EFTA00311012.pdf

PAUL HOFFMAN, ATTORNEVS•AT•LAW 41-42 KONGENS GADE POST OFFICE BOX 870 ST. THOMAS. V.S. VIRGIN ISLANDS 00804-0870 September 14, 2000 BY FAX AND REGULAR MAIL Mr. Darren K. Indyke J. Epstein & Company, Inc. 457 Madison Avenue New York, NY 10022 Re: J. Epstein Virgin Islands Foundation, Inc. Dear Darren: Enclosed are copies of Forms 1023 and 8718 which are date-stamped as received by the Virgin Islands Bureau of Internal Revenue on September 13, 2000. The determination letter. when issued by the Internal Revenue Service, will be sent directly to the Foundation at 6100 Red Hook Quarter, St. Thomas, VI 00802. Please send us a copy of the determination letter when received so we can forward it on to Attorney Smalls at the Virgin Islands Bureau of Internal Revenue. Attorney Smalls will then issue a determination letter from the Virgin Islands Bureau of Internal Revenge. Sincerely, PAUL HOFFMAN, a BMW:lb Enclosures cc: Mrs. Cecile R. de Jongh (w/encl.) Barbara Mignon Weatherly EFTA00311012 Form 8713 (Rev. January 1998) onsarunsat ate Traestry Memel Reams Simla user ree run Exempt.uryanlcauvn Determination Letter Request In Attach this form to determination letter application. (Form 8718 is NOT a determination letter application.) Contra number Amami paid Use lea scream 1 Name or organization J F-425 tein Tcancld. Pon HA aticr1, . Caution: Do not attach Form 8778 to an application for a pension plan determination e er. se OfT 8717 instead. 3 Type of request a 0 Initial request for a determination letter for: • An exempt organization that has had annual gross receipts averaging not more than S10.000 during the preceding 4 years. or • A new organization that anticipates gross receipts averaging not more than $10,000 during its firs. 4 years ► Note: If you checked box 3a. you must complete the Certification below. 2 Employer Identification Number Fed $15 Certification I certify that the annual gross receipts of name of organnatiOn have averaged (or are expected to average) not more than $10.000 during the preceding 4 (or the first 4) years : operation. Signature ► Title tio b [s] Initial request for a determination letter for: • An exempt organization that has had annual gross receipts averaging more than S10.000 during the preceding 4 years. or • A new organization that anticipates gross receipts averaging more than $10.000 during its rust 4 years . ► c 0 Group exemption letters Instructions The law requires payment of a user fee with each application for a determination letter. The user fees are listed on line 3 above. For more information, see Rev. Proc. 98-8. 1998.1. I.R.B. 225. Check the box on line 3 for the type of application you are submitting. If you check box 3a. you must complete and scc the carhresticn statemert that appears under line 3a. Attach to Form 8718 a check or money order payable to the Internal Revenue Service for the full amount of the user fee. If you do not include the full amount. your application will be returned. Attach Form 8718 to your determination letter application. RECEIVED WITH REMITTANCE PROCESS & ACCT. BRAWL SEP 1 3 2000 Inv; ISLANDS BUREAU OF INTERNAL REVENUE ST, THOMAS VI SSC SEC Send the determination letter application and Form 8718 to: Internal Revenue Service P.O. Box 192 Covington, KY 41012.0192 If you are using express mail or a delivery service. Send the application and Form 8718 to: Internal Revenue Service 201 West Rivercenter Blvd. Attn: Extracting Stop 312 Covington. KY 41011 FINANCIAL TRUST COMPANY, INC. 6100 RED HOOK QUARTERS, SUITE B-3 ST. THOMAS. USVI 00802 SCOTIABANK THE BANK OF NOVA SCOTIA CHARLOTTE AMALIE ST. THOMAS. USVI HD-605/216 5127 9/I II2000 PAY TO ORDER OFTHE Internal Revenue Service j $ "500.00 Five Hundred and 00/100 DOLLARS SKvmiau Internal Revenue Service r Den en or. THOMAS. LIEU! MEMO PIP EFTA00311013 ,„,1023 le September 19981 lesionent of the henry Iran Reventit Set•Ne Application for Recognition of Exemption Under Section 501(c)(3) of the Internal Revenue Code OMB No. 1545-0056 Note: If exempt ;fetus is appmvert this application wit be open for public inspection. Read the instructions for each Part carefully. A User Fee must be attached to this application. If the required information and appropriate documents are not submitted along with Form 8718 (with payment of the appropriate user fee), the application may be returned to you. Complete the Procedural Checklist on page 8 01 the instructions. art Identification &Applicant a Full name of organization (as shown in organizing document) EDatelb Virstin Islands Foundation. Inc 2 Employer identification number (EIN) PI none. see page 3 of the Specific Instrecifons.1 _ti7 b c/o Name applicable) 3 Name and telephone number of person to be contacted if additional information is needed Jeffrey Schantz c Address (number and street) Room/Suite Suite d City, town, or post office. state. and ZIP • 4. If you have a foreign see Specific Instructions for Part I, page 3. St Thomas. 