Instructions for Form 1024

Instructions for Form 1024

Department of the Treasury

Internal Revenue Service

(Rev. January 2022)

Application for Recognition of Exemption Under Section 501(a) or Section 521 of

the Internal Revenue Code

Section references are to the Internal Revenue

Code unless otherwise noted.

Note. Keep a copy of the completed Form

1024 in the organization’s permanent

records.

Future Developments

For the latest information about

developments related to Form 1024 and

its instructions, such as legislation

enacted after they were published, go to

IRS.gov/Form1024.

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 1024, 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. The IRS sends 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 to receive

local and national tax news by email.

Mar 03, 2022

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.

What's New

Organizations filing Form 1024,

Application for Recognition of Exemption

Under Section 501(a) or Section 521 of

the Internal Revenue Code, must

complete and submit their Form 1024

application electronically (including paying

the correct user fee) using Pay.gov.

Organizations requesting

determinations under subsections 501(c)

(11), (14), (16), (18), (21), (22), (23), (26),

(27), (28), (29) or section 501(d)

previously submitted letter applications,

but now are required to submit the

electronic Form 1024. Organizations

requesting determination under section

521 may also submit the electronic Form

1024 instead of Form 1028, Application for

Recognition of Exemption Under Section

521 of the Internal Revenue Code. Form

1024 has been revised accordingly.

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 1024, 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.

Answers

Form 1024 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 the

subsection you applied. Answer questions

completely. If an explanation provided for

an earlier question also applies to a later

question, your response to the later

question may simply refer to your previous

answer.

Cat. No. 47909G

Your answers must provide sufficient

detail about your past, present, and

planned activities to demonstrate that

you're described in the subsection of

501(c), 501(d), or section 521 under which

you are seeking recognition of exemption.

We won't be able to recognize you as tax

exempt based on a mission statement

unless you also describe the activities that

further accomplish your mission. We need

to understand the specific activities you

undertake to accomplish your exempt

purpose(s).

Financial data. Financial data, whether

budgets or actual, should be consistent

with other information presented in your

application. Budgeted financial data

should be prepared based on 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 1024 are written in

the present tense; however, base your

answers on your past, present, and

planned activities.

Language and currency requirements.

Complete Form 1024 and attachments in

English. Provide an English translation if

your organizational document, bylaws, or

any other attachments are in any other

language.

Report financial information in United

States dollars (specify the conversion rate

used). Combine amounts from within and

outside the United States and report the

totals on the financial statements.

Purpose of Form

Don't use Form 1024 if you are

applying under Section 501(c)(3)

CAUTION or Section 501(c)(4). Instead, use

Form 1023-EZ, Form 1023, or Form

1024-A.

!

Form 1024 is used by most types of

organizations to apply for recognition of

exemption under section 501(a) or section

521.

Certain organizations aren't required to

apply for tax-exempt status; however, they

may wish to file Form 1024 to receive a

determination letter of IRS recognition of

their section 501(c) status in order to

obtain certain incidental benefits such as:

• Public recognition of tax-exempt status,

• Possible exemption from certain state

taxes,

• Advance assurance to donors of

deductibility of contributions (in certain

cases), and

• Nonprofit mailing privileges, etc.

victims of emergencies such as floods and

hurricanes.

• An IRS error has caused delays in

review of the application.

Group exemption. Don't use Form 1024

to apply for a group exemption. We may

issue a group exemption to a central

organization recognizing, 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.

User Fee

Leaving a group exemption. A

subordinate organization under a group

exemption can use Form 1024 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 intent to

leave the group ruling before filing Form

1024.

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 for 3 consecutive years,

you must apply to have your tax-exempt

status reinstated. You must complete and

submit Form 1024 and pay the appropriate

user fee, even if you did not previously

choose to apply for recognition of

exemption.

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,

2014-3 I.R.B. 411 at IRS.gov/IRB2014-3

for details, including additional

requirements for retroactive reinstatement.

Requesting Expedited Review

We generally review applications for

exemption in the order we receive them.

We expedite processing of an application

only where a written request presents a

compelling reason for processing the

application ahead of others. Even if your

request for expedited processing is

approved, this does not mean your

application will be immediately approved

or denied. Expedited processing means

that it will be assigned to a specialist for

review ahead of applications received

earlier in time. 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

The law requires payment of a user fee

with each application. You must pay this

fee through Pay.gov when you file Form

1024.

Payments can be made directly from

your bank account or by credit or debit

card. You won't be able to submit Form

1024 without paying the correct fee.

User fee amounts are listed in Rev.

Proc. 2022-5, updated annually. For the

current Form 1024 user fee, go to

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

What To File

All applicants must complete Parts I

through VIII of Form 1024 and must

provide any required attachments.

Attachments to Form 1024

A complete application will include one or

more documents in addition to Form 1024.

Pay.gov can accommodate only one

uploaded file. Before submitting Form

1024, 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

Generally, if you file Form 1024 within 27

months after the month in which you were

legally formed, and we approve your

application, the effective date of

recognition of your exempt status will be

your legal date of formation.

If you otherwise meet the requirements

for tax exempt status but don't meet the

requirements for recognition from your

date of formation, the effective date of

-2-

recognition of your exempt status will be

the date you submitted Form 1024.

For exceptions and special rules,

including automatic extensions, see Pub.

557.

How To File

As of January 3, 2022, the IRS requires

that Form 1024 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 1024 (and letter

applications from organizations previously

required to submit in that format). To

submit Form 1024, you must:

1. Register or have previously

registered for an account on Pay.gov.

2. Enter “Form 1024” or “1024” in the

search box and select Form 1024.

3. Complete the form.

Filing Assistance

For help in completing this form or general

questions relating to exempt

organizations, you may access

information on our website at IRS.gov/EO.

You may find the following publications

available on IRS.gov.helpful.

• Pub. 557, Tax-Exempt Status for Your

Organization.

• Pub. 598, Tax on Unrelated Business

Income of Exempt Organizations.

• Pub. 3079, Tax-Exempt Organizations

and Gaming.

• Pub. 4221-NC, Compliance Guide for

Tax Exempt Organizations (Other than

501(c)(3) Public Charities and Private

Foundations).

Signature Requirements

An officer, director, trustee, or other official

who is authorized to sign for the

organization must digitally sign Form 1024

at the end of Part VIII. 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

TIP (CAF) number isn't required to be

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.

Instructions for Form 1024

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.

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.

After You Submit Form 1024

Information available for public inspection. If we approve exempt status

under section 501(a) or section 521, the

information that will be open for public

inspection includes the following.

• Your complete Form 1024 and any

supporting documents.

• All correspondence between you and

the IRS concerning Form 1024, including

Form 2848.

• Your determination letter.

• Annual information returns (Form 990,

990-EZ, or 990-N) including schedules,

except for the names and addresses of

contributors and other identifying

information about contributors.

Unless we approve a request for

expedited processing, we'll 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, we'll

send you a determination letter stating that

you're exempt.

Additional information needed. If we

can't make a determination without more

information, we'll write or call you.

Examples of the types of questions you

may be asked 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'll send you a determination

letter stating that you're exempt under

either section 501(a) or section 521. If we

determine that you don't qualify for

exemption, we'll 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 began as

soon as you were formed. If you have an

annual information return or tax return due

while your Form 1024 is pending,

complete the return checking 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

request to be set up to allow filing of Form

990-N.

Note: It takes the IRS up to 6 weeks to

update its records before you can file your

Form 990-N.

You can find information on return filing

requirements and exceptions in Pubs. 557

and 598.

You may also be required to file

TIP other returns, such as

employment tax returns or benefit

plan returns, which aren't discussed here.

Instructions for Form 1024

!

Public Inspection

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 other identifying information about

contributors included with Form 990 or

990-EZ.

• Form 990-T.

When applying for tax-exempt status,

you must clearly identify any information

that isn't open to public inspection by

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.

Making documents available for public

inspection. Both the organization 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 delete only the information that

isn't open for public inspection.

-3-

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.

See Pub. 557 for additional information

on public inspection requirements.

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.

Contributions by U.S. residents to

foreign organizations generally

CAUTION aren't deductible. Tax treaties

between the United States and certain

foreign countries provide specific limited

exceptions.

!

Annual returns for foreign organizations. A foreign organization that obtains

exemption must file an information return

annually (Form 990 or Form 990-EZ).

However, a foreign organization may file

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

990 or Form 990-EZ when its gross

receipts from U.S. source income 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 for further information. A

foreign organization that is subject to

unrelated business income tax must file

Form 990-T.

Organizations created in U.S. territories and possessions. Organizations

created in possessions and territories of

the United States 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 1024 to apply for recognition of

exempt status.

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).

Specific Instructions

Part I. Identification of

Applicant

Line 1. Enter your complete name exactly

as it appears in your organizing document,

including amendments.

Line 2. If you have an “in care of” name,

enter it here; otherwise, leave this space

blank.

Lines 3–9. 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 10. 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

searching 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 11. Month tax year ends. Select

the month your tax year (annual

accounting period) ends. Your tax year is

the 12-month period on which your annual

financial records are based.

Line 12. 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 Form 1024.

Line 13. Provide a daytime telephone

number for the contact listed on line 12.

Line 14. You may provide a fax number

for the contact listed on line 12.

Line 15. Pay.gov will populate this field

with the current user fee for filing Form

1024.

Line 16. If you have a website, enter the

complete web address. Also, list any

websites maintained on your behalf. The

information on your website should be

consistent with the information in your

Form 1024.

Line 17. 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, check the box

provided to add more officer, director,

and/or trustee information.

The person who is signing Form 1024

must be listed within the first five entries of

line 17.

Part II. Organizational Structure

You must be a corporation, limited liability

company, unincorporated association, or

trust to be tax exempt. 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 statute of a federally recognized

Indian tribal or Alaskan native

government.

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 and is recognized

as exempt under either section 501(a) or

-4-

section 521 is automatically 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

incorporation, 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 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 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.

