

members of the family, go to IRS.gov/

Charities-Non-Profits/CharitableOrganizations/Member-of-the-Family.

Further information about disqualified

persons, can be obtained at IRS.gov/

Charities-Non-Profits/IRC-Setion-4946Definition-of-Disqualified-Person.

Line 2a(iii). Use Schedule A (Form 990

or 990-EZ), Public Charity Status and

Public Support, Part III, Support Schedule

for Organizations Described in Section

509(a)(2), and its instructions to determine

if you meet the public support test for your

most recent 5-year period.

Part VIII. Effective Date

Line 1. Use the formation date you listed

in Part II, line 2, and the date you will

submit this electronic form and required

user fee payment to determine whether

you’re submitting this application within 27

months from the month in which you were

formed. If you’re not submitting this

application within 27 months from your

formation, complete Schedule E.

Part IX. Annual Filing

Requirement

Most organizations must file an annual

return (Form 990, 990-EZ, or Form

990-PF) or notice (Form 990-N, Electronic

Notice (e-Postcard)). Exceptions to this

rule include churches, certain church

affiliated organizations, and certain

affiliates of a governmental unit. You can

find more detailed information about filing

requirements and exceptions from the

requirement to file in the Instructions for

Form 990.

The following are some general rules.

• A private foundation must file Form

990-PF annually, regardless of its gross

receipts.

• Unless specifically required to file Form

990 or Form 990-EZ (see the Instructions

for Form 990), most public charities that

normally have gross receipts of $50,000 or

less may satisfy their filing obligation with

Form 990-N, Electronic Notice

(e-Postcard).

If you fail to file a required

information return or notice for 3

CAUTION consecutive years, your exempt

status will be automatically revoked.

Line 1. Check “Yes,” if you’re claiming you

are excepted from filing a Form 990-series

return or notice and indicate the reason

you believe you’re excepted from filing.

See Pub. 557 and the Instructions for

Form 8940, Request for Miscellaneous

Determination, for more information on the

requirements for the various filing

exceptions. Provide information regarding

how you meet your requested exception in

your narrative description of activities or as

part of an uploaded supplemental

response.

Part X. Signature

Signature requirements. An officer,

director, trustee, or other official who is

authorized to sign for the organization

must sign Form 1023. The signature must

be accompanied by the title or authority of

the signer and the date.

The person signing Form 1023

TIP must be listed as an officer,

director, or trustee within the first

five entries of Part I, line 9.

Upload Checklist

Documents to upload. Check the boxes

to indicate which documents are included

in the file you upload with your application.

You must upload a copy of your

organizing document and any

amendments to it along with a copy of

your bylaws, if adopted. The other listed

documents are not required.

Put your name and EIN on each page

of your supplemental response and

identify the part and line number to which

the information relates.

Pay.gov can accommodate only one

uploaded file. Consolidate your

attachments into a single PDF file, which

cannot exceed 15MB.

If your PDF file exceeds the 15MB limit,

remove any items over the limit and

contact IRS Customer Accounts Services

at 877-829-5500 for assistance on how to

submit the removed items.

Schedule A. Churches

There is no single definition of the word

“church” for tax purposes. When

determining whether a section 501(c)(3)

religious organization is described as a

church (described in section 509(a)(1) and

170(b)(1)(A)(i)), we will consider

characteristics generally attributed to

churches and the facts and circumstances

of each organization applying for public

charity classification as a “church.”

The characteristics generally attributed

to churches are:

• A distinct legal existence,

• A recognized creed and form of

worship,

• A definite and distinct ecclesiastical

government,

• A formal code of doctrine and

discipline,

• A distinct religious history,

• A membership not associated with any

other church or denomination,

• Ordained ministers ministering to the

congregation,

• Ordained ministers selected after

completing prescribed courses of study,

• A literature of its own,

• Established places of worship,

• Regular congregations,

• Regular religious services,

• Sunday schools for the religious

instruction of the young, and

• Schools for the preparation of ministers.

Although you don’t need to meet each

of the above criteria to be classified as a

church, you’re generally required to have a

congregation or other religious

membership group. For purposes of

foundation classification under section

509(a)(1) and 170(b)(1)(A)(i), the term

“church” includes, without limitation,

mosques, temples, and synagogues, and

certain other forms of religious

organizations. For more information, see

Pub. 1828.

The practices and rituals associated

with your religious beliefs or creed must

not be illegal or contrary to public policy.

Specific Line Items

Line 1. Describe your written creed,

statement of faith, or summary of beliefs.

Line 2. Your literature includes any

writings about your beliefs, rules, or

history.

Line 3. A “code of doctrine and discipline”

refers to a body of laws or rules that

govern behavior.

Line 4. A “religious hierarchy or

ecclesiastical government” refers to

people or institutions that exercise

significant influence or authority over your

church.

Line 5. Answer “Yes,” if you’re part of a

group of churches with similar beliefs and

structures, such as a convention,

association, or union of churches.

Line 6. A “form of worship” refers to

religious practices that express your

devotion to your creed, faith, or beliefs.

Line 7. Indicate the regular days and

times of your religious services. Describe

the order of events during your regular

worship service and explain how the

activities conducted as part of your

services further your religious purposes.

Line 7a. Enter the average number of

members and non-members who attend

your regularly scheduled religious

services.

Line 8. An “established place of worship”

is a place where you hold regularly

scheduled religious services. It may be a

place that you own, rent, or that is

provided free for your use.

Line 9. An “established congregation” or

“other religious membership group”

includes individuals who regularly attend

and take part in the religious services of

your organization at an established

location. An established congregation

generally doesn’t include members of only

one family. If you answer “No,” because

you don’t have an established

congregation or other religious

membership, you may be a religious

organization that doesn’t qualify as a

church. If you don’t qualify as a church,

you will need to go back to Part VII, line 1,

to reconsider your public charity

classification.

You may request classification as

TIP a church at a later date after you

establish a congregation or other

religious membership group. For

information about this option, see Form

8940, Request for Miscellaneous

Determination Under Section 507, 509(a),

4940, 4942, 4945, and 6033 of the Internal

Revenue Code, or contact our customer

account service representatives at

877-829-5500 (toll-free).