00102 address. 4 nnua accounting period ends December S Date inconprategbfermed June a, z e Web site address 6 Check here d applying under section: a 0501(e) b 0 501th e ❑SO1 d ❑501 Did the organization previously apply for recognition of exemption under this Code section or under any other section of the Code? II 'Yes." attach an explanation is the organization required to hie Form 990 (or Form 990-EZ)? (2) N/A 0 Yes 0 No if No. attach an explanation (see page 3 of the Specific Instructions). Has the organization filed Federal income tax returns or exempt organization information returns? 0 Yes EtTI No if 'Yes.* state the form numbers. years filed. and Internal Revenittiftwhere PROCESS& ACCT. BRANCH 0 Yes al No SEP 1 3 ma Check the box for the type of organization. ATTASeitigAgyAgfyifrE47.ECOpyrA5y,T2211C.DRRESPONDING ORGANIZING DOCUMENTS TO THE APPLICATION BEFORE MAILING (See Specilic Instructions for Part I. Line 10. on page 3) See also Pub. 557 for examples of organizational documents) a )0 Corporation— Attach a copy of the Articles of Incorporation (including amendments and restatements) showing approval by the appropriate state official: also include a copy of the bylaws. o 0 Trust— Attach a copy of the Trust Indenture or Agreement, including all appropriate signatures and dates. 0 Association— Attach a copy of the Articles of Association. Constitution, or other creating document, with a declaration (see instructions) or other evidence the organization was lormed by adoption of the document by more than one person; also include a copy of the bylaws. If the organization is a corporation or an unincorporated association that has not yet adopted bylaws. check here In: declare under me penalties of perpsy Mat I am sulhoroied to yin inn Opkeati011 on behae of the above organization and that i hare clammed inn application gong tn. accompanying scneeuies and attachments. and to the test of my knowledge *I is true. correct and complete ase .• • n Inn EFTA00311014 Form 1021 (Rey 9181 Page 2 Part Activities and Operational Inforrnation Provide a detailed narrative description of all the activities of the organization-past, present, and planned. Do not merely refer to or repeat the language in the organizational document. List each activity separately in the order of importance based on the relative time and other resources devoted to the activity. Indicate the percentage of time for each activity. Each description should include, as a minimum, the following: (a) a detailed description of the activity including its purpose and how each acitivity furthers your exempt purpose: (b) when the activity was or will be initiated: and (c) where and by whom the activity will be conducted. The Foundation intends to use its financial resources to support other not-for-profit organizations exempt under Section 501(c)(3) of the Internal Revenue Code. It will from time to time hold funds in in interest bearing accounts or investments in income yielding securities. Any income derived from such investments will be used for its stated exempt purposes. The activities of the Foundation will be administered by its Board of Trustees and duly appointed officers. 2 What are or will be the organization's sources of financial support? List in order of size. The Foundation will be funded principally by contributions from the initial donor. 3 Describe the organization's fundraising program. both actual and planned, and explain to what extent it has been put IMO effect. Include details of fundraising activities such as selective mailings. formation of fundraising committees. use of volunteers or professional fundraisers, etc. Attach representative copies of solicitations for financial support. No fund raising activities are planned for the Foundation. EFTA00311015 form 7023 IRO 'I'M Page 3 Part 11 Activities and Operational IrfOrmation (Continua. 