If you're an LLC with a tax-exempt

TIP organization as its sole member

and you want to be treated as a

disregarded entity, 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.

Instructions for Form 1024

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 aren't formed

under the laws of the Unites 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.

Part III. Your Activities

Reminder. Answer all questions in this

part as they pertain to your past, present,

and planned activities.

Line 1. Describe completely and in detail

your past, present, and planned activities.

Your narrative description of activities

should be thorough and accurate because

501(c)(15) - Mutual Insurance Companies or Associations. If you are applying

under section 501(c)(15), provide the

following in addition to your narrative

description of activities:

• Whether you're a member of a

controlled group of corporations as

defined in section 831(c)(2)(C)(ii).

(Disregard section 1563(b)(2)(B) in

determining whether the organization is a

member of a controlled group.)

Note. You would be considered a

member of a controlled group of

corporations if you were not exempt from

tax under section 501(a). In applying

section 1563(a), use a “more than 50%”

stock ownership test to determine whether

the applicant or any other corporation is a

member of a controlled group.

• If you are a such a member, include in

the following table the total amount

received by you and all other members of

the controlled group. If not, include only

the amounts that relate to you.

3 Prior Tax Years

(a) Current Year

From __________

To __________

we determine whether you qualify for

exempt status based on the information in

your application.

For each past, present, or planned

activity, include information that answers

the following questions:

• What is the activity?

• Who conducts the activity?

• 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

allocated to this activity?

• How does the activity further your

exempt purposes?

(b)

__________

(c)

__________

(d)

__________

1. Direct written premiums *

2. Reinsurance assumed **

3. Reinsurance ceded **

4. Net written premiums

((line 1 plus line 2) minus line 3)

*1. In addition to other direct written premiums, include on line 1 the full amount of any prepaid or advance premium in the year the prepayment is received.

For example, if a $5,000 premium for a 3-year policy was received in the current year, include the full $5,000 amount in the Current Year column.

**2 and **3. If you entered an amount on line 2 or 3, upload a copy of the reinsurance agreement into which you have entered.

501(c)(29) - CO-OP Health Insurance

Issuers. If you are applying under section

501(c)(29) as a qualified nonprofit health

insurance issuer (QNHII), provide the

following in addition to your narrative

description of activities:

1. Upload a copy of both the Notice of

Award issued by Centers for Medicare

Instructions for Form 1024

and Medicaid Services (CMS) and the

fully executed Loan Agreement with CMS.

2. The following representations:

• Except to the extent allowed by section

1322(c)(4) of the Patient Protection and

Affordable Care Act, no part of your net

earnings inures to the benefit of any

private shareholder or individual, or has so

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inured since the later of your date of

formation or March 23, 2010;

• No substantial part of your activities

constitutes, or has constituted since the

later of your date of formation or March 23,

2010, carrying on propaganda, or

otherwise attempting to influence

legislation; and

• You do not participate or intervene in

(including the publishing or distributing of

statements) any political campaign on

behalf of (or in opposition to) any

candidate for public office, nor have you

so participated or intervened since the

later of your date of formation or March 23,

2010.

Line 2. National Taxonomy of Exempt

Entities (NTEE) code. An NTEE code is

a three-character series of letters and

numbers that generally describe a type of

organization. Enter the code from the list

of NTEE codes, located in Appendix A,

that best describes you. 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.urba.org.

NTEE codes are also used for

TIP purposes other than identification

of organizations described in

section 501(a) or section 521. Therefore,

all codes in the list don't necessarily

correspond to a section 501(a) or section

521 purpose.

Line 3. Describe any money or time

(whether volunteer or paid) you spent or

will spend attempting to influence the

selection, nomination, election, or

appointment of any person to any federal,

state, or local public office or to an office in

a political organization.

Line 4. You are a successor to another

organization if you:

• Took or will take over activities

previously conducted by another

organization,

• Took or will take 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

nonprofit status.

Line 4a. 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.

Line 5. Answer “Yes” if you have

members and enter the requested

information.

Line 6. Indicate if you distribute, or plan

to distribute, any of your property or funds

(such as a distribution of profits) to your

shareholders or members.

Line 7. Answer “Yes” if you have or will

issue stock as a means of indicating

ownership by your members or others.

Enter the requested information.

Line 8. If you should cease operations as

a tax-exempt organization, explain to

whom your assets will be distributed.

Line 9. Answer “Yes” if you provide or will

provide insurance through a third party or

provide the insurance yourself.

Line 10. Answer “Yes” if you make

grants, loans, or other distributions (such

as goods) to a foreign organization. A

relationship between you and the recipient

organization includes the following

situations.

• You control the recipient organization,

or it controls you through common

officers, directors, or trustees, or through

authority to approve budgets or

expenditures.

• You and the recipient organization were

created at approximately the same time

and by the same persons.

• You and the recipient organization

operate in a coordinated manner with

respect to facilities, programs, employees,

or other activities.

Persons who exercise substantial

influence over you also exercise

substantial influence over the recipient

organization.

Lines 10d–10f. The Office of Foreign

Assets Control (OFAC) of the U.S.

Department of the Treasury administers

and enforces economic and trade

sanctions based on U.S. foreign policy

and national security goals against certain

governments, entities, and individuals, as

directed in Executive Orders. As part of

the comprehensive and sustained

campaign against terrorist financing, all

U.S. persons, including U.S.-based

charities, are prohibited from dealing with

persons (individuals and entities)

identified as being associated with

terrorism on OFAC's Specially Designated

Nationals and Blocked Persons List

(OFAC SDN List). Information about

OFAC sanction programs and the OFAC

SDN List are available at treasury.gov/

ofac. If you make grants, loans,

distributions, or you provide goods or

services to a foreign organization or

engage in activities in a foreign country,

you are responsible to know whether an

OFAC sanctions program applies and

whether your activities require a license

from OFAC to engage in a transaction that

otherwise would be prohibited.

Line 11. A foreign country is a country

other than the United States, its territories

and possessions, and the District of

Columbia.

Lines 11a–11c. The Office of Foreign

Assets Control (OFAC) of the U.S.

Department of the Treasury administers

and enforces economic and trade

sanctions based on U.S. foreign policy

and national security goals against certain

governments, entities, and individuals, as

-6-

directed in Executive Orders. As part of

the comprehensive and sustained

campaign against terrorist financing, all

U.S. persons, including U.S.-based

charities, are prohibited from dealing with

persons (individuals and entities)

identified as being associated with

terrorism on OFAC's Specially Designated

Nationals and Blocked Persons List

(OFAC SDN List). Information about

OFAC sanction programs and the OFAC

SDN List are available at treasury.gov/

ofac. If you make grants, loans,

distributions, or you provide goods or

services to a foreign organization or

engage in activities in a foreign country,

you are responsible to know whether an

OFAC sanctions program applies and

whether your activities require a license

from OFAC to engage in a transaction that

otherwise would be prohibited.

Part IV. Compensation and

Other Financial Arrangements

Line 1. Answer “Yes” if you pay or will

pay compensation to your officers,

directors, trustees, employees, members,

or independent contractors.

Line 1a. A conflict of interest arises when

a person in a position of authority over an

organization, such as a director, officer, or

manager, may benefit personally from a

decision he or she could make. Adoption

of a conflict of interest policy is not

required to obtain tax-exempt status.

However, by adopting a policy, you will be

choosing to put in place procedures that

will help you avoid the possibility that

those in positions of authority may receive

an inappropriate benefit.

Reasonable compensation is the

amount that would ordinarily be paid for

like services by like organizations under

like circumstances as of the date the

compensation arrangement is made.

Establishing and documenting reasonable

compensation is important because

excessive compensation may result in

excise taxes on both the individual and

you. In addition, excessive compensation

may jeopardize your tax-exempt status.

Line 1b. A fixed payment means a

payment that is either a set dollar amount

or fixed through a specific formula where

the amount doesn't depend on discretion.

For example, a base salary of $200,000

that is adjusted annually based on the

increase in the Consumer Price Index is a

fixed payment.

A nonfixed payment means a payment

that depends on discretion. For example,

a bonus of up to $100,000 that is based on

an evaluation of performance by the

governing board is a nonfixed payment

because the governing body has

discretion over whether the bonus is paid

and the amount of the bonus.

Instructions for Form 1024

Line 2. Don't include purchases or sales

of goods and services in your normal

course of operations that are available to

the general public under similar terms and

conditions. Answer “Yes” if any of your

officers, directors, or trustees:

• Is an officer, director, or trustee in

another organization from or to which you

will purchase or sell goods, services, or

assets; or

• Possesses more than 35% ownership

interest in any organization to which you

will purchase or sell goods, services, or

assets.

An arm's length standard exists where

the parties have an adverse (or opposing)

interest. For example, a seller wants to sell

his goods at the highest possible price,

while a buyer wants to buy at the lowest

possible price. These are adverse

interests.

In negotiating with a person, an

adverse interest is assumed if that person

is otherwise unrelated to you in the sense

of not being in a position to exercise

substantial influence over you or your

affairs. If the person is in a position to

exercise substantial influence over your

affairs, then an arm's length standard

requires additional precautions to

eliminate the effect of the relationship.

Using a conflict of interest policy,

information about comparable

transactions between unrelated parties,

and reliable methods for evaluating the

transaction, are examples of precautions

that would help make the negotiation

process equivalent to one between

unrelated persons.

Fair market value is the price at which

property or the right to use property would

change hands between a willing buyer

and a willing seller, neither being under

any compulsion to buy, sell, or transfer

property or the right to use property, and

both having reasonable knowledge of

relevant facts.

Line 3. Answer “Yes” if any of your

officers, directors, or trustees:

• Is an officer, director, or trustee in

another organization that has a lease,

contract, loan, or other agreement with

you; or

• Possesses more than a 35% ownership

interest in any organization that has a

lease, contract, loan, or other agreement

with you.