Line 9a. Enter the total number of your

current members. If you have no

members, enter zero (0).

Line 9b. Answer “Yes,” if you have a

prescribed way to become a member.

Answer “Yes,” even if you just keep records

of who is currently a member. Describe

Instructions for Form 1023

any actions required for individuals to

become members.

Line 9c. Describe any rights and benefits

of members. You should include details of

any levels of membership and the rights

and/or benefits associated with each level.

Line 9d. If your members may be

associated with another denomination or

church, describe the circumstances in

which your members would be members

of your church and another church.

Line 9e. See Appendix C for a

description of the word “family.”

Line 10. Answer “Yes,” if you conduct

baptisms, weddings, funerals, or other

religious rites.

Line 11. A school for the religious

instruction of the young refers to any

regularly scheduled religious, educational

activities for youth.

Line 12. A “prescribed course of study”

refers to formal or informal training. It

doesn’t include self-ordination or paying a

fee for an ordination certificate without

completing a course of study. Describe the

course of study completed by your

religious leaders.

Line 15. Provide any additional

information you would like us to consider

that would help us classify you as a

church.

Schedule B. Schools,

Colleges, and Universities

An organization qualifies as a school (for

purposes of classification under sections

509(a)(1) and 170(b)(1)(A)(ii)) if all the

following applies. It:

• Presents formal instruction as its

primary function,

• Has a regularly scheduled curriculum,

• Has a regular faculty of qualified

teachers,

• Has a regularly enrolled student body,

and

• Has a place where educational

activities are regularly carried on.

The term “school” includes primary,

secondary, preparatory, high schools,

colleges, and universities. An organization

won’t be described as a school under

sections 509(a)(1) and 170(b)(1)(A)(ii) if it

engages in both educational and

non-educational activities, unless the latter

are merely incidental to the educational

activities. Non-traditional schools such as

an outdoor survival school or a yoga

school may qualify. However, an

organization may further an educational

purpose without satisfying all the

conditions listed above that describe a

school. Such organizations may qualify as

public charities based upon their sources

of support as organizations described in

sections 509(a)(1) and 170(B)(1)(A)(vi) or

section 509(a)(2).

Specific Line Items

Line 1. Answer “Yes,” if you have a

regularly scheduled curriculum, a regular

faculty of qualified teachers, a regularly

enrolled student body, and facilities where

your educational activities are regularly

carried on.

If you answer “Yes,” you should

TIP maintain in your records evidence

as:

that you meet these factors, such

• A list of required courses of study, dates

and times courses are offered, and other

information about how to complete

required courses;

• Certification by the appropriate state

authority or successful completion of

required training for qualified teachers;

• Records of regular attendance by

students at your facility; and

• A lease agreement or deed for your

facility.

If you answer “No,” you may not meet

the requirements of a school and you may

need to go back to Part VII, line 1, to

reconsider your foundation classification if

you requested classification as a school

under sections 509(a)(1) and 170(b)(1)(A)

(ii).

Line 2. Answer “Yes,” if your primary

function of the school is the presentation

of formal instruction. If you answer “No,”

you may not meet the requirements for

classification as a school and may want to

go back to Part VII, line 1, to reconsider

your foundation classification if you

requested classification as a school under

sections 509(a)(1) and 170(b)(1)(A)(ii).

Line 3. Answer “Yes,” if you’re a public

school and explain how you’re operated by

the state or a subdivision of a state,

including if you have a signed contract or

agreement with a state or local

government under which you operate and

receive funding. If you answer “Yes,” don’t

complete the remainder of Schedule B.

Line 4. Answer “Yes,” if you were formed

or substantially expanded when public

schools in your district or county were

desegregated by court order.

If you're unsure whether to answer

“Yes,” contact an appropriate

CAUTION school official.

Line 5. Answer “Yes,” if a state or federal

administrative agency or judicial body ever

determined your organization to be racially

discriminatory. Identify the parties involved

and the forum in which the case was

presented. Explain the reason for the

action, the decision reached, and provide

legal citations (if any) for the decision.

Also, explain in detail any changes made

in response to the action against your

organization or the decision reached.

Establishment of Racially

Nondiscriminatory Policy

Every private school is subject to the

provisions of Revenue Procedure 75-50,

1975-2 C.B. 587, modified by Rev. Proc.

2019-22, 2019-22 I.R.B. 1260. See Pub.

557, which sets forth the requirements of

Rev. Proc. 75-50 under the section for

Private Schools.

Publication of racially nondiscriminatory policy. A section 501(c)(3)

organization that is a private school must

publish a notice of its racially

nondiscriminatory policy as to students as

follows.

The M school admits students

of any race, color, national

origin, and ethnic origin to all the

rights, privileges, programs, and

activities generally accorded or

made available to students at

the school. It doesn't

discriminate on the basis of

race, color, national origin, and

ethnic origin in administration of

its educational policies,

admission policies, scholarship

and loan programs, and athletic

and other school-administered

programs.

Annual certification. A private school

must certify annually that it meets the

requirements of Rev. Proc. 75-50, as

modified by Rev. Proc. 2019-22, by filing

Schedule A (Form 990, or Form 990-EZ)

Organization Exempt Under Section

501(c)(3).

Schools that don’t file Form 990 or

990-EZ must make the certification by

filing Form 5578, Annual Certification of

Racial Nondiscrimination for a Private

School Exempt From Federal Income Tax.

Line 7. Answer “Yes,” if your organizing

document or bylaws contain a

nondiscriminatory statement as to

students similar to the one shown above

or if you adopted such a policy by

resolution of your governing body. State

where your policy is located in your

organizing document, bylaws, or if it is in

an adopted resolution. If you answered

“No,” you must adopt a nondiscriminatory

policy before submitting this application.

Line 8. Answer “Yes,” if your brochures,

application forms, advertisements, and

catalogues dealing with student

admissions, programs, and scholarships

contain a statement similar to the

following:

The M school admits students of any

race, color, and national or ethnic

origin.

Line 8a. If you answered “No” to Line 8,

check the box on line 8a if you agree that

all future printed materials, including

website content, will contain a statement

of nondiscriminatory policy as to students

similar to the one provided above.