4 Give the following information about the organization's governing body: a Names. addresses. and titles of officers. directors, trustees. etc. b Annual compensation Jeffrey Epstein - Trustee, President and Treasurer None c/o American Yacht Harbor, 6100 Red Hook, Quarters #2, St. Thomas, U.S.V.I. 00802 Paul Hoffman - Trustee, Vice President, Asst. None Treasurer and Asst. Secretary 41-42 Kongens Gade, St. Thomas, U.S.V.I. 00802 Jeffrey Schantz - Trustee, Vice President and None Secretary 457 Madicnn 417orsua, Ath Now York, NY 10032 e Oo any of the above persons serve as members of the governing body by reason of being public officials or being appointed by public officials? O Yes No If 'Yes.' name those persons and explain the basis of their selection or appointment. —> a U.S.V.I. corporation which is the initial donor and a substantial contibutor to the Foundation. Mr. Schantz is an employee of a business entity controlled by Mr. Epstein. d Are any members of the organization's governing body 'disqualified persons" with organization (other than by reason of being a member of the governing body) or do any have either a business or family relationship with 'disqualified persons"? (See Specific Part II, Line 4d. on page 3 ) if -res.- explain. Jeffrey Epstein, Trustee, President and Schantz, Trustee, Vice President and Secretary, of disqualified persons. Mr. Epstein is a principal, Pr door ann Mr- ccnanta }s a director Does the organization control or is it controlled by any other organization" is the organization the outgrowth of (or successor to) another organization, or does it have a special relationship with another organization by reason of interlocking directorates or other factors? . . . Yes O No if either of these questions is answered 'Yes." explain. See response to item 4.d. above. Mr. Epstein is director and President of The C.0.U.Q. Foundation, Inc. and a Trustee of the J. Epstein Foundation both of which are already qualified under Section 501(c)(3) of the Internal Revenue Code. It is not intended that there will be any dealings between either of these organizations and the Foundation. respect to the of the members Instructions for co Yes O No Treasurer, and Jeffrey the Foundation, are a director and the 6 Does or will the organization directly or indirectly engage in any of the following transactions with any political organization or other exempt organization (other than a 501(c)(3) organization). (a) grants: (b) purchases or sales of assets; (c) rental of facilities or equipment; (d) loans or loan guarantees. (e) reimbursement arrangements; (0 performance of services, membership, or fundraising solicitations; or (g) sharing of facilities. equipment, marling lists or other assets. or paid employees' K Yes No 'Yes: explain fully and identify the other organizations involved. 7 Is the organization financially accountable to any other organization' O Yes )p No if - Yes," explain and identify the other organization. Include details concerning accountability or attach copies of reports if any have been submitted C. EFTA00311016 Fenn 1023 IRev 9 99) Pave 4 Part II Activities and Operational Inkeniatian (Ccritinual 8 What assets does the organization have that are used in the performance of its exempt function? (Do. not include property producing investment income.) If any assets are not fully operational, explain their status, what additional steps remain to be completed, and when such final steps will be taken. If none, indicate -NIA: N/A 9 Will the organization be the beneficiary of tax-exempt bond financing within the next 2 years?. . O Yes El No 10a Will any of the organization's facilities or operations be managed by another organization or individual under a contractual agreement' O Yes fa No b Is the organization a party to any leases? O Yes J No If either of these questions is answered 'Yes; attach a copy of the contracts and explain the relationship between the applicant and the other parties. 11 Is the organization a membership organization? O Yes Q No If 'Yes.' complete the following: a Describe the organization's membership requirements and attach a schedule of membership fees and dues. b Describe the organization's present and proposed efforts to attract members and attach a copy of any descriptive literature or promotional material used for this purpose. c What benefits do (or will) the members receive in exchange for their payment of dues" 12a if the organization provides benefits. services, or products. are the recipients required. or will they be required. to pay for them? N/A O Yes O No If -yes: explain how the charges are determined and attach a copy of the current fee schedule. b Does or will the organization limit its benefits, services. or products to specific individuals or classes of individuals? N/A O Yes O No if - Yes: explain how the recipients or beneficiaries are or will be selected. 13 Does or will the organization attempt to influence legislation? O Yes No if 'Yes.