For example, answer “Yes,” if one of

your directors is an officer for a section

501(c)(3) organization with whom you

have a lease for office space or if one of

your directors owns more than 35% of the

voting stock of a corporation to which you

made a loan.

Line 4. Indicate if you perform any

services for any other organization or

individual for which you receive a fee.

Instructions for Form 1024

Line 5. A joint venture is a legal

agreement in which the persons jointly

undertake a transaction for mutual profit.

Generally, each person contributes assets

and shares risks. Like a partnership, joint

ventures can involve any type of business

transaction and the persons involved can

be individuals, groups of individuals,

companies, or corporations.

Part V. Financial Data

A. Statement of Revenue and

Expenses

You must complete the Statement of

Revenue and Expenses for a total of 3

years including the current year.

Completed less than 1 year. If you

existed less than 1 year, provide

projections of your likely income and

expenses for your current year and next 2

years based on a reasonable and good

faith estimate of your finances for a total of

3 years financial information.

Completed at least 1 year but fewer

than 3. If you've existed for more than 1

year but fewer than 3 years, provide your

actual income and expenses for the

current year and 1 year prior and

projected income and expenses for next

year for a total of 3 years financial

information.

Completed more than 3 years. If

you've existed more than 3 years, provide

your actual income and expenses for the

current year and 2 years prior for a total of

3 years financial information.

!

We may request financial data for

more than 3 years.

CAUTION

Preparing the statement. Prepare the

statement using the method of accounting

you use in keeping your books and

records. Place financial information for the

year you're filing this form in the column

marked Current tax year.

Prepare the statement using the

accounting period you entered on Part I,

line 11. Enter “0” if a particular revenue or

expense doesn't apply to you.

Your financial information should reflect

your activities described in this

application.

Line 1. Enter the total gifts, grants, and

contributions you receive. Include items of

value that you receive as gifts, grants, or

contributions. Do not include membership

dues reported on line 2.

Line 2. Enter the amount you receive

from members to provide support to the

organization. Do not include payments

from members or on behalf of members to

purchase admissions, merchandise,

services, or use of facilities.

-7-

Line 3. Enter your gross income from

dividends, interest, payments received on

securities, loans, rents, and royalties that

are held for investment purposes.

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, not conducted with

substantially all (at least 85%) volunteer

labor, and not related to your exempt

purposes. Special rules apply to

organizations described in section 501(c)

(7), (9), or (17). In addition, unrelated

business income can be generated by

assets you acquire with debt

(“debt-financed income”). (You can take

this amount from Form 990-T, if filed.)

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 to the public without charge.

Line 7. Enter the total income from all

sources not reported on lines 1 through 6,

or lines 9, and line 11. Provide an itemized

list showing each type and amount of

income included on this line. Also, briefly

describe each type of income.

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.

Note. 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 have

done the study rather than by the

tax-exempt conservation group.

Provide an itemized list of your gross

receipts on line 24, 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 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 on line 24.

You may use the format in Figure 2.

Figure 2. Net Gain or Loss On Sales of Capital Assets

Category

(A) Real Estate

(B) Securities

(C) Other

1. Gross Sales Price of assets (other

than inventory) by category

2. Less: Cost or other basis and sales

expense

3. Gain or (loss). Subtract line 3 from

line 1.

4. Net gain or (loss) ---- Add line 3 of Columns (A), (B), and (C), Enter here and on Form 1024-A, Part IX-A. Statement of

Revenues and Expenses, line 11.

Line 13. 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 14. Enter the total amounts you pay

out to both individuals and organizations.

Provide an itemized list on line 24,

identifying recipients (using letter

designations such as A, B, C, etc., for

individuals) a brief description of the

purposes or conditions of payments, and

the amounts paid.

Maintain (but don't submit) a list

showing the names of recipients

associated with each letter designation.

Line 15. Enter total payments you make

to or for the benefit of your members.

Provide an itemized list on line 24,

identifying recipients (using letter

designations), a brief description of the

purposes or conditions of payment, and

the amounts paid. Do not include any

amounts reported on line 14.

Maintain (but don't submit) a list

showing the names of recipients

associated with each letter designation.

Line 16. Enter the total amount of

compensation you pay to your officers,

directors, and trustees.

Line 17. Enter the total amount of

salaries you pay to employees (not

reported on line 16 above).

Line 18. Enter your total interest expense

for the year. Don't include mortgage

interest treated as an occupancy expense

on line 19.

Line 19. 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 20. Enter the total depreciation,

depletion, and similar expenses you incur.

Line 21. 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 included on line 13, above),

accounting services, legal counsel,

consulting services, contract

management, or any independent

contractors.

Line 22. Enter any expenses you didn't

include in the lines above, such as for

program services. Provide an itemized list

on line 24, showing the type and amount

of each significant expense.

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 the total interest and noninterest-bearing 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), change funds,

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.

-8-

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 on line 19 that

shows the name of the 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 on line 19.

For stock traded on an organized

exchange or in substantial quantities over

the counter, the schedule should show the

name of the corporation, a description of

the stock and the principal exchange on

which it is traded, the number of shares

held, and their value as carried on the

organization's books.

Line 6. Enter your total amount of loans

(personal and mortgage loans) receivable.

Provide an itemized list on line 19 that

identifies each borrower name (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.

Instructions for Form 1024

Line 7. Enter the total book value of your

other investments. Include the total book

value of governmental securities (federal,

state, and municipal), buildings, and

equipment held for investment purposes.

Provide an itemized list on 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 listing on 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 on

line 19.

Line 12. Enter the total 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 year/period. Provide

an itemized list on line 19 showing each

note separately and 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 on

line 19 of these liabilities, including the

amounts you owe.

If the organization doesn’t use fund

accounting, report only the “net assets”

account balances, such as capital stock,

paid-in capital, and retained earnings or

accumulated income.

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.

Instructions for Form 1024

Part VI. Reinstatement After

Automatic Revocation

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,

provides procedures for seeking

reinstatement of 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 have been

automatically revoked pursuant to Section

6033(j)(1); 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 Section 4, you're also

attesting that your failure to file was not

intentional and you have put in place

procedures to file required returns or

notices in the future.

If 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 are 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 Section 5, you're also

attesting that you have 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

-9-

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 6. Select this section if:

• You're 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

Auto-Revocation List at

apps.irs.gov/app/eos/.

By selecting Section 6, you're also

attesting that you have 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 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.

Part VII. Annual Filing

Requirements

Most organizations must file an annual

information return (Form 990 or 990-EZ) or

notice (Form 990-N, Electronic Notice

(e-Postcard)). Exceptions to this rule

include 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.

Unless specifically required to file Form

990 or Form 990-EZ (see the Instructions

for Form 990), most organizations that

normally have gross receipts of $50,000 or

less may satisfy their filing obligation with

the Form 990-N, Electronic Notice

(e-Postcard).

Note. Organizations exempt under

section 501(d) use Form 1065, U.S.

Return of Partnership Income, to satisfy

their annual filing requirement.

Organizations exempt under section 521

use Form 1120-C, U.S. Income Tax

Return for Cooperative Associations, to

satisfy their annual filing requirements.

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. Answer “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 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.

For example, if you're claiming exception

as an affiliate of a governmental unit

based on Rev. Proc. 95-48, you must

demonstrate that your bylaws or other

organizational documents state that your

board members were appointed by a

governmental unit, an affiliate of a

governmental unit, a public official acting

in an official capacity, or elected by the

public at large, pursuant to local statute or

ordinance. Also include information

demonstrating that you meet at least two

(2) of the affiliation factors listed in Rev.

Proc. 95-48, Section 4.03 and how you

meet all of the facts and circumstances

detailed in Rev. Proc. 95-48, Section 4.04.

Part VIII. Signature

Signature Requirements

An officer, director, trustee, or other official

who is authorized to sign for the

organization must sign Form 1024. The

signature must be accompanied by the

title or authority of the signer and the date.

The person signing Form 1024

TIP must be listed as an officer,

director, or trustee within the first

five entries of Part I, Line 17.

Upload Checklist

Documents to upload. Check the boxes

to indicate which documents are included

in the file you upload with your application.

For your application to be complete,

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 documents in the

upload checklist are optional unless

required for a complete response to a

question.

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 not to

exceed 15MB.

organization to be recognized as tax

exempt by the IRS, you are required to

give us this information. We need it to

determine whether the organization meets

the legal requirements for tax-exempt

status.

The organization isn’t 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. The rules

governing the confidentiality of the Form

1024 application are covered in section

6104.

The time needed to complete and file

this form will vary depending on individual

circumstances.

The estimated average times are:

Paperwork Reduction Act Notice. We

ask for the information on this form to carry

out the Internal Revenue laws of the

United States. If you want your

Taxpayer Burden for Exempt Organizations

Form 1024

Parts I–III

Part IV

Sch. A

Sch. C

Sch. D

Sch. E

Sch. F

Sch. G

Sch. H

Sch. I

Sch. J

Sch. K

Comments and suggestions. If you

have comments concerning the accuracy

of these time estimates or suggestions for

making Form 1024 simpler, we would be

happy to hear from you.

You can send us comments from

IRS.gov/FormComments.

Or you can write to the

Internal Revenue Service

Tax Forms and Publications Division

1111 Constitution Ave. NW, IR-6526

Washington, DC 20224

Learning about

the law or the

form

3 hr., 2 min.

47 min.

18 min.

12 min.

18 min.

18 min.

6 min.

6 min.

6 min.

30 min.

6 min.

6 min.

Recordkeeping

26 hr., 1 min.

1 hr., 40 min.

2 hr., 52 min.

57 min.

4 hr., 4 min.

1 hr., 40 min.

2 hr., 23 min.

1 hr., 54 min.

1 hr., 40 min.

5 hr., 30 min.

2 hr., 23 min.

3 hr., 21 min.

Preparing and

sending the form

to the IRS

5 hr., 35 min.

51 min.

21 min.

13 min.