Line 9. You must make your

nondiscriminatory policy known to all

segments of the general community

served by the school. One way to meet

this requirement is to publish your

nondiscriminatory policy annually in a

newspaper or over broadcast media. Rev.

Proc. 2019-22 now allows this publication

requirement to be satisfied by

continuously displaying your

nondiscrimination statement on your

Internet site, as described below.

Check “Yes,” if you make your racially

nondiscriminatory policy known to all

segments of the general community you

serve by:

• Publishing a notice of your policy in a

newspaper of general circulation that

serves all racial segments of the

community;

• publicizing your policy over broadcast

media in a way that is reasonably

expected to be effective; or

• display a notice of your policy at all

times on your primary, publicly accessible

Internet home page in a manner

reasonably expected to be noticed by

visitors to the home page.

See Rev. Proc. 75-50, as modified by

Rev. Proc. 2019-22, for guidance on the

format and content of the required notice

and whether any exceptions may apply to

you.

A notice published in the legal

TIP notices section or classified

advertisements of your local

newspaper generally is not acceptable.

Line 9a. If you answered “No,” to line 9,

check the box on line 9a if you agree that

you will publicize your nondiscriminatory

policy in a way that meets the

requirements of Revenue Procedure 75–

50, as modified by Revenue Procedure

2019-22.

Line 11. Enter the racial composition of

your student body, faculty, and

administrative staff in the spaces provided.

Enter actual numbers, rather than

percentages, for the current year and

projected numbers for the next academic

year. If the number is zero, then enter “0.”

If you’re not operational, submit an

estimate based on the best information

available (such as the racial composition

of the community you serve).

Don’t identify students, faculty,

and staff by name.

CAUTION

Line 12. Enter the racial composition of

students to whom you award loans and

scholarships in the spaces provided. Enter

actual numbers, rather than percentages,

for the current year and projected numbers

for the next academic year. If the number

is zero, then enter “0.” If you won’t provide

any loans or scholarships, check the box

provided.

Don’t identify students by name.

CAUTION

If you complete line 12 indicating

TIP you do or will provide loans or

scholarships, be sure your

response to Part IV, line 15 is consistent

with your response here.

Line 13. Identify each of your

incorporators, founders, board members,

donors of land, and donors of buildings by

name (whether individuals or

organizations).

Line 14. Answer “Yes,” if any individuals

or organizations on your list have an

objective to keep public or private school

education segregated by race and explain

how these individuals or organizations

promote segregation in public or private

schools.

Line 15. Answer “Yes,” if on a continuing

basis, you will maintain for a minimum

period of 3 years the following records.

• Your racial composition (similar to the

information requested on Schedule B,

line 11).

• Evidence that your scholarships and

loans are awarded on a racially

nondiscriminatory basis (similar to the

information requested on Schedule B,

line 12).

• Copies of all materials used by you or

on your behalf to solicit contributions.

• Copies of brochures, application forms,

advertisements, and catalogues dealing

with student admissions, programs, and

financial aid.

Answer “No,” if you don’t maintain

records and explain how you meet the

recordkeeping requirements under Rev.

Proc. 75-50.

Failure to maintain these records

or produce them upon the proper

CAUTION request will create a presumption

that you haven’t complied with the

requirements of Rev. Proc. 75-50.

Schedule C. Hospitals and

Medical Research

Organizations

An organization qualifies as a hospital for

purposes of classification under sections

509(a)(1) and 170(b)(1)(iii) if it is a:

• Hospital,

• Medical research organization

operated in conjunction with a hospital, or

• Cooperative hospital service

organization.

Hospital. An organization is a

“hospital” if its principal purpose or

function is providing medical or hospital

care or medical education or research.

Medical care includes treatment of any

physical or mental disability or condition,

on an inpatient or outpatient basis. Thus, if

an organization is a rehabilitation

institution, outpatient clinic, or community

mental health or drug treatment center, it

is a hospital if its principal function is

providing treatment services, as described

above.

A hospital doesn't include convalescent

homes, homes for children or the aged, or

institutions whose principal purposes or

function is to train handicapped individuals

to pursue a vocation.

Medical research organization. An

organization is a “medical research

organization” if its principal purpose or

function is the direct, continuous, and

active conduct of medical research in

conjunction with a hospital. The hospital

with which the organization is affiliated

must be described in section 501(c)(3), a

federal hospital, or an instrumentality of a

governmental unit, such as a municipal

hospital.

“Medical research” means

investigations, experiments, and studies to

discover, develop, or verify knowledge

relating to the causes, diagnosis,

treatment, prevention, or control of human

physical or mental diseases and

impairments. For more information, see

Regulations section 1.170A-9(c)(2).

Cooperative hospital service

organization. A cooperative hospital

service organization performs one or more

of the specific services listed below for

one or more exempt hospitals on a

cooperative basis. The services listed

below are exclusive. A cooperative service

organization that provides services other

than those listed below, or that provides

services to an organization other than an

exempt hospital, doesn’t qualify for

exemption under section 501(c)(3). The

list of services includes:

1. Data processing;

2. Purchasing (including the

purchasing of insurance on a group basis);

3. Warehousing;

4. Billing and collection (including the

purchasing of patron accounts receivable

on a recourse basis);

5. Food;

6. Clinical;

7. Industrial engineering;

8. Laboratory;

9. Printing;

10. Communications;

11. Record center; and

12. Personnel services (including

selection testing, training, and education

of personnel).

Specific Line Items

Line 1. Answer “Yes,” if your organization

is a medical research organization, as

described above.

Line 1a. As a medical research

organization, you must be associated with

a hospital described in section 501(c)(3),

a federal hospital, or an instrumentality of

a government. Provide the name of the

hospital(s) you’re associated with and

describe the relationship(s).

Line 1b. List your assets and their fair

market value and the portion of your

assets directly devoted to medical

research. Don’t complete the remainder of

Schedule C.

Line 2. Answer “Yes,” if you’re a

cooperative hospital service organization

and describe the services you provide to

your member hospitals and the exempt

status of your membership. Don’t

complete the remainder of Schedule C.