- explain. Also. give an estimate of the percentage of the organization's time and funds that it devotes or plans to devote to this activity 14 Does or will the organization intervene in any way in political campaigns. including the publication or distribution of statements' 1/ Yes,' ?)i plain fully O Yes No EFTA00311017 F011,1 1023 Rea 9.9a1 Page 5 Part III Technical Reqdrennents 1 Are you filing Form 1023 within 15 months from the end of the month in which your organization was created or formed" LYes K No If you answer "Yes,* do not answer questions on lines 2 through 6 below. 2 If one of the exceptions to the 15-mOnth filing requirement shown below applies. check the appropriate box and proceed to question 7. Exceptions— You are not required to file an exemption application within 15 months if the organization: a Is a church. interchurch organization of local units of a church, a convention or association of churches. or an integrated auxiliary of a church. See Specific Instructions, Line 2a. on page 4: b Is not a private foundation and normally has gross receipts of not more than 55.000 in each tax year: or c Is a subordinate organization covered by a group exemption letter, but only if the parent or supervisory organization timely submitted a notice covering the subordinate. 3 if the organization does not meet any of the exceptions on line 2 above. are you filing Form 1023 within 27 months from the end of the month in which the organization was created or formed? K Yes K No il "Yes.- your organization qualifies under Regulation section 301.9100-2. for an automatic 12 month extension of the 15 -month filing requirement. Oo not answer questions 4 through 6. if 'No.- answer question 4 4 II you answer No to question 1. does the organization wish to request an extension of time to apply under the 'reasonable action and good faith' and the 'no prejudice to the interest of the government* requirements of Regulations section 301 9100-3? K Yes K No if "Yes." give the reasons for not filing this application within the 27-month period described in question 3 See Specific Instructions, Part HI. Line 4. before completing this item. Do not answer questions 5 and 6 if No. answer questions 5 and 6 5 :1 you answer -No' to question 4. your organizations qualification as a section 501(c)(3) organization can be recognized only from the date this application is filed. Therefore, do you want us to consider the application as a request for recognition of exemption as a section 501(c)(3) organization from the date the application is received and not retroactively to the date the organization was created or formed' . K Yes K No 6 it you answer 'Yes' to question S above and wish to request recognition of section 501(c1(4) status for the period beginning with the date the organization was formed and ending with the date the Form 1023 application was received (the effective date of the organizations section 501(O31 status). check here ► K and attach a completed page 1 of Form 1024 to this application EFTA00311018 Form 1023 Pm 9el Page 6 Part Techrical Requirements (antimal 7 is the organization a private foundation? Na Yes (Answer question 8.) K No (Answer question 9 and proceed as instructed.) 8 II you answer "Yes" to question 7. does the organization claim to be a private operating foundation? K Yes (Complete Schedule E.) fR No After answering quesiacrt 8 m this tire. go to lire 14 cri page 7. 9 If you answer 'No' to question 7. indicate the public charity classification the organization is requesting by checking the bnx below that most appropriately applies: THE ORGANIZATION IS NOT A PRIVATE FOUNDATION BECAUSE IT QUALIFIES: a K As a church or a convention or association of churches Sections 509(a)(1) (CHURCHES MUST COMPLETE SCHEDULE A.) and 170(b)(1)(A)(i) Sections 509(a)(1) b K As a school (MUST COMPLETE SCHEDULE B.) and 170(3)(1)(Allii) e K As a hospital or a cooperative hospital service organization, or a medical research organization operated in conjunction with a hospital (These organizations, except for hospital service organizations. MUST COMPLETE SCHEDULE C.) Sections S09(a)(1) d K As a governmental unit described in section 110(c)(1). and 170(b)(1)(A)(v) e K As being operated solely for the benefit of, or in connection with. one or more of the organizations described in a through d, g, h, or i (MUST COMPLETE SCHEDULE 0.) I K As being organized and operated exclusively for testing for public safety. Section S09(a)(4) g K As being operated for the benefit of a college or university that is owned or operated by a governmental unit. h K As receiving a substantial pail of its support in the form of contributions from publicly supported organizations. from a governmental unit, or from the general public. Sections 509(a)(1) and 170(b)(1)(A)(iii) Section 509(a)(3) Sections S09(a)(1) and 170())(1)(A)(ivl Sections S09(a)(1) and 1701b1110)(vd