22 min.

20 min.

8 min.

7 min.

7 min.

36 min.

8 min.

9 min.

Don’t send Form 1024 to this address.

Instead, see Where To File, earlier.

Line 2. Describe the property to which

you hold or will hold title.

Schedule A

Line 3. Answer “Yes” if you turn over the

entire amount of your income, less

expenses, to your parent organization.

The type of distribution is immaterial. It

could be termed a dividend on stock or

given some other description. What is

important is that the income must be

distributed to the exempt organization. A

mere obligation to use the income for the

parent's benefit doesn't satisfy this

requirement.

Organizations described in

section 501(c)(2) or 501(c)

(25) --Title holding corporations

or trusts

Line 1. Provide the requested information

on each organization for which you hold

title to property. Also indicate the number

and types of shares of your stock that are

held by each.

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Instructions for Form 1024

Often, an exempt parent occupies

realty that the title-holding company owns.

The exempt parent generally doesn't pay

rent. In this situation, the statutory

requirement that income be paid over to

the parent is satisfied if the title-holding

company turns over whatever income is

available.

If you answer “No,” state the purpose

for which the excess is or will be retained.

Line 4. Answer “Yes” if you engage or will

engage in any activities other than holding

title to property and collecting income

therefrom. Describe the activities in detail.

Line 5. Check the appropriate box below

to indicate the section under which you

are applying.

Line 5a. Answer “Yes” if your

shareholders or beneficiaries are

permitted to dismiss your investment

adviser upon a majority vote.

If you answer “No,” explain why your

shareholders or beneficiaries aren't

permitted to dismiss your investment

adviser upon a majority vote of your

shareholders or beneficiaries.

Line 5b. Answer “Yes” if your

shareholders or beneficiaries are

permitted to terminate their interest in you

by selling or exchanging their stock to any

organization described in section 501(c)

(25)(C) so long as the sale or exchange

does not increase the number of your

shareholders or beneficiaries above 35, or

by having their stock or interest redeemed

by you after they provide you 90 days

notice.

If you answer “No,” explain why your

shareholders or beneficiaries aren't

permitted to terminate their interest in you

in such a way.

Line 5c. Answer “Yes” if you hold or will

hold interests in partnerships or real estate

trusts. Describe the interests in detail.

Line 5d. Answer “Yes” if you make or will

make mortgage loans. Describe the loans

in detail.

Line 5e. Answer “Yes” if you hold

property through a corporation,

partnership, or trust. Identify the

corporation, partnership, or trust and

describe the property held.

Schedule B.

Organizations described in

section 501(c)(5) --Labor,

agricultural, or horticultural

organizations

Line 1. Select your type of organization

from the list.

A labor organization is an association

of workers who have combined to protect

and promote the interests of their

Instructions for Form 1024

members by bargaining collectively with

their employers to secure better working

conditions, wages, and similar benefits.

Agricultural and horticultural

organizations are connected with raising

livestock, cultivating land, raising and

harvesting crops or aquatic resources,

cultivating useful or ornamental plants,

and similar pursuits.

Schedule C.

Organizations described in

section 501(c)(6) --Business

leagues, chambers of

commerce, etc.

Line 1. Select your type of organization

from the list.

A business league, in general, is an

association of persons having some

common business interest, the purpose of

which is to promote that common interest

and not to engage in a regular business of

a kind ordinarily carried on for profit. Trade

associations and professional

associations are considered business

leagues.

A chamber of commerce is usually

composed of the merchants and traders of

a city.

A board of trade often consists of

persons engaged in similar lines of

business. For example, a nonprofit

organization formed to regulate the sale of

a specified agricultural commodity to

assure equal treatment of producers,

warehouse workers, and buyers is a board

of trade.

Chambers of commerce and boards of

trade usually promote the common

economic interests of all the commercial

enterprises in a given trade community.

A real estate board consists of

members interested in improving the

business conditions in the real estate field.

It isn't organized for profit and no part of

the net earnings inures to the benefit of

any private shareholder or individual.

The Internal Revenue Code specifically

defines professional football leagues as

exempt organizations under section

501(c)(6). They are exempt whether or not

they administer a pension fund for football

players.

Line 2. Describe your members' common

business interests.

Line 3. Describe any services you

perform or will perform for members or

others. You must show that your purpose

is the improvement of business conditions.

This isn't established by evidence of

particular services that provide a

convenience or economy to individual

members in their businesses, such as

advertising that carries the name of

-11-

members, interest-free loans, assigning

exclusive franchise areas, operation of a

real estate multiple listing system, or

operation of a credit reporting agency.

Line 4. Answer “Yes” if you restrict or will

restrict your membership to individuals,

firms, associations, and/or corporations,

each representing a different trade,

business, occupation, or profession, and

organized for the purpose of exchanging

information on business prospects.

Explain in detail.

Line 5. Answer “Yes” if you market or will

market a specific product(s) and/or

brand(s) within an industry. Identify the

specific product(s) and/or brand(s) and

explain in detail how you market them.

Line 6. Answer “Yes” if you limit or will

limit your activities to users of a specific

product within an industry. Explain in

detail.

Line 7. Answer “Yes” if you operate or will

operate a listing or referral system. Explain

in detail.

Schedule D

Organizations described in

section 501(c)(7) --Social clubs

Line 1. Answer “Yes” if personal contact,

commingling, and fellowship exist among

members. If not, explain.

Line 2. Answer “Yes” if you conduct

activities such as take-out food sales,

liquor sales, operation of a gas station,

parking garage, barber shop, etc.

Describe these activities and indicate the

percentage of your time and resources

devoted to them.

Line 3. Answer “Yes” if you have entered

or will enter into any contract or agreement

for the management or operation of your

property and/or activities, such as

restaurants, pro shops, lodges. Describe

any written or oral arrangements that you

made or intend to make, with whom you

have or will have such arrangements, how

the terms are or will be negotiated at arm's

length, and how you determine you pay no

more than fair market value or you are

paid at least fair market value.

Line 4. Answer “Yes” if gross receipts

from your activities will include amounts

paid by non-members for goods and

services. Explain in detail.

Line 5. Answer “Yes” if non-members,

other than guests of members, are

permitted or will be permitted to use the

club facilities or participate in or attend any

functions or activities conducted by you.

Describe the functions or activities in

which there has been or will be

non-member participation or admittance.

Line 6. Enter the figure for the current

year and each of the prior tax years.

Line 7. Enter the figure for the current

year and each of the prior tax years.

Line 8. Answer “Yes” if your charter,

bylaws, other governing instrument, or any

written policy statement contain any

provision that provides for discrimination

against any person on the basis of race,

color, or religion. Identify where this

provision is located; whether or not it will

be kept; and if you have such a provision

that will be repealed, deleted, or otherwise

stricken from your requirements, state

when this will be done.

Line 9. Answer “Yes” if you restrict or will

restrict your membership to members of a

particular religion. Explain in detail.

Line 9a. Answer “Yes” if you are an

auxiliary of a section 501(c)(8) fraternal

beneficiary society. Provide the name and

EIN of the organization.

Line 9b. Answer “Yes” if you, in good

faith, limit your membership to the

members of a particular religion in order to

further the teachings or principles of that

religion and not to exclude individuals of a

particular race or color.

Schedule E

Organizations described in

section 501(c)(8) or 501(c)

(10) --Fraternal beneficiary

societies, orders, or

associations.

Unlike organizations exempt under section

501(c)(8), organizations exempt under

section 501(c)(10) are not “beneficiary”

societies; that is, they may not provide for

the payment of life, sick, accident or other

benefits to their members. Ensure your

selection in Part II is consistent with your

operations.

Line 1. Operating under the lodge system

means carrying on activities under a form

of organization that is composed of local

branches, chartered by a parent

organization, largely self-governing, and

called lodges, chapters, or the like.

Line 2. Answer “Yes” if you operate or will

operate for the exclusive benefit of the

members of an organization operating

under the lodge system. Explain in detail.

Line 3. Answer “Yes” if you are a

subordinate or local lodge, etc. List the

name, address, and EIN of your parent

organization.

Line 4. Answer “Yes” if you are a parent

or grand lodge. List the name, address,

and EIN of each subordinate lodge in

active operation.

Schedule F

Organizations described in

section 501(c)(9) --Voluntary

employees' beneficiary

associations

Line 1. Describe in detail the benefits you

provide or will provide. For each benefit

include the account, duration, eligibility

requirements, and the circumstances that

will entitle a recipient to payment of the

benefit.

Line 2. Answer “Yes” if you provide or will

provide deferred compensation benefits,

property or malpractice insurance, loans

(other than loans at times of disaster or

whole life insurance policy loans), savings

plans, reimbursement of commuting

expenses, or benefits similar to those

provided by a pension, stock bonus or

profit sharing plan. Describe these

benefits in detail.

Line 3. Provide the requested information

for each plan as of the last day of the most

recent plan year. If you have more than

one plan, at the end of this form, upload a

separate schedule.

Line 4. State the number of persons, if

any, other than employees and their

dependents (for example, the proprietor of

a business whose employees are

members of the association) who are

entitled to receive benefits.

Line 5. Answer “Yes” if any employees or

classes of employees are entitled to

benefits to which other employees or

classes of employees are not entitled.

Explain in detail.

Line 6. Answer “Yes” if you are organized

under the terms of a collective bargaining

agreement. At the end of this form, upload

a current copy.

Line 7. 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.

Line 7a. Generally, if you didn't file Form

1024 within 27 months of formation, the

effective date of your exempt status will be

the date you filed Form 1024 (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. See Rev. Proc. 2021-5

(updated annually) for more information.

Select the appropriate box to indicate

whether you accept the submission date

as the effective date of your exempt status

-12-

or whether you are requesting an earlier

effective date.

Line 7b. You may be eligible for

consideration for relief from the

requirement that you file Form 1024 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 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 1024.

• You filed the required Form 990 series

returns consistent with your requested

status.