Line 3. Answer “Yes,” if all the doctors in

your community are eligible for staff

privileges at your facility. You must answer

“Yes,” even if staff privileges at your

facilities are limited by capacity, provided

that all qualified medical professionals in

your community may seek and would be

considered for eligibility.

Answer “No,” if all doctors in your

community aren’t eligible for staff

privileges at your facility.

If you answer “No,” describe in detail

how you limit eligibility for staff privileges

at your facility. Include details of your

eligibility criteria and selection procedures

for your courtesy staff of doctors.

Line 4. Answer “Yes,” if you admit all

patients in your community who can pay

for themselves or through some form of

third-party reimbursement (for example,

private health insurance, Medicare, or

Medicaid).

Answer “No,” if you limit admission for

these individuals in any way and describe

your admission policy in detail, including

Instructions for Form 1023

how and why you restrict patient

admission.

Line 5. Answer “Yes,” if you offer

emergency medical or hospital care at

your facility on a 24-hour basis, seven

days a week.

Line 5a. Answer “Yes,” if the reason you

don’t maintain a full-time emergency room

is either because you’re a specialty

hospital where emergency care would be

inappropriate for the services you provide

or another emergency medical care facility

that provides such services is located so

near to you as to make such services as

you might provide duplicative.

Line 6. Answer “Yes,” if you provide free

or low-cost medical or hospital care

services. If you answer “Yes,” describe

your policy and to whom you provide these

services. Include details on how these

services promote benefits to the

community. For example, you may want

to indicate how you determine who is

eligible for the services, how you inform

the general public about your policy, any

requirements you require of patients to

receive reduced cost or free care, and any

agreements you might have with

municipalities or government agencies to

subsidize the cost of admitting or treating

patients through this policy.

Line 7. Answer “Yes,” if you have a formal

program of medical training and research.

If you answer “Yes,” describe your

program, including the programs you offer,

the scope of such programs, and affiliation

with other hospitals or medical care

providers with which you carry on the

medical training or research programs.

Line 8. Answer “Yes,” if you have a formal

program of community educational

programs and describe your programs,

including the types of programs offered,

the scope of the programs, and affiliation

with other hospitals or medical care

providers with whom you offer community

educational programs.

Line 9. Answer “Yes,”if you have a board

of directors that is representative of the

community you serve or if an

organization described under section

501(c)(3) with a community board

exercises rights or powers over you.

Answer “Yes,”if you’re subject to a state

corporate practice of medicine law that

requires your governing board to be

composed solely of physicians licensed to

practice medicine in the state.

Line 9a. List each board member by

name and describe that person’s

relationship to you. Also, for each board

member, describe if and how that

individual represents the community.

Generally, hospital employees and staff

physicians aren’t individuals considered to

be community representatives. If you

operate under a parent organization

whose board of directors isn’t comprised

of a majority of individuals who are

representative of the community you

serve, provide the requested information

for your parent organization's board of

directors as well.

Line 10. Section 501(r). Answer “Yes,” if

you operate a facility that is required by a

state to be licensed, registered, or

similarly recognized as a hospital.

Organizations that respond “Yes,” to this

question are required to meet additional

requirements described in section 501(r)

to be considered a hospital exempt from

taxation by section 501(c).

Line 10a. A community health needs

assessment (CHNA) is an assessment of

the significant health needs of the

community. To meet the requirements of

section 501(r)(3), a CHNA must take into

account input from persons who represent

the broad interests of the community

served by the hospital facility, including

those with special knowledge of or

expertise in public health, and must be

made widely available to the public. Each

hospital facility must conduct a CHNA at

least once every 3 years and adopt an

implementation strategy to meet the

community health need identified through

such CHNA.

Answer “Yes,” if the hospital facility

conducted a complying CHNA in the

current tax year or in either of the 2

immediately preceding tax years or if the

hospital facility intends to conduct a CHNA

before the end of its first 3-year period.

Line 10b. A financial assistance policy

(FAP), sometimes referred to as a charity

care policy, is a policy describing how an

organization will provide financial

assistance at its hospital(s) and other

facilities, if any. Financial assistance

includes free or discounted health

services provided to persons who meet

the organization’s criteria for financial

assistance and are unable to pay for all or

a portion of the services. Financial

assistance doesn’t include:

• Bad debt or uncollectible charges that

the organization recorded as revenue but

wrote off due to a patient’s failure to pay or

the cost of providing such care to such

patients;

• The difference between the cost of care

provided under Medicaid or other

means-tested government programs or

under Medicare and the revenue derived

therefrom;

• Self-pay or prompt pay discounts; or

• Contractual adjustments with any

third-party payors.

Answer “Yes,” if the hospital facility has

adopted a written financial assistance

policy and a written policy relating to

emergency medical care as required by

section 501(r)(4).

Line 10c. Under section 501(r)(5), the

maximum amounts that can be charged to

FAP-eligible individuals for emergency or

other medically necessary care are the

amounts generally billed to individuals

who have insurance covering such care.

Answer “Yes,” if the hospital facility:

1. Limits or will limit any charges to

FAP-eligible individuals to whom the

hospital facility provided emergency or

other medically necessary services to not

more than the amounts generally billed to

individuals who had insurance covering

such care; and

2. Prohibits, or upon beginning

operations will prohibit, the use of gross

charges as described in section 501(r)(5).

The hospital facility may check “Yes,” if

it charged more than the amounts

generally billed to individuals who had

insurance covering such care to an

individual if:

• The charge in excess of the amounts

generally billed (AGB) wasn’t made or

requested as a pre-condition of providing

medically necessary care to the

FAP-eligible individual;

• As of the time of the charge, the

FAP-eligible individual hadn’t submitted a

complete FAP application and hadn’t

otherwise been determined by the hospital

facility to be FAP eligible for the care; and,

• If the individual subsequently submits a

complete FAP application and is

determined to be FAP-eligible for care, the

hospital facility refunds any amount that

exceeds the amount they are determined

to be personally responsible for paying as

a FAP-eligible individual, unless such

excess amount is less than $5.