K As normally receiving not more than one-third of its support from gross investment income and more than one•third of its support from contributions, membership fees. and gross receipts from activities related to its exempt functions (subject to certain exceptions). Section S09(a)(2) j K The organization is a publicly supported organization but is not sure whether it meets the public support test of h or i. The organization would like the 'RS to decide the proper classification. Sections sos(a)(1) and I 70021(1)(Allvil or Section 509(a)(2) If you checked one of the boxes a through I in question 9, go to question 14. If you checked box g in question 9, go to questions 11 and 12. If you checked box h, i, or j, in question 9, go to question 10. EFTA00311019 F dim 1023 iRev 9.90) Page 7 Part III Technical Requinernents (Contrive°, 10 If you checked box h, i, or j in question 9, has the organization completed a tax year of at least 8 months? O Yes—Indicate whether you are requesting: O A definitive ruling. (Answer questions 11 through 14.) O An advance ruling. (Answer questions 11 and 14 and attach two Forms 1372.G completed and signed.) K No—You must request an advance ruling by completing and signing two Forms $72-C and attaching them to the Form 1023. 11 If the organization received any unusual grants during any of the tax years shown in Part IV-A. Statement of Revenue and Expenses, attach a list for each year showing the name of the contributor: the date and the amount of the grant; and a brief description of the nature of the grant. 12 II you are requesting a definitive ruling under section 170(1)0)(0v) or (vi), check here ► O and: a Enter 2% of line 8, column (e), total, of Part IV-A h Attach a list showing the name and amount contributed by each person (other than a governmental unit or "publicly supported" organization) whose total gifts, grants, contributions. etc., were more than the amount entered on line 12a above. 13 If you are requesting a definitive ruling under section 509(a)(2). check here ► O and: 14 a For each of the years included on lines 1. 2. and 9 of Part IV.A, attach a list showing the name of and amount received from each 'disqualified person.' (For a definition of 'disqualified person,' see Specific Instructions, Part II. Line 4d, on page 3.1 to For each of the years included on line 9 of Part IV-A. attach a list showing the name of and amount eceived from each payer (other than a 'disqualified person') whose payments to the organization were more than SS,000. For this purpose. 'payer" includes, but is not limited to. any organization described in sections 110(b)(1)(A)(i) through i) and any governmental agency or bureau. indicate if your organization is one of the following. II so. complete the required schedule. (Submit If "Yes,' only those schedules that apply to your organization. Do not submit blank schedules.) Yes No complete Schedule: is the organization a church, is the organization. or any part of it, a school? is the organization. or any part of it. a hospital or medical research organization? . X A B C is the organization a section 509(a)(3) supporting organization? X 0 is the organization a private operating foundation? is the organization, or any part of it, a home for the aged or handicapped? is the organization. or any part of it. a child care organization? X E Does the Organization provide or administer any Scholarship benefits, student aid, etc 7 El Has the organization taken over or will it take over, the facilities of a 'for prole institution, X EFTA00311020 F we 1023 leer 9 981 Page 8 Part IV Financial Data Complete the financial statements for the current year and for each of the 3 years immediately before it. If in existence less than 4 years. complete the statements for each year in existence. If in existence less than 1 year, also provide proposed budgets for the 2 years following the current year. A Stater ran of Reueruo ad BA:tenses I Gifts. grants, and contributions reamed (not including unusual grants-see page 6 of the instructions) 2 Membership fees received 3 Gross investment income (see instructions for definition) 4 Net income from organization's unrelated business activities not included on line 3 5 Tax revenues levied for and either paid to or spent on behalf of the organization 6 Value of services a facilities lumisted by a governmental unit to the aganization without charge (not including the value of services or fealties generally ftsnished the public without charge) . 