Schedule G

Organizations described in

section 501(c)(12)—Benevolent

life insurance associations,

mutual ditch or irrigation

companies, mutual or

cooperative telephone

companies, or like

organizations

Line 1. Select your type of organization

from the list.

A benevolent life insurance association

of a purely local character is one that

confines its business activities to a

particular community, place, or district,

irrespective of political subdivisions.

Ditch and irrigation companies,

telephone companies, electric companies,

and “like organizations” that seek

exemption under section 501(c)(12) must

be organized and operated as mutual or

cooperative organizations.

Line 2. Answer “Yes” if your business

activities will be confined to a particular

Instructions for Form 1024

community, place, or district. If “No,”

explain in detail.

Line 3. List the counties or geographical

region from which your members are or

will be accepted.

Line 4. Answer “Yes” if members have

democratic control. If “No,” explain in

detail.

Democratic Control means you

periodically hold democratically

conducted meetings with members.

Election of officers must be on a one

member, one vote basis. Meetings must

have a quorum of members in attendance

or voting by proxy.

Line 5 Answer “Yes” if the rights and

interests of members in your annual

savings are determined in proportion to

their business with you.

Line 6. Answer “Yes” if you keep the

records necessary to determine at any

time each member’s rights and interests in

such savings, including assets acquired

with the savings.

Line 7. Answer “Yes” if the rights and

interests of members are forfeited upon

termination of membership. Explain in

detail.

Line 8. Answer “Yes” if you receive or will

receive at least 85% of your income from

amounts collected from members for the

sole purposes of meeting losses and

expenses. If “No,” explain in detail.

Schedule H

Organizations described in

section 501(c)

(13)—Cemeteries, crematoria,

and like corporations

Line 1. Answer “Yes” if you are claiming

exemption as a perpetual care fund for an

organization described in section 501(c)

(13).

Line 1a. Answer “Yes” if the cemetery

organization, for which funds are held, has

established exemption under section

501(c)(13). If “No,” explain in detail.

Line 1b. Answer “Yes” if your funds are

devoted exclusively to the perpetual care

and maintenance of the non-profit

cemetery as a whole. If “No,” explain in

detail.

Line 2. Answer “Yes” if you operate or will

operate a mortuary. Explain in detail.

Line 3. Answer “Yes” if you engage or will

engage in land sale agreements,

percentage-of-sales land sale

agreements, or other similar financial

arrangements. Describe in detail any

written or oral arrangements that you

made or intend to make, with whom you

have or will have such arrangements, how

Instructions for Form 1024

the terms are or will be negotiated at arm's

length, and how you determine you pay no

more than fair market value or you are

paid at least fair market value.

Line 4. Answer “Yes” if you currently, or

will, own, operate, or maintain a cemetery

for pets. Explain in detail.

Schedule I

Organizations described in

section 501(c)(14)—Credit

Unions

Line 1. Answer “Yes” if you are formed

under a state credit union law.

Line 2. Select the state credit union law

under which you are organized and

operated from the drop down menu.

Line 3. Answer “Yes” if you are being

operated under uniform bylaws adopted

by the state you selected on Line 3a.

If you answer “No,” explain in detail the

rules and regulations under which you are

operated.

Line 4. Answer “Yes” if you comply or will

comply with the state credit union law

requirements, including their purposes,

security, and rate of interest charged

thereon, in making loans.

If you answer “No,” explain in detail

why you do not or will not comply with

state credit union law requirements.

Line 5. Answer “Yes” if you limit or will

limit your investments to securities which

are legal investments for credit unions

under the state credit union law.

If you answer “No,” explain in detail

why you do not or will not comply with

state credit union law requirements.

Line 6. Answer “Yes” if you distribute or

will distribute dividends on shares, if any,

as prescribed by the state credit union

law.

If you answer “No,” explain in detail

why you do not or will not comply with

state credit union law requirements.

Line 7. Answer “Yes” if you are operated

for the mutual benefit of your members.

Line 8. Answer “Yes” if your members

share a common bond such as

association, occupation, or residence.

Describe the common bond in detail.

Line 9. 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.

Line 10. Answer “Yes” if you issue or will

issue stock as a means of indicating

ownership by your members or others.

Describe the provisions for the issuance of

stock to shareholders that would take

-13-

ownership in the corporation and share in

the earnings.

Line 11. Answer “Yes” if you allow or will

allow individuals who aren’t members to

be shareholders. Explain in detail.

Line 12. If you answer “No,” explain in

detail why you do not or will not ensure

that loans to members benefit the

borrower and meet their needs.

Line 13. Answer “Yes” if you make or will

make loans to individuals who aren’t

members. Explain in detail.

Line 14. Answer “Yes” if you advertise or

will advertise to individuals who aren’t

members. Explain in detail.

Line 15. Answer “Yes” if you are a mutual

fund organized before September 1, 1957.

Line 15a. Answer “Yes” if you provide

reserve funds for-- and insurance of

shares or deposits in-- a domestic building

and loan association, cooperative bank

without capital stock organized and

operated for mutual purposes and without

profit, mutual savings bank not having

capital stock represented by shares, or a

mutual savings bank described in section

591(b).

Line 15b. Select the type of organization

for which you provide reserve funds and

insurance of shares or deposits.

Line 15c. Provide the name of the

organization for which you provide reserve

funds and insurance of shares or deposits.

Line 15d. Answer “Yes” if 85% or more of

your income is attributable to providing

reserve funds and to investments.

If you answer “No,” specify the

percentage of your income that is

attributable to providing reserve funds and

to investments.

Schedule J

Organizations described in

section 501(c)(17)—Trusts

providing for the payment of

supplemental unemployment

compensation benefits

Line 1. A full description of the

supplemental unemployment benefits

available to the participants must

accompany your application, showing the

amount, duration, eligibility requirements,

and the circumstances that will entitle a

recipient to payment of the benefit.

A copy of your plan documents that

describe such benefits and the terms and

conditions of eligibility for each benefit

should be uploaded at the end of the form.

Line 2. Answer “Yes” if you provide or will

provide benefits for individual proprietors,

partners, or self-employed persons under

the plan. Explain in detail.

Line 3. Provide the requested information

for each plan as of the last day of the most

recent plan year and enter that date in the

space provided. If you have more than

one plan, at the end of this form, upload a

separate schedule.

Line 4. Answer “Yes” if the creator of the

trust or a contributor to the trust; a brother

or sister (whole or half-blood), a spouse,

an ancestor, or a lineal descendant of

such a creator or contributor; or a

corporation controlled directly or indirectly

by such a creator or contributor has or will

(a) borrow or receive any part of the trust’s

income or corpus, (b) receive any

compensation for personal services, (c)

obtain any part of the trust’s services, or

(d) sell or purchase any securities or other

properties from or to the trust.

Line 5. 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.

Line 5a. Generally, if you didn’t file Form

1024 within 27 months of formation, the

effective date of your exempt status will be

the date you filed Form 1024 (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. See Rev. Proc. 2021-5

(updated annually) for more information.

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 5b. You may be eligible for

consideration for relief from the

requirement that you file Form 1024 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 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 1024.

• You filed the required Form 990 series

returns consistent with your requested

status.

Schedule K

Organizations described in

section 501(c)(19)—A post,

organization, auxiliary unit,

etc., of past or present

members of the Armed Forces

of the United States

Line 1. Answer “Yes” if you are a post or

organization of past or present members

of the Armed Forces of the United States.

Line 1a. Enter the total number of your

members.

Line 1b. Enter the number of your

members that are present or former

members of the U.S. Armed forces.

Line 1c. Enter the total number of your

members that are cadets (include

students in college or university ROTC

programs or at armed services academies

only), or spouses, widows, or widowers of

cadets or past or present members of the

U.S. Armed Forces.

Line 1d. Answer “Yes” if you have a

membership category other than the ones

asked about above. Describe other

membership categories and state the

number of members in each category.

Line 1e. Answer “Yes” if you wish to

apply for a determination that

contributions to your organization are

deductible by donors.

Line 1f. Enter the number of your

members from line 1b that are war

veterans. (A war veteran is a person who

served in the Armed Forces of the United

States during the following periods of war:

April 21, 1898, through July 4, 1902; April

6, 1917, through November 11, 1918;

December 7, 1941, through December 31,

1946; June 27, 1950, through January 31,

1955; August 5, 1964, through May 7,

1975; and August 2, 1990, through a

future date to be set by law or Presidential

Proclamation.)

Line 2. Answer “Yes” if you are an

auxiliary unit or society of a post or

organization of past or present members

of the Armed Forces of the United States.

-14-

Enter the name, address, and EIN of the

post or organization.

Line 2a. Answer “Yes” if you are affiliated

with and organized according to the

bylaws and regulations formulated by

such an exempt post or organization. A

copy of such bylaws or regulations should

be uploaded at the end of this form.

Line 2b. Enter the total number of your

members.

Line 2c. Enter the number of your

members that are themselves past or

present members of the Armed Forces of

the United States, or are their spouses, or

persons related to them within two

degrees of blood relationship.

(Grandparents, brothers, sisters, and

grandchildren are the most distant

relationships allowable.)

Line 2d. Answer “Yes” if all of your

members are themselves members of a

post or organization, past or present

members of the Armed Forces of the

United States, spouses of members of

such a post or organization, or related to

members of such a post or organization

within two degrees of blood relationship.

Line 3. Answer “Yes” if you are a trust or

foundation organized for the benefit of an

exempt post or organization of past or

present members of the Armed Forces of

the United States.

Line 3a. Answer “Yes” if your corpus or

income be used solely for the funding of

such an exempt organization (including

necessary related expenses). If not,

answer “No” and explain.

Line 3b. Answer “Yes” if you are formed

for charitable purposes and your

organizational document contain a proper

dissolution provision as described in

section 1.501(c)(3)-1(b)(4) of the Income

Tax Regulations.