Line 10d. Answer “Yes,” if the hospital

facility has, or will have at the beginning of

operation, either a separate written billing

and collections policy, or include in a

written FAP:

• A description of any actions that the

hospital facility (or other authorized party)

may take related to obtaining payment of a

bill for medical care, including, but not

limited to, any extraordinary collection

actions (ECAs);

• The process and time frames the

hospital facility (or other authorized party)

uses in taking those actions (including, but

not limited to, the reasonable efforts it will

make to determine whether an individual

is FAP-eligible before engaging in ECAs);

and

• The office, department, committee, or

other body with the final authority or

responsibility for determining that the

hospital facility has made reasonable

efforts to determine whether an individual

is FAP-eligible and may therefore engage

in ECAs against the individual.

Schedule D. Section

509(a)(3) Supporting

Organizations

Supporting organizations are described

in section 509(a)(3). The term “supported

organization” refers to an organization that

a supporting organization benefits. A

supporting organization may support more

than one supported organization.

An organization qualifies as a

supporting organization (for purposes of

classification under section 509(a)(3)) if:

• It is organized and at all times thereafter

is operated exclusively for the benefit of, to

perform the function of, or to carry out the

purposes of one or more public charities

described in section 509(a)(1) or 509(a)

(2);

• It meets one of three required

relationship tests (Type I, Type II, or Type

III) with the supported organization(s); and

• It isn’t controlled by “disqualified

persons,” directly or indirectly. See

Appendix C for a definition of a

“disqualified person.”

A supporting organization can also

support the charitable purposes of

organizations that are exempt under

sections 501(c)(4), (5), or (6).

Specific Line Items

Line 1. List the name, address, and EIN

of each organization you support.

Line 2. Answer “Yes,” if each supported

organization has a letter from the IRS

recognizing it as a public charity under

section 509(a)(1) or 509(a)(2).

Before you file your application,

TIP use Tax Exempt Organization

Search on IRS.gov to confirm

whether each of your supported

organizations is currently recognized as

exempt and is classified as a public

charity.

Line 2a. Answer “Yes,” if any supported

organization you listed on line 1 received a

letter from the IRS stating that it’s exempt

under sections 501(c)(4), (5), or (6) and

meets the public support test under

section 509(a)(2). See Pub. 557 for

information on the public support test for

section 509(a)(2).

If you answer “No,” describe how each

organization you support is a public charity

under section 509(a)(1) or 509(a)(2). For

example, if you support a church or foreign

organization that hasn’t received a

determination letter recognizing it as a

public charity, you should describe how

this organization qualifies as a public

charity under section 509(a)(1) or 509(a)

(2). See Pub. 557 for information on public

charities under sections 509(a)(1) and

509(a)(2).

Line 3. Relationship test. To qualify

under section 509(a)(3), you must show

that you meet one of three relationship

tests with your supported organization(s).

Select the option that best describes your

relationship with your supported

organization(s).

• Type I (“operated, supervised, or

controlled by” relationship; comparable

to a parent–subsidiary relationship): A

majority of your governing board or

officers are elected or appointed by the

governing body, members of the governing

body, officers acting in their official

capacity, or the membership of your

supported organization(s).

• Type II (“supervised or controlled in

connection with” relationship;

comparable to a brother–sister

relationship): Your control or management

is vested in the same persons who control

or manage your supported

organization(s).

• Type III (“operated in connection

with” relationship; responsive to the

needs or demands of, and having

significant involvement in the affairs of, the

supported organization(s)):

(a) One or more of your officers, directors,

or trustees are elected or appointed by the

officers, directors, trustees, or

membership of your supported

organization(s);

(b) One or more of your officers, directors,

trustees, or other important office holders

are also members of the governing body

of your supported organization(s); or

maintain a close and continuous working

relationship with the officers, directors, or

trustees of your supported organization(s).

If you don't meet one of these

TIP three relationship tests, you aren't

described in section 509(a)(3) and

should review the other foundation

classification options in Part VII, line 1.

Line 4. Describe how your governing

board and officers are selected, including

where (if applicable) this information is in

your governing document, bylaws, or other

internal rules and regulations.

If applicable, for Type III organizations

describe how your officers, directors, or

trustees maintain a close and continuing

relationship with the officers, directors, or

trustees of your supported organization(s).

Line 5. Prohibited control by disqualified person. You can’t be described in

section 509(a)(3) if you’re directly or

indirectly controlled by disqualified

persons. You are controlled if disqualified

persons:

• Can exercise 50% or more of the total

voting power of your governing body;

• Have authority to affect significant

decisions, such as power over your

investment decisions, or power over your

charitable disbursement decisions; or

• Can exercise veto power over your

actions.

Although control is generally

demonstrated where disqualified persons

have the authority over your governing

body to require you to take an action or

refrain from taking an action, indirect

control by disqualified persons will also

disqualify you as a supporting

organization.

See Appendix C for a description of the

terms “disqualified person,” “family,”

“foundation manager,” and “business

relationship.”

Public charities and foundation

TIP managers who otherwise are

disqualified persons only because

they are foundation managers aren't

disqualified persons for this purpose.

Line 7. Organizational test. If you

answered “No,” and you are a Type III

supporting organization, you must amend

your organizing document to specify

your supported organization(s) by name;

or you won’t meet the organizational test

under section 509(a)(3) and need to

reconsider your requested public charity

classification in Part VII, line 1.

Line 7a. If you answered “No,” you won’t

meet the organizational test under section

509(a)(3) unless you amend your

organizing document to specify your

supported organization(s) by name, class,

or purpose and need to reconsider your

requested public charity classification in

Part VII, line 1.

Line 8. When responding to this question,

don’t include donors that are section

509(a)(1), (2), or (4) organizations.

This prohibition on contributions

TIP from controlling donors only

applies to Type I and Type III

supporting organizations.

Line 9. Type III responsiveness test.

Answer “Yes,” if, because of your

relationship described in line 3, each of

your supported organizations has a

significant voice in your investment

policies, making and timing of grants, and

directing the use of your income and

assets, and explain how each of your

supported organizations is involved in

these matters.