7 Other income (not including gain or loss from sale of capital assets) (attach schedule) 8 Total (add lines 1 through 7) 9 Gross peelers from admissions, sales d mattandise or services. or furnshng of facilities in any activity that rs not an unrelated business within the meaning of section 513. Include related cost of sates on line 22 10 Total (add lines 8 and 9) 11 Gain Gloss from sale of capital assets (attach schedule) 12 Unusual grants 13 Total revenue (add lines 10 through 12) Current tax year 3 prior tax years or proposed budget for 2 years (*from 6J15 to 4/13 (b) 2001 (c) 2002 (dl (e) TOTAL 1$7,son 25411111 25,OOO 237, 500 1 0, 000 10,000 20, 00 0 187,500 35,000 35,000 257,5OO 14 Fundranng expenses . . . 15 Contributions. gifts. grants. and similar amounts paid (attach schedule) 16 Disbursements to or for benefit of members (attach schedule) . 17 2, 18 PC LI 19 20 21 22 23 Compensation of officers. directors. and trustees (attach schedule) Other salaries and wages- Interest Occupancy (rent, utilities. etc.) Depreciation and depletion Other (attach schedule) . Total ”roenses ladd Ines L1 37, 500 37,500 EFTA00311021 Form 1023 Ian 3.911) Page 9 Part IV Financial Data (Contirvect EL Balance Sheet (a the end of the period shone Current tag year Date9 inn Assets 1 Cash 2 Accounts receivable. net 1 Inventories 4 Bonds and notes receivable (attach schedule) 5 Corporate stocks (attach schedule) 6 Mortgage loans (attach schedule) 7 Other investments (attach schedule) 8 Depreciable and depletable assets (attach schedule) 9 Land 0 Other assets (attach schedule) 1 Total assets (add tines 1 through 10) Liabilities Accounts payable 3 Contributions. gills. grants. etc . payable 4 Mortgages and notes payable (attach schedule) 5 Other liabilities (attach schedule) 6 Total liabilities (add lines 12 through 15) Fund Balances n Net Assets 7 Total fund balances or net assets 8 Total liabilities and fund balances or net assets (add line 16 and line 17) there has been any substantial change in any aspect of the organization's financial activities since the end of the period hown above. check the box and attach a detailed explanation 1 187,500 2 3 4 6 7 8 9 10 11 12 187,500 13 14 15 16 17 18 187,500 EFTA00311022 Jeffrey E. Epstein CERTIFICATION OF BY-LAWS OF J. EPSTEIN VIRGIN ISLANDS FOUNDATION, INC. I, as the sole member ofJ. EPSTEIN VIRGIN ISLANDS FOUNDATION, INC., state that on June 15, 2000, I adopted By-Laws for the J. EPSTEIN VIRGIN ISLANDS FOUNDATION, INC., and the attached is a true and complete copy of the said By-Laws of J. EPSTEIN VIRGIN ISLANDS FOUNDATION, INC. In witness whereof I set my hand and seal this-to uly, 2000. EFTA00311023 ARTICLES OF INCORPORATION RECEIVED OF LT. li0V. OFFICE W : J. EPSTEIN VIRGIN ISLANDS FOUNDATION, M 13 P 1 48' ::;:.T!nt13 We. the undersigned natural persons of the age of twenty-one years or more. all of whom are bona tide residents of the Virgin Islands of the United States, acting as incorporators of a corporation to be named J. Epstein Virgin Islands Foundation. Inc.. do adopt the following Articles of Incorporation for such corporation pursuant to the Nonprofit Corporations Law of the Virgin Islands (Chapter 3. Title 13. Sections 491 et seq. of the Virgin Islands Code), as the same may be amended from time to time, do make and tile these Articles of Incorporation in writing and do certify: ARTICLE I The name of the corporation (hereinafter referred to as the "Corporation") is J. EPSTEIN VIRGIN ISLANDS FOUNDATION, INC. ARTICLE II The principal office of the Corporation in the Virgin Islands is located at 41-42 Kongens Gade. St. Thomas. Virgin Islands. and the name of the resident agent of the Corporation at that address is Paul Hoffman. ARTICLE III A. The Corporation is organized exclusively for charitable, educational and scientific purposes within the meaning of section 501(c)(3) of the Internal Revenue Code of 1986 (or the corresponding provision of subsequent tax law). Notwithstanding any other provision of these Articles. the Corporation shall not carry on any activities not permitted to be carried on 0) by a corporation exempt from federal income tax under Section 501(c)(3). or (ii) by a corporation. contributions to which are deductible under Sections 170(c)(2). 2055(ai(2). 2106ta it21( A )( ii). 