Line 4. Answer “Yes” if you currently, or

will, (a) rent your facilities to the general

public; (b) make your facilities, such as bar

and dining facilities, open to the general

public; (c) sell liquor and/or food to

members and/or the general public for

consumption off premises; or (d) conduct

gaming activities with the general public.

Explain in detail, including the percentage

of your time and resources devoted to

such activities.

Schedule L

Organizations described in

section 501(d)—Religious and

apostolic organizations

Line 1. Answer “Yes” if you are organized

for the purpose of operating a communal

religious community where members live a

communal life following your tenets and

teachings.

Instructions for Form 1024

Line 2. Answer “Yes” if you maintain a

common or community treasury.

Line 3. Answer “Yes” if all your members

live in a communal manner.

Line 4. Answer “Yes” if your members are

permitted to own, in their own names, any

real or personal property.

Line 5. Answer “Yes” if your members are

required to furnish their own support (food,

clothing, and shelter).

Line 6. State your membership

requirements, the method of member

admission, members’ right to property

owned at the time they’re admitted and

terminating members’ rights to share in

the organization’s property, or to a return

of any property contributed.

Schedule M

Organizations described in

section 521 – Farmers'

Cooperative Associations

Line 1. Complete the table. Show the

number of shares of each class of capital

stock currently outstanding, if any, the

value of the consideration for which it was

issued, and the rate of dividend paid.

Line 2. Complete the table. Show the

number of shares of capital stock (other

than non-voting preferred) owned by

current and active producers, inactive

producers, and non-producers.

The term “producer” means an

individual or corporation engaged in

farming as a business receiving income

based on farm production rather than fixed

compensation. For example, a corporation

leases its land to a tenant farmer who

agrees to pay a rental fee based on a

percentage of the farm crops produced.

Both the landowner and the tenant farmer

qualify as producers.

“Current and active” producers are

patrons of a cooperative who market more

than 50% of their products or purchase

more than 50% of their supplies and

equipment through the cooperative during

the cooperative's tax year.

Line 3. Answer “Yes” if you issue or will

issue non-voting preferred stock. Explain

in detail whether the owners, upon

dissolution or liquidation, may share in the

profits of the association beyond fixed

dividends.

Line 4. Answer “Yes” if you make or will

make any provisions for retiring the voting

stock held by a non-producer. Explain in

detail.

Line 5. Enter the legal rate of interest in

the state where you are located. If the

state in which you are located differs from

Instructions for Form 1024

the state in which you are incorporated,

enter the legal rate of interest in the state

of your incorporation.

Line 6. Answer “Yes” if you are required

by state law to accumulate and maintain

reserves. State the names and purposes

of the reserves and specify the amounts of

each.

Line 7. Answer “Yes” if you maintain or

will maintain any reserves other than those

required by state law. State the names

and purposes of the reserves and specify

the amounts of each.

Line 8. Describe who is accorded voting

rights in the cooperative and how many

votes one person may have. If a person

may be entitled to more than one vote,

explain in detail how voting rights are

acquired.

Line 9. Answer “Yes” if you are a

federated cooperative.

Line 10. Answer “Yes” if all your member

cooperatives are exempt under section

521.

Line 11. Answer “Yes” if the nonexempt

member cooperatives have the same

annual accounting period as you. If “No,”

describe the method that you use or will

use to provide a common or comparable

unit of time for analyzing and evaluating

your operations and those of your

members.

Line 12. Answer “Yes” if you do business

with or will do business with both

members and non-members. Explain in

detail.

Line 13. Answer “Yes” if you pay or will

pay patronage dividends. Explain in detail

whether they will be paid to members and

non-members on the same basis.

Line 14. Answer “Yes” if you allocate or

will allocate patronage dividends based on

an obligation in existence before you

received the amounts allocated. Explain

the obligation in detail.

Line 15. Explain how distribution is or will

be made of the proceeds of products

marketed for members and non-members.

Also, if you operate on a basis of allocated

units (i.e., functional, departmental, etc.),

explain how losses are or will be treated.

Line 16. Explain how you charge for

supplies and equipment purchased for

members and non-members.

Line 17 – 19. The information requested

on lines 17 through 19 must be completed

for the current year and each of the 2

immediately preceding years (or for the

time you have existed if less than 3 years).

The requested information for the current

year must cover the period beginning on

the first day of your established annual

-15-

accounting period and ending on any day

which is within 60 days of the date of the

application. If the date of the application is

less than 60 days after the first day of the

current accounting period, no information

is required for the current year.

Requested information is required for

the 2 preceding years regardless of the

current year requirement. Please note that

if no information is required for the current

year, the preceding years information

period can end on any day which is within

60 days of the date of the application.

Line 17. Enter the value of agricultural

products marketed or handled for

members and non-members below:

Line 17a. Members – Note: If it is

necessary to own one or more shares of

stock in order to become a member,

include only the amount of business

transacted with persons actually owning

the required number of shares.

Line 17a.1 List the amount actually

produced by members.

Line 17a.2 List the amount not actually

produced by members but marketed by

them through you

Line 17b.1 Non-members

Line 17b.2 List the amount not actually

produced by non-members but marketed

by them through you

Line 17c. List the amount by

nonproducers (purchased from

nonproducers for marketing by you)

Line 18. Enter the value of supplies and

equipment purchased for or sold to

members and non-members below:

Line 18a. List the amount from members

who were producers Note: If it is

necessary to own one or more shares of

stock in order to become a member,

include only the amount of business

transacted with persons actually owning

the required number of shares.

Line 18b. List the amount from

non-members who were producers

Line 18c. List the amount from members

and non-members who were not

producers

Line 19. List the amount of business

done with the United States Government

or any of its agencies

Line 20. Answer “Yes” if all the net

earnings (after payment of dividends, if

any, on capital stock) for the years shown

on lines 17-19 were distributed as

patronage dividends. If your net earnings

were not distributed as patronage

dividends, also indicate whether they were

apportioned on the records to all patrons

on a patronage basis.

Appendix A: National Taxonomy of

Exempt Entities (NTEE) Codes

Arts, Culture & Humanities

Code

A01

A02

A03

A05

A11

A12

A19

A20

A23

A24

A25

A26

A27

A30

A31

A32

A33

A34

A40

A50

A51

A52

A54

A56

A57

A60

A61

A62

A63

A65

A68

A69

A6A

A6B

A6C

A6E

A70

A80

A82

A84

A90

A99

Alliances & Advocacy

Management & Technical

Assistance

Professional Societies &

Associations

Research Institutes & Public

Policy Analysis

Single Organization Support

Fund Raising & Fund Distribution

Support N.E.C.

Arts & Culture

Cultural & Ethnic Awareness

Folk Arts

Art Education

Arts & Humanities Councils &

Agencies

Community Celebrations

Media & Communications

Film & Video

Television

Printing & Publishing

Radio

Visual Arts

Museums

Art Museums

Children’s Museums

History Museums

Natural History & Natural

Science Museums

Science & Technology Museums

Performing Art

Performing Arts Centers

Dance

Ballet

Theater

Music

Symphony Orchestras

Opera

Singing & Choral Groups

Bands & Ensembles

Performing Arts Schools

Humanities Organizations

Historical Organizations

Historical Societies & Historic

Preservation

Commemorative Events

Arts Service

Arts, Culture & Humanities

N.E.C.

Education

Code

B01

B02

B03

B05

B11

B12

B19

B20

B21

B24

B25

B28

B29

B30

B40

B41

B42

B43

B50

B60

B70

B80

B82

B83

B84

B90

Alliances & Advocacy

Organizations

Management & Technical

Assistance

Professional Society &

Associations

Research Institutes & Public

Policy Analysis

Single Organization Support

Fundraising & Fund Distribution

Support N.E.C.

Elementary & Secondary

Schools

Preschools

Primary & Elementary Schools

Secondary & High Schools

Special Education

Charter Schools

Vocational & Technical Schools

Higher Education Institutions

Two-Year Colleges

Two-Year Colleges

Undergraduate Colleges

Graduate & Professional Schools

Adult Education

Libraries

Student Services

Scholarships & Student Financial

Aid

Student Sororities & Fraternities

Alumni Associations

Educational Services

B92

B94

B99

Remedial Reading &

Encouragement

Parent & Teacher Groups

Education N.E.C.

Environment

Code

C01

C02

C03

C05

C11

C12

C19

C20

C27

C30

C32

C34

C35

C36

C40

C41

C42

C50

C60

C99

Alliances & Advocacy

Management & Technical

Assistance

Professional Societies &

Associations

Research Institutes & Public

Policy Analysis

Single Organization Support

Fundraising & Fund Distribution

Support N.E.C.

Pollution Abatement & Control

Recycling

Natural Resources Conservation

& Protection

Water Resources, Wetland

Conservation & Management

Land Resources Conservation

Energy Resources Conservation

& Development

Forest Conservation

Botanical, Horticultural &

Landscape Services

Botanical Gardens & Arboreta

Garden Clubs

Environmental Beautification

Environmental Education

Environmental N.E.C.

Animal-Related

Code

D01

D02

D03

D05

D11

D12

D19

D20

D30

D31

D32

D33

D34

D40

D50

D60

D61

D99

Alliance & Advocacy

Management & Technical

Assistance

Professional Societies &

Associations

Research Institutes & Public

Policy Analysis

Single Organization Support

Fundraising & Fund Distribution

Support N.E.C.

Animal Protection & Welfare

Wildlife Preservation &

Protection

Protection of Endangered

Species

Bird Sanctuaries

Fisheries Resources

Wildlife Sanctuaries

Veterinary Services

Zoos & Aquariums

Animal Services N.E.C.

Animal Training

Animal Related N.E.C.

Health Care

Code

E01

E02

E03

E05

E11

E12

E19

E20

E21

E22

E24

E30

E31

E32

E40

E42

E50

E60

E61

E62

Alliances & Advocacy

Management & Technical

Assistance

Professional Societies &

Associations

Research Institutes & Public

Policy Analysis

Single Organization Support

Fundraising & Fund Distribution

Support N.E.C.