Line 10. Type III notification requirement. A Type III supporting organization

must provide the notice described in this

question. If you’re a Type III supporting

organization, you’ll be required to answer

this question annually on your annual

information return (Schedule A of Form

990 or 990-EZ).

Instructions for Form 1023

A Type III supporting organization must

annually provide the following to each of

its supported organizations:

(a) a written notice addressed to a

principal officer of the supported

organization describing the type and

amount of all of the support, including any

amounts counting toward the distribution

requirement you provided to the supported

organization during the immediately

preceding tax year and including a brief

narrative description of the support

provided and sufficient financial detail to

identify the types and amounts of support

being reported,

(b) a copy of your most recently filed Form

990-series return or notice, and

and any amendments, if not previously

provided.

Lines 11–13. Type III integral part test.

An organization seeking classification as a

Type III supporting organization must meet

an integral part test, which is satisfied by

maintaining significant involvement in the

operations of one or more supported

organizations and providing support on

which the supported organization(s) are

dependent. A Type III supporting

organization may be functionally

integrated (lines 11–12) or

non-functionally integrated (lines 13 and

13a-c) depending on the manner in which

it meets the integral part test. Functionally

integrated Type III supporting

organizations are subject to fewer

restrictions and requirements than

nonfunctionally integrated Type III

supporting organizations.

Lines 11–12, Integral part test – Functionally integrated. To be a functionally

integrated supporting organization you

must meet one of the following:

• You are the parent of each of your

supported organization(s) (Line 11);

• You support only governmental

supported organizations (Line 11); or

• Substantially all your activies directly

further the exempt purposes of your

supported organization(s) (Line 12).

Line 11. Answer “Yes” and explain if

you’re the parent of each of your

supported organizations because:

1. You and your supported

organizations are part of an integrated

system (for example, a hospital system);

2. You direct the overall policies,

programs, and activities of each of your

supported organizations (for example,

coordinating the activities of the supported

organizations and engaging in overall

planning, policy development, budgeting,

and resource allocation); and

3. Your governing body, members of

your governing body or your officers

(acting in their official capacities) appoint

or elect directly or indirectly, a majority of

the officers, directors, or trustees of each

of your supported organizations and have

the power to remove and replace such

directors, officers, or trustees, or otherwise

have an ongoing power to appoint or elect

such director, officers or trustees with

reasonable frequency.

For example, N, an organization

described in section 501(c)(3), is the

parent organization of a healthcare system

consisting of two hospitals (Q and R) and

an outpatient clinic (S), each of which is

described in section 509(a)(1), and a

taxable subsidiary (T). N is the sole

member of each of Q, R, and S. Under the

charter and bylaws of each of Q, R, and S,

N appoints all members of the board of

directors of each corporation. N engages

in the overall coordination and supervision

of the healthcare system’s exempt

subsidiary corporations Q, R, and S in

approval of their budgets, strategic

planning, marketing, resource allocation,

securing tax-exempt bond financing, and

community education. N also manages

and invests assets that serve as

endowments of Q, R, and S.

Also answer “Yes” and explain if you

qualify as a functionally integrated

supporting organization because you

support a governmental supported and;

1. You only support one or more

governmental supported organizations;

2. A substantial part of your activities

directly further the exempt purposes of at

least one governmental supported

organization; and

3. If you support more than one

governmental supported organization, all

of the governmental supported

organizations either operate in the same

city, country, or metropolitan area, or they

work in close coordination or collaboration

together to conduct a service, program, or

activity you support.

Line 12. Answer “Yes,” if substantially all

of your activities directly further the

exempt purpose of one or more supported

organizations by performing the functions

of, or carrying out the purposes of, such

supported organization(s), and but for your

involvement, your supported

organization(s) would normally engage in

such activities. Describe the activities that

you conduct.

Holding title to and managing assets

that are used (or held for use) directly in

carrying out the exempt purposes of your

supported organization (exempt-use

assets) are activities that directly further

the exempt purposes of your supported

organization. Conversely, with certain

exceptions, fundraising, making grants

(whether to the supported organization or

to third parties), and investing and

managing non-exempt-use assets aren’t

activities that directly further the exempt

purposes of the supported organization.

See Regulations section 1.509(a)-4(i)(4)

(ii) for more information.

Line 13. Integral part test non-functionally integrated. To satisfy the

integral part test as a nonfunctionally

integrated supporting organization, you

must distribute at least 85% of your annual

net income or 3.5% of the aggregate fair

market value of all of your

non-exempt-use assets (whichever is

greater) to your supported organization(s).

You can use Part V of Schedule A (Form

990 or 990-EZ) to help determine your

answer to this question.

The distributable amount for the

TIP first tax year an organization is

treated as a nonfunctionally

integrated Type III supporting organization

is zero.

For purposes of this line, “net income” has

the same meaning as the term “adjusted

net income.” In general, “adjusted net

income” is the excess of gross income,

including gross income from any unrelated

trade or business, determined with certain

modifications, reduced by total

deductions. Gross income doesn’t include

gifts, grants, or contributions. See

Appendix C.

For purposes of this line,

“non-exempt-use assets” are all assets of

the supporting organization other than:

1. Assets described in Regulations

section 53.4942(a)(2)(c)(2)(i) through (iv),

and

2. Exempt-use assets, which are

assets that are used (or held for use)

directly in carrying out the exempt

purposes of your supported organization.

See Regulations section 1.509(a)-4(i)(8)

for more information.

Line 13a. List the total amount you

distribute(d) annually to each supported

organization. Also, indicate how each

amount will vary from year to year.

Line 13b. List the total annual income for

each supported organization. If you

distribute your income to, or for the use of,

a particular department or program of an

organization, list the annual revenue of the

supported department or program.

Line 13c. Answer “Yes,” if your funds are

“earmarked” for a particular program or

activity conducted by your supported

organization.

Schedule E. Effective Date

The questions in this schedule will help us

determine the effective date of exemption

if you’re either seeking reinstatement after

automatic revocation or you’re filing this

application more than 27 months after the

end of the month in which you were legally

formed.

Specific Line Items

Line 1. Answer “Yes,” if your exempt

status was automatically revoked under

section 6033(j)(1) for failure to file required

annual returns or notices for 3 consecutive

years and you’re applying for

reinstatement.