2522(aif 2) or 25.2203)(2). B. No part of the net earnings of the Corporation shall inure to the benefit of any individual. The Corporation shall. however. be authorized and empowered to pay reasonable compensation for services rendered and to make payments in furtherance of its purposes. The Corporation may cam on propaganda or otherwise attempt to influence legislation but only to the extent permitted by the Internal Revenue Code. The Corporation shall not participate in. or intervene in (including the publishing or distributing of statements t. any political campaign on behalf of or in opposition to any candidate for public office. EFTA00311024 Articles of Incorporation Page 2 ARTICLE IV The member of the Corporation shall be Jeffrey E. Epstein or such person or entity as he shall designate in writing. ARTICLE V A. The Corporation shall be managed by a Board of Trustees which may further delegate management responsibilities to the officers of the Corporation. The number of Trustees constituting the Board of Trustees is three. The number of Trustees may be increased or decreased from time to time by amendment to the By-laws. but in no event shall the number be less than three. B. The names and addresses of the initial Board of Trustees are as follows: Paul Hoffman 41-42 Kongens Gade St. Thomas, VI 00802 Jeffrey Epstein Jeffrey Schantz 6100 Red Hook Quarter. Suite B-3 American Yacht Harbor St. Thomas. VI 00802 6100 Red Hook Quarter. Suite B-3 American Yacht Harbor St. Thomas. VI 00802 C. Trustees shall be elected by the member as specified in the By-Laws. Any vacancy occurrinu in the Board of Trustees upon the death. resignation, expiration of term of office. or removal °lam Trustee. or as a result of an increase in the number of Trustees. shall be tilled by a majority vote of the remaining members of the Board of Trustees then in office under procedures specified in the - Law s. D. The names and addresses of the initial Officers of the Corporation are as follows: President Jeffrey Epstein 6100 Red Hook Quarter. Suite 13-3 American Yacht Harbor St. Thomas. VI 00802 EFTA00311025 Articles of Incorporation Page 2 ARTICLE IV The member of the Corporation shall be Jeffrey E. Epstein or such person or entity as he shall designate in writing. ARTICLE V A. The Corporation shall be managed by a Board of Trustees which may further delegate management responsibilities to the officers of the Corporation. The number of Trustees constituting the Board of Trustees is three. The number of Trustees may be increased or decreased from time to time by amendment to the By-laws. but in no event shall the number be less than three. B. The names and addresses of the initial Board of Trustees are as follows: Paul Hoffman 41-42 Kongens Gade St. Thomas, VI 00802 Jeffrey Epstein Jeffrey Schantz 6100 Red Hook Quarter. Suite 13-3 American Yacht Harbor St. Thomas. VI 00802 6100 Red Hook Quarter. Suite B-3 American Yacht Harbor St. Thomas. VI 00802 C. Trustees shall be elected by the member as specified in the By-Lau s. Any vacancy occurring in the Board of Trustees upon the death. resignation. expiration of term of office. or removal of an. Trustee. or as a result of an increase in the number of Trustees. shall be tilled by a majority vote of the remaining members of the Board of Trustees then in office under procedures specified in the - Law s. The :lames and addresses of the initial Officers of the Corporation are as follows: President Jeffrey Epstein 6 i 00 Red Hook Quarter. Suite B-$ American Yacht Harbor St. Thomas. VI 00802 EFTA00311026 Articles of Incorporation Page 3 Vice President Vice President Secretary Treasurer Assistant Secretary Assistant Treasurer Jeffrey Schantz 6100 Red Hook Quarter. Suite B-3 American Yacht Harbor St. Thomas, VI 00802 Paul Hoffman 4142 Kongens Gade St. Thomas. VI 00802 Jeffrey Schantz 6100 Red Hook Quarter. Suite 8-3 American Yacht Harbor St. Thomas. VI 00802 Jeffrey Epstein 6100 Red Hook Quarter. Suite B-3 American Yacht Harbor St. Thomas. VI 00802 Paul Hoffman 41-42 Koneens Gade St. Thomas. VI 00802 Paul Hoffman 4142 Koneens Gade St. Thomas. VI 00802 E. The officers of the Corporation shall be elected at an annual meeting of the Board ot'Trustees un a date to he specified in the By-Laws. ARTICLE VI The Corporation is to have perpetual existence. ARTICLE VII A. -The-initial By-Laws of theCorporation shall be adopted by the Board of TrusieeiTihich may alter. amend or repeal the By-Laws or adopt new By-Laws. EFTA00311027 Articles of Incorporation Page 4 B. In the event of the dissolution or final liquidation of the Corporation: (1) None of the property of the Corporation nor any proceeds thereof shall be distributed to or divided among any of the Trustees or officers of the Corporation or inure to the benefit of any individual. (2) After all liabilities and obligations of the Corporation have been paid. satisfied and discharged. or adequate provisions made therefor. all remaining property and assets of the Corporation shall be distributed for an exempt purpose or for public use in accordance with section 501(c)(3) of the Internal Revenue Code of 1986 (or the corresponding provision of subsequent tax law) and the regulations issued thereunder. ARTICLE VIII The