Hospitals

Community Health Systems

General Hospitals

Specialty Hospitals

Ambulatory & Primary Health

Care

Group Health Practices

Community Clinics

Reproductive Health Care

Family Planning

Rehabilitative Care

Health Support

Blood Banks

Emergency Medical Services &

Transport

E65

E6A

E70

E80

E86

E90

E91

E92

E99

Organ & Tissue Banks

Pharmacies & Drugstores

Public Health

Health (General & Financing)

Patient & Family Support

Nursing

Nursing Facilities

Home Health Care

Health Care N.E.C.

Mental Health & Crisis

Intervention

Code

F01

F02

F03

F05

F11

F12

F19

F20

F21

F22

F30

F31

F32

F33

F40

F42

F50

F52

F53

F54

F60

F70

F80

F99

Alliances & Advocacy

Management & Technical

Assistance

Professional Societies &

Associations

Research Institutes & Public

Policy Analysis

Single Organization Support

Fundraising & Fund Distribution

Support N.E.C.

Substance Abuse Dependency,

Prevention & Treatment

Substance Abuse Prevention

Substance Abuse Treatment

Mental Health Treatment

Psychiatric Hospitals

Community Mental Health

Centers

Residential Mental Health

Treatment

Hot Line & Crisis Intervention

Sexual Assault Services

Addictive Disorders N.E.C.

Smoking Addiction

Eating Disorders & Addictions

Gambling Addiction

Counseling

Mental Health Disorders

Mental Health Associations

Mental Health & Crisis

Intervention N.E.C.

Volutary Health Associations &

Medical Disciplines

Code

G01

G02

G03

G05

G11

G12

G19

G20

G25

G30

G32

G40

G41

G42

G43

G44

G45

G48

G50

G51

G54

G60

G61

G70

G80

G81

G83

G84

G90

G92

G94

G96

G98

-16-

Alliances & Advocacy

Management & Technical

Assistance

Professional Societies &

Associations

Research Institute & Public

Policy Analysis

Single Organization Support

Fundraising & Fund Distribution

Support N.E.C.

Birth Defects & Genetic Diseases

Down Syndrome

Cancer

Breast Cancer

Diseases of Specific Organs

Eye Diseases, Blindness &

Vision Impairments

Ear & Throat Diseases

Heart & Circulator System

Diseases & Disorders

Kidney Diseases

Lung Diseases

Brain Disorder

Nerve, Muscle, & Bone Diseases

Arthritis

Epilepsy

Allergy Related Diseases

Asthma

Digestive Diseases & Disorders

Specific Named Disorders

AIDS

Alzheimer’s Diseases

Autism

Medical Disciplines

Biomedicine & Bioengineering

Geriatrics

Neurology & Neuroscience

Pediatrics

G99

G9B

Voluntary Health Associations,

Medical Disciplines N.E.C.

Surgical Specialties

Medical Research

Code

H01

H02

H03

H05

H11

H12

H19

H20

H25

H30

H32

H40

H41

H42

H43

H44

H45

H48

H50

H51

H54

H60

H61

H70

H80

H81

H83

H84

H90

H92

H94

H96

H98

H99

H9B

Alliances & Advocacy

Management & Technical

Assistance

Professional Societies &

Associations

Research Institute & Public

Policy Analysis

Single Organization Support

Fundraising & Fund Distribution

Support N.E.C.

Birth Defects & Genetic Diseases

Research

Down Syndrome Research

Cancer Research

Breast Cancer Research

Diseases of Specific Organs

Research

Eye Diseases, Blindness &

Vision Impairments Research

Ear & Throat Diseases Research

Heart & Circulatory System

Diseases & Disorders Research

Kidney Diseases Research

Lung Diseases Research

Brain Disorders Research

Nerve, Muscle & Bone Diseases

Research

Arthritis Research

Epilepsy Research

Allergy-Related Diseases

Research

Asthma Research

Digestive Diseases & Disorders

Research

Specifically Named Diseases

Research

AIDS Research

Alzheimer’s Disease Research

Autism Research

Medical Disciplines Research

Biomedicine & Bioengineering

Research

Geriatrics Research

Neurology & Neuroscience

Research

Pediatrics Research

Medical Research N.E.C.

Surgical Specialties Research

Crime & Legal-Related

Code

I01

I02

I03

I05

I11

I12

I19

I20

I21

I23

I30

I31

I40

I43

I44

I50

I51

I60

I70

I71

I72

I73

I80

I83

I99

Alliances & Advocacy

Management & Technical

Assistance

Professional Societies &

Associations

Research Institutes & Public

Policy Analysis

Single Organization Support

Fundraising & Fund Distribution

Support N.E.C.

Crime Prevention

Youth Violence Prevention

Drunk Driving-Related

Correctional Facilities

Half-Way Houses for Offenders

& Ex-Offenders

Rehabilitation Services for

Offenders

Inmate Support

Prison Alternatives

Administration of Justice

Dispute Resolution & Mediation

Law Enforcement

Protection Against Abuse

Spouse Abuse Prevention

Child Abuse Prevention

Sexual Abuse Prevention

Legal Services

Public Interest Law

Crime & Legal-Related N.E.C.

Appendix A: National Taxonomy of Exempt Entities (NTEE) Codes (Continued)

Employment

Code

J01

J02

J03

J05

J11

J12

J19

J20

J21

J22

J30

J32

J33

J40

J99

Alliances & Advocacy

Management & Technical

Assistance

Professional Societies &

Associations

Single Organization Support

Consumer Lending

Fundraising & Fund Distribution

Support N.E.C.

Employment Preparation &

Procurement

Vocational Counseling

Job Training

Vocational Rehabilitation

Goodwill Industries

Sheltered Employment

Labor Unions

Employment N.E.C.

Food, Agriculture & Nutrition

Code

K01

K02

K03

K05

K11

K12

K19

K20

K25

K26

K28

K2A

K2B

K2C

K30

K31

K34

K35

K36

K40

K50

K6A

K6B

K6C

K6D

K6E

K6F

K90

K91

K92

K93

K94

K95

K96

K97

K98

K99

Alliances & Advocacy

Management & Technical

Assistance

Professional Societies &

Associations

Research Institutes & Public

Policy Analysis

Single Organization Support

Fundraising & Fund Distribution

Support N.E.C.

Agricultural Programs

Farmland Preservation

Animal Husbandry

Farm Bureaus & Granges

Other Vegetable (except Potato)

& Melon Farming

Soil Preparation, Planting, &

Cultivating

Wineries

Food Programs

Food Banks & Pantries

Congregate Meals

Soup Kitchens

Meals on Wheels

Nutrition

Home Economics

Meat Markets

Confectionery & Nut Stores

Caterers

Mobile Food Services

Drinking Places

Snack Nonalcoholic Beverage

Bars

Limited-Service Restaurants

Supermarkets & Other Grocery

(except Convenience) Stores

Convenience Stores

Fruit & Vegetable Markets

All Other Specialty Food Stores

Food (Health) Supplement

Stores

Warehouse Clubs &

Supercenters

Food Service Contractors

Full-Service Restaurants

Food, Agriculture & Nutrition

N.E.C.

Housing & Shelter

Code

L01

L02

L03

L05

L11

L12

L19

L20

L21

L22

L24

Alliances & Advocacy

Management & Technical

Assistance

Professional Societies &

Associations

Research Institutes & Public

Policy Analysis

Single Organization Support

Fundraising & Fund Distribution

Support N.E.C.

Housing Development,

Construction & Management

Low-Income & Subsidized Rental

Housing

Senior Citizens’ Housing &

Retirement Communities

Independent Housing for People

with Disabilities

L25

L30

L40

L41

L4A

L4B

L50

L80

L81

L82

L99

Housing Rehabilitation

Housing Search Assistance

Temporary Housing

Homeless Shelters

Hotels (except Casino Hotels) &

Motels

Bed and Breakfast Inns

Homeowners & Tenants

Associations

Housing Support

Home Improvement & Repairs

Housing Expense Reduction

Support

Housing & Shelter N.E.C.

Public Safety, Disaster

Preparedness & Relief

Code

M01

M02

M03

M05

M11

M12

M19

M20

M23

M24

M40

M41

M42

M60

M99

Alliances & Advocacy

Management & Technical

Assistance

Professional Societies &

Associations

Research Institutes & Public

Policy Analysis

Single Organization Support

Fundraising & Fund Distribution

Support N.E.C.

Disaster Preparedness & Relief

Services

Search & Rescue Squads

Fire Prevention

Safety Education

First Aid

Automotive Safety

Public Safety Benevolent

Associations

Public Safety, Disaster

Preparedness & Relief N.E.C.

N05

N11

N12

N19

N20

N2A

N2B

N30

N31

N32

N40

N50

N52

N60

N61

N62

N63

N64

N65

N66

N67

N68

N69

N6A

N70

N71

N72

N80

N99

Code

O01

O02

O03

O05

O11

Alliances & Advocacy

Management & Technical

Assistance

Professional Societies &

Associations

Research Institutes & Public

Policy Analysis

Single Organization Support

Fundraising & Fund Distribution

Support N.E.C.

Youth Centers & Clubs

Boys Clubs

Girls Clubs

Boys & Girls Clubs

Adult & Child - Matching

Programs

Big Brothers & Big Sisters

Scouting

Boy Scouts of America

Girl Scouts of the U.S.A.

Camp Fire

Youth Development Programs

Youth Community Service Clubs

Youth Development - Agricultural

Youth Development - Business

Youth Development - Citizenship

Youth Development - Religious

Leadership

Youth Development N.E.C.

Human Services

Code

P01

P02

P03

P05

P11

P12

P19

P20

P21

P22

P24

P26

P27

Alliances & Advocacy

Employment Services

Professional Societies &

Associations

Research Institutes & Public

Policy Analysis

Single Organization Support

Fundraising & Fund Distribution

Support N.E.C.