Rev. Proc. 2014-11, 2014-3 I.R.B. 411,

at IRS.gov/irb/2014-03_IRB establishes

several different procedures for reinstating

an organization’s exempt status

depending upon its size, the number of

times it’s been automatically revoked, and

the timeliness of filing for reinstatement.

Review the revenue procedure to

determine which section applies to you.

Line 1a. Select the section of Rev. Proc.

2014-11 under which you’re applying for

reinstatement.

Section 4. Select this section if:

• You were eligible to file either Form

990-EZ or Form 990-N for each of the 3

consecutive years that you failed to file;

• This is the first time you’ve been

automatically revoked pursuant to section

6033(j)(1); and

• You’re submitting this application no

later than 15 months after the later of the

date of your Revocation Letter or the date

on which the IRS posted your name on the

Auto-Revocation List at

apps.irs.gov/app/eos/.

By selecting this item, you’re also

attesting that your failure to file wasn’t

intentional and you’ve put in place

procedures to file required returns or

notices in the future.

If you were classified as a private

TIP foundation prior to your

automatic revocation, you weren't

eligible to file either Form 990-EZ or Form

990-N and, therefore, aren't eligible to

request reinstatement under Section 4.

If your exempt status was

automatically revoked more than

CAUTION once, you’re not eligible for

reinstatement under Section 4; however,

you may apply for reinstatement under

Section 5, Section 6, or Section 7.

Section 5. Select this section if:

• You’re ineligible to file for reinstatement

under Section 4, and

• You’re submitting this application not

later than 15 months after the later of the

date of your Revocation Letter or the date

on which the IRS posted your name on the

Auto-Revocation List at

apps.irs.gov/app/eos/.

By selecting this item, you’re also

attesting that you filed the required annual

returns, your failure to file was not

intentional, and you have put in place

procedures to file required returns or

notices in the future.

Describe how you exercised ordinary

business care and prudence in

determining and attempting to comply with

your filing requirements in at least 1 of the

3 years of revocation. Include a detailed

explanation of all the facts and

circumstances that led to the failure, the

discovery of the failure, and the steps you

have taken or will take to avoid or to

mitigate future failures to file timely returns

or notices.

Section 6. Select this section if you are

applying for reinstatement of your

tax-exempt status more than 15 months

from the later of the date of the Revocation

Letter or the date on which the IRS posted

your name on the Auto-Revocation List at

apps.irs.gov/app/eos/.

By selecting this item, you’re also

attesting that you filed the required annual

returns, your failure to file wasn’t

intentional, and you have put in place

procedures to file required returns or

notices in the future.

Describe how you exercised ordinary

business care and prudence in

determining and attempting to comply with

your filing requirements in each of the 3

years of revocation. Include a detailed

explanation of all the facts and

circumstances that led to the failure, the

discovery of the failure, and the steps you

have taken or will take to avoid or mitigate

future failures to file timely returns or

notices.

Section 7. Select this section if you’re

seeking reinstatement with an effective

date of reinstatement of the date of

submission of this application.

Line 2. Generally, if you didn’t file Form

1023 within 27 months of formation, the

effective date of your exempt status will be

the date you filed Form 1023 (submission

date). We may grant requests for an earlier

effective date when there’s evidence to

establish you acted reasonably and in

good faith, and the grant of relief won’t

prejudice the interests of the government.

Select the appropriate box to indicate

whether you accept the submission date

as the effective date of your exempt status

or whether you are requesting an earlier

effective date.

Line 2a. You may be eligible for

consideration for relief from the

requirement that you file Form 1023 within

27 months of formation if you can

establish that you acted reasonably and in

good faith, and that granting an extension

won’t prejudice the interests of the

government.

Describe in detail your reasons for filing

late, how you discovered your failure to

file, any reliance on professional advice or

advice from the IRS, and any other

information you believe will support your

request for relief. Also, you may want to

provide a comparison of (1) what your

aggregate tax liability would be if you had

filed this application within the 27-month

period with (2) what your aggregate

liability would be if you were exempt as of

your formation date.

We may consider the following factors.

• You filed Form 1023 before we

discovered your failure to file.

• You failed to file because of intervening

events beyond your control.

• You exercised reasonable diligence, but

you weren’t aware of the filing

requirements. (The complexity of your

filing and experience in these matters may

be taken into consideration.)

• You reasonably relied on written advice

from us.

• You reasonably relied on the advice of a

qualified tax professional who failed to file

or advise you to file Form 1023.

Schedule F. Low-Income

Housing

To qualify for tax exemption, low-income

housing must provide affordable housing

for a significant segment of individuals in

your community with low incomes. Your

low-income housing may serve a

combination of purposes, such as for poor,

frail, and elderly persons.

Specific Line Items

Line 1. The “type” of facility may be an

apartment complex, condominium,

cooperative, or private residence, etc.

Line 6. Answer “Yes,” if you charge daily,

weekly, monthly, or annual fees or

maintenance charges.

Line 8. Government programs include

federal, state, or local government

programs.

Schedule G. Successors

to Other Organizations

You should consider this schedule as a

successor organization if any of the

following situations pertain to you.

• You took or will take over activities

previously conducted by another

organization.

• You took or will take over 25% or more

of the fair market value of the net assets

of another organization.

• You were established upon the

conversion of an organization from

for-profit to non-profit status.

The other organization is the

predecessor organization. You should

complete this schedule regardless of

whether the predecessor (other

organization) was exempt or not exempt

from federal income tax.

For purposes of this schedule, a

“for-profit” organization is one in which

persons are permitted to have an

ownership or partnership interest, such as

corporate stock. It includes sole

proprietorships, corporations, and other

entities that provide for ownership

interests.

Schedule H. Organizations

Providing Scholarships,

Fellowships, Educational

Loans, or Other

Educational Grants to

Individuals and Private

Foundations Requesting

Advance Approval of

Individual Grant

Procedures

Complete this schedule if you provide

scholarships, fellowships, grants, loans, or

other distributions to individuals for

educational purposes. When answering

the questions on this schedule, you should

demonstrate how these distributions

further your exempt purposes.