names and addresses of the persons who are the incorporators of the Corporation are as follows: Barbara Mignon Weatherly Paul Hoffman Jeffrey Epstein 2-21 Bonne Esperance St. Thomas. Virgin Islands 4142 Kongens Gade St. Thomas. VI 00802 6100 Red Hook Quarter. Suite B-3 American Yacht Harbor St. Thomas. VI 00802 ARTICLE IX The amount of indebtedness to which the Corporation may be subject is unlimited. ARTICLE X The articles of incorporation may be amended when authorized by a vote of two-thirds of the members comprising the membership of this Corporation. given at a meeting. or by the written consent of all the members without a meeting. EFTA00311028 Articles of Incorporation Page 5 IN WITNESS WHEREOF we have made, signed and acknowledged these Articles of Incorporation thisL day of 2000. BARB MI ON THE PAUL HOFF AN JEPFREY EPSTEIN TERRITORY OF THE VIRGIN ISLANDS ) )ss: DIVISION OF ST. THOMAS & ST. JOHN ) The foregoing instrument was acknowledged before me this / V day of by Barbara Mignon Weatherly and Paul Hoffman. STATE OF NEW YORK COUNTY OF N Notary Public )ss: X/ Linos it Pubic No. 81 'Munn!' Ira John, 13.8. Icon aA hip Commission expires Lela 2000 The foregoing instrument was acknowledged before me this it. day of June 2000 by Jeffrey Epstein. Notary Public LAUREN J. KWINTNER Notary Public, State of New York No. 02KW6016686 Oualified in New York Count). U+ Commission Expires November 30, 20 EFTA00311029 BY-LAWS OF J. EPSTEIN VIRGIN ISLANDS FOUNDATION ARTICLE I OFFICE The principal business office of J. EPSTEIN VIRGIN ISLANDS FOUNDATION (the "Corporation") shall be located at 41-42 Kongens Gade, St. Thomas, Virgin Islands. The Corporation may establish and maintain other offices in the Virgin Islands, any of the States or possessions of the United States, and at such other places as may from time to time be selected by the Board of Trustees. ARTICLE II CORPORATE SEAL The corporate seal of the Corporation shall have inscribed thereon the name of the Corporation. the year of its incorporation and the words "Virgin Islands". The Seal shall be in the possession of the Secretary of the Corporation. ARTICLE III BOARD OF TRUSTEES SECTION I. Number. Classification and Term of Office. The business, affairs, concerns, direction and the property of the Corporation shall be managed and controlled by the Board of Trustees. The number of Trustees shall be three (3), but the number may be changed from time to time by the amendment of these By-Laws, but in no event shall the number be less than three (3). Trustees may be elected by the written consent of the member. Any vacancy occurring in the Board of Trustees upon the death, resignation. expiration of term of office, or removal of any Trustee, or as a result of an increase in the number of Trustees, shall be filled by the consent of the member or by a majority vote of the remaining members of the Board of Trustees then in office. EFTA00311030 By-Laws Page 2 The first Board of Trustees of the Corporation shall be composed of Paul Hoffman, Jeffrey Epstein and Jeffrey Schantz, who, subject to Article III, Section 6, shall hold office until new trustees are elected by the member. SECTION 2. Place of Meeting. The Trustees may hold their meetings in such place or places within or without the Virgin Islands as a majority of the Board of Trustees may, from time to time, determine. SECTION 3. Meetings. Meetings of the Board of Trustees may be called at any time by the President or the Secretary, or by a majority of the Board of Trustees. Trustees shall be notified in writing of the time, place and purpose of all meetings of the Board. Any trustee shall, however, be deemed to have waived such notice by his attendance at any meeting. SECTION 4. ationtii . A majority of the Board of Trustees shall constitute a quorum for the transaction of business, and if at any meeting of the Board of Trustees there is less than a quorum present. a majority of those present may adjourn the meeting from time to time. SECTION 5. Manner of Acting. At all meetings of the Board of Trustees, each trustee present shall have one vote. Except as otherwise provided by statute, by the Articles of Incorporation, or by these By-Laws, the action of a majority of the Trustees present at any meeting at which a quorum is present shall be the act of the Board of Trustees. Any action authorized, in writing, by all of the Trustees entitled to vote thereon and filed with the minutes of the Corporation shall be the act of the Board of Trustees with the same force and effect as if the same had been passed by unanimous vote at a duly called meeting of the Board, at which a quorum was present. SECTION 6. Removal and