Camps

RV (Recreational Vehicle) Parks

& Campgrounds

Recreational and Vacation

Camps (Except Campgrounds)

Physical Fitness & Community

Recreational Facilities

Community Recreational Centers

Parks & Playgrounds

Sports Training Facilities,

Agencies

Recreational Clubs

Fairs

Amateur Sports

Fishing & Hunting

Basketball

Baseball & Softball

Soccer

Football

Racquet Sports

Swimming & Other Water

Recreation

Winter Sports

Equestrian

Golf

Amateur Sports Competitions

Olympics

Special Olympics

Professional Athletic Leagues

Recreation & Sports N.E.C.

Youth Development

O31

O40

O41

O42

O43

O50

O51

O52

O53

O54

O55

O99

Recreation & Sports

Code

N01

N02

N03

O12

O19

O20

O21

O22

O23

O30

P28

P29

P30

P31

P32

P33

P40

P42

P43

P44

P45

P46

P47

P50

P51

P52

P58

P60

P61

P62

P70

P71

P73

P74

P75

P76

P7A

P80

P81

P82

P83

P84

P85

P86

P87

P88

P99

-17-

Alliances & Advocacy

Management & Technical

Assistance

Professional Societies &

Associations

Research Institutes & Public

Policy Analysis

Single Organization Support

Fundraising & Fund Distribution

Support N.E.C.

Human Service Organizations

American Red Cross

Urban League

Salvation Army

Volunteers of America

Young Men’s or Women

Associations

Neighborhood Centers

Thrift Shops

Children & Youth Services

Adoption

Foster Care

Child Day Care

Family Services

Single Parent Agencies

Family Violence Shelters,

Services

In-Home Assistance

Family Services for Adolescent

Parents

Family Counseling

Pregnancy Centers

Personal Social Services

Financial Counseling

Transportation Assistance

Gift Distribution

Emergency Assistance

Travelers’ Aid

Victims’ Services

Residential Care & Adult Day

Programs

Adult Day Care

Group Homes

Hospices

Supportive Housing for Older

Adults

Homes for Children &

Adolescents

Residential Intellectual &

Developmental Disability

Facilities (Group Homes,

Intermediate Care Facilities &

Hospitals)

Centers to Support the

Independence of Specific

Populations

Senior Centers

Developmentally Disabled

Centers

Womens’ Centers

Ethnic & Immigrant Centers

Homeless Centers

Blind & Visually Impaired

Centers

Deaf & Hearing Impaired Centers

LGBT Centers

Human Services N.E.C.

International, Foreign Affairs &

National Security

Code

Q01

Q02

Q03

Q05

Q11

Q12

Q19

Q20

Q21

Q22

Q23

Q30

Q31

Q32

Q33

Q35

Q40

Q41

Q42

Q43

Q50

Q51

Q70

Q71

Q99

Alliances & Advocacy

Management & Technical

Assistance

Professional Societies &

Associations

Research Institutes & Public

Policy Analysis

Single Organization Support

Fundraising & Fund Distribution

Support N.E.C.

Promotion of International

Understanding

International Cultural Exchange

International Academic

Exchange

International Exchange N.E.C.

International Development

International Agricultural

Development

International Economic

Development

International Relief

International Democracy & Civil

Society Development

International Peace & Security

Arms Control & Peace

United Nations Associations

National Security

International Affairs, Foreign

Policy & Globalization

International Economic & Trade

Policy

International Human Rights

International Migration &

Refugee Issues

International, Foreign Affairs &

National Security N.E.C.

Civil Rights, Social Action &

Advocacy

code

R01

R02

R03

R05

R11

R12

R19

R20

R22

R23

R24

R25

R26

R28

R30

R40

R60

R61

R62

R63

R67

R99

Alliances & Advocacy

Organizations

Management & Technical

Assistance

Professional Societies &

Associations

Research Institutes & Public

Policy Analysis

Single Organization Support

Fundraising & Fund Distribution

Support N.E.C.

Civil Rights

Minority Rights

Disabled Persons’ Rights

Womens’ Rights

Seniors’ Rights

Lesbian & Gay Rights

Children’s Rights

Intergroup & Race Relations

Voter Education & Registration

Civil Liberties

Reproductive Rights

Right to Life

Censorship, Freedom of Speech

& Press

Right to Die & Euthanasia

Civil Rights, Social Action &

Advocacy N.E.C.

Community Improvement &

Capacity Building

Code

S01

S02

S03

S05

S11

S12

S19

S20

S21

S22

Alliances & Advocacy

Management & Technical

Assistance

Professional Societies &

Associations

Research Institutes & Public

Policy Analysis

Single Organization Support

Fund Raising & Fund Distribution

Support N.E.C.

Community & Neighborhood

Development

Community Coalitions

Neighborhood & Block

Associations

Appendix A: National Taxonomy of Exempt Entities (NTEE) Codes (Continued)

S30

S31

S32

S40

S41

S43

S46

S47

S50

S80

S81

S82

S99

Economic Development

Urban & Community Economic

Development

Rural Economic Development

Business & Industry

Chambers of Commerce &

Business Leagues

Small Business Development

Boards of Trade

Real Estate Associations

Nonprofit Management

Community Service Clubs

Women’s Service Clubs

Men’s Service Clubs

Community Improvement &

Capacity Building N.E.C.

Philanthropy, Volunteerism &

Grantmaking Foundations

Code

T01

T02

T03

T05

T11

T12

T19

T20

T21

T22

T23

T30

T31

T40

T50

T70

T90

T99

Alliances & Advocacy

Management & Technical

Assistance

Professional Societies &

Associations

Research Institutes & Public

Policy Analysis

Single Organization Support

Fundraising & Fund Distribution

Support N.E.C.

Private Grantmaking

Foundations

Corporate Foundations

Private Independent Foundations

Private Operating Foundations

Public Foundations

Community Foundations

Voluntaryism Promotion

Philanthropy, Charity &

Voluntaryism Promotion

Federated Giving Programs

Named Trusts N.E.C.

Philanthropy, Voluntaryism &

Grantmaking Foundations N.E.C.

Science & Technology

Code

U01

U02

Alliances & Advocacy

Management & Technical

Assistance

U03

U05

U11

U12

U19

U20

U21

U30

U31

U33

U34

U36

U40

U41

U42

U50

U99

Professional Societies &

Associations

Research Institutes & Public

Policy Analysis

Single Organization Support

Fundraising & Fund Distribution

Support N.E.C.

General Science

Marine Science & Oceanography

Physical & Earth Sciences

Astronomy

Chemistry & Chemical

Engineering

Mathematics

Geology

Engineering & Technology

Computer Science

Engineering

Biological & Life Sciences

Research

Science & Technology N.E.C.

Social Science

Code

V01

V02

V03

V05

V11

V12

V19

V20

V21

V22

V23

V24

V25

V26

V30

V31

V32

V33

V34

V35

V36

Alliances & Advocacy

Management & Technical

Assistance

Professional Societies &

Associations

Research Institutes & Public

Policy Analysis

Single Organization Support

Fund Raising & Fund Distribution

Support N.E.C.

Social Science

Anthropology & Sociology

Economics

Behavioral Science

Political Science

Population Studies

Law & Jurisprudence

Interdisciplinary Research

Black Studies

Women’s Study

Ethnic Studies

Urban Studies

International Studies

Gerontology

V37

V99

Labor Studies

Social Science N.E.C.

Public & Societal Benefit

Code

W01

W02

W03

W05

W11

W12

W19

W20

W22

W24

W30

W40

W50

W60

W61

W70

W80

W90

W99

Alliances & Advocacy

Management & Technical

Assistance

Professional Societies &

Associations

Research Institutes & Public

Policy Analysis

Single Organization Support

Fundraising & Fund Distribution

Support N.E.C.

Government & Public

Administration

Public Finance, Taxation &

Monetary Policy

Citizen Participation

Military & Veterans’

Organizations

Public Transportation Systems

Telecommunications

Financial Institutions

Credit Unions

Leadership Development

Public Utilities

Consumer Protection

Public & Societal Benefit N.E.C.

Religion-Related

Code

X01

X02

X03

X05

X11

X12

X19

X20

X21

X22

X30

X40

X50

-18-

Alliances & Advocacy

Management & Technical

Assistance

Professional Societies &

Associations

Research Institutes & Public

Policy Analysis

Single Organization Support

Fundraising & Fund Distribution

Support N.E.C.

Christianity

Protestant

Roman Catholic

Judaism

Islam

Buddhism

X70

X80

X81

X82

X83

X84

X90

X99

Hinduism

Religious Media &

Communications

Religious Film & Video

Religious Television

Religious Printing & Publishing

Religious Radio

Interfaith Coalitions

Religion Related, N.E.C.

Mutual & Membership Benefit

Code

Y01

Y02

Y03

Y05

Y11

Y12

Y19

Y20

Y22

Y23

Y24

Y25

Y30

Y33

Y34

Y35

Y40

Y41

Y42

Y43

Y44

Y50

Y99

Alliances & Advocacy

Management & Technical

Assistance

Professional Societies &

Associations

Research Institutes & Public

Policy Analysis

Single Organization Support

Fundraising & Fund Distribution

Support N.E.C.

Insurance Providers

Local Benevolent Life Insurance

Associations

Mutual Insurance Companies &

Associations

Supplemental Unemployment

Compensation

State-Sponsored Workers’

Compensation Reinsurance

Organizations

Pension & Retirement Funds

Teachers’ Retirement Fund

Associations

Employee-Funded Pension

Trusts

Multi-Employer Pension Plans

Fraternal Societies

Fraternal Beneficiary Societies

Domestic Fraternal Societies

Voluntary Employees Beneficiary

Associations (Non-Government)

Voluntary Employees Beneficiary

Associations (Government)

Cemeteries

Mutual & Membership Benefit

N.E.C.