If you’re a private foundation,

you’re subject to the rules under

CAUTION section 4945 and may incur an

excise tax if you make grants for the

purpose described above without seeking

advance approval of your grant-making

procedures (see Schedule H–Section II).

Generally, distributions made to

individuals may advance educational

purposes if selection is made:

• In a non-discriminatory fashion in terms

of racial preference;

• Based on need and/or merit; and

• To a charitable class in terms of being

available to an open-ended group, rather

than to pre-selected individuals.

A scholarship or fellowship is tax free to

the recipient only if they are candidate for

a degree at an eligible educational

institution and uses the scholarship or

fellowship to pay qualified education

expenses.

Qualified education expenses include

tuition and fees; and course-related

expenses such as books, supplies, and

equipment. Room and board, travel,

research, clerical help, and non-required

equipment aren’t qualified education

expenses. See Pub. 970, Tax Benefits for

Education, for additional information.

Selection of individuals using a lottery

system generally hasn’t been approved by

the IRS.

Specific Line Items

Section I

Line 1. If you conduct more than one

grant program, describe each program

separately.

If you make educational loans, describe

the terms of the loan (for example, the

factors you consider in selecting or

approving loan recipients, interest rate,

duration, forgiveness provision, etc.). Also,

describe whether any financial institutions

or other lenders are involved in your

program.

Explain how you will publicize your

program and whether you publicize to the

general public or to another group of

possible recipients. Include specific

information about the geographic area in

which your program will be publicized and

the means you will use, such as through

newspaper advertisements, school district

announcements, or community groups.

Line 2. Organizations that make grants to

individuals must maintain adequate

records and case histories showing the

name and address of each recipient,

pursuant Rev. Rul. 56-304, 1956-2 C.B.

306 but don’t provide this information as

part of your application.

Section II

If you requested public charity

classification in Part VII, line 1, don’t

complete Schedule H – Section II.

Line 1. Answer “Yes,” if you’re a private

foundation and you’re requesting

advance approval of your grant-making

procedures under section 4945(g).

Answer “No,” if you’re a private foundation

but don’t wish to request advance

approval of your grant-making procedures

under section 4945(g). If you answer “No,”

the amounts you distribute as educational

grants provided to individuals may be

considered taxable expenditures under

section 4945.

For more information about advance

approval of grant-making procedures of a

private foundation, go to IRS.gov/charitiesnon-profit/private-foundations/advanceapproval-of-grant-making-procedures.

Line 1a. Check the box for section

“4945(g)(1)” if your award qualifies as a

scholarship or fellowship grant that’s

awarded on an objective and

nondiscriminatory basis and is used for

study at a school (see Schedule B for what

is considered a school).

Check the box for “4945(g)(3)” if the

purpose of your award is to achieve a

specific objective, produce a report or

other similar product, or improve or

enhance a literary, artistic, musical,

scientific, teaching, or other similar

capacity, skill, or talent of the recipient.

Include your educational loan program

under this section.

You may check more than one box.

If your award qualifies as a prize or

TIP award that is subject to the

provisions of section 74(b) and

your recipient is selected from the general

public, you don’t have to request advance

approval of your grant-making procedures

since a prize or award isn’t subject to the

advance approval procedure requirements

because it isn’t a grant for travel, study, or

other similar purposes. See Rev. Ruls.

77-380, 1977-2 C.B. 419; 76-460, 1976-2

C.B. 371; and 75-393, 1975-2 C.B. 451.

Line 4. Answer “Yes,” if you award

scholarships on a preferential basis

because you require, as an initial

qualification, that the individual be an

employee or be related to an employee of

a particular employer.

Line 7. For purposes of this schedule, a

program for children of employees of a

particular employer includes children and

family members of employees.

Instructions for Form 1023

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

Instructions for Form 1023

Appendix A: Sample Conflict of Interest Policy

The purpose of the conflict of

interest policy is to protect this

tax-exempt organization's

(Organization) interest when it

is contemplating entering into

a transaction or arrangement

that might benefit the private

interest of an officer or director

of the Organization or might

result in a possible excess

benefit transaction. This policy

is intended to supplement but

not replace any applicable

state and federal laws

governing conflict of interest

applicable to nonprofit and

charitable organizations.

indirectly, through business,

investment, or family:

a. An ownership or

investment interest in any

entity with which the

Organization has a

transaction or

arrangement,

b. A compensation

arrangement with the

Organization or with any

entity or individual with

which the Organization has

a transaction or

arrangement, or

c. A potential ownership or

investment interest in, or

compensation

arrangement with, any

entity or individual with

which the Organization is

negotiating a transaction

or arrangement.

d. Compensation includes

direct and indirect

remuneration as well as

gifts or favors that aren’t

insubstantial. A financial

interest isn’t necessarily a

conflict of interest. Under

Article III, Section 2, a

person who has a financial

interest may have a conflict

of interest only if the

appropriate governing

board or committee

decides that a conflict of

interest exists.

Article II

Article III

Definitions

Procedures

1. Interested Person Any

director, principal officer, or

member of a committee with

governing board delegated

powers, who has a direct or

indirect financial interest, as

defined below, is an interested

person.

1. Duty to Disclose In

connection with any actual or

possible conflict of interest, an

interested person must

disclose the existence of the

financial interest and be given

the opportunity to disclose all

material facts to the directors

and members of committees

with governing board

delegated powers considering

the proposed transaction or

arrangement.

Note. This Sample Conflict of

Interest Policy is intended to

provide an example of a

conflict of interest policy for

organizations. The sample

conflict of interest policy does

not prescribe any specific

requirements. Therefore,

organizations should use a

conflict of interest policy that

best fits their organization.

Note. Items marked Hospital

insert — for hospitals that

complete Schedule C are

intended to be adopted by

hospitals.

Article I

Purpose

[Hospital insert – for

hospitals that complete

Schedule C. If a person is an

This text is long and has been trimmed here. Open the source document for the complete record.

This is a copy of a public record, reproduced as it was published. It is not legal advice, and it may not be the version a court would rely on. Check the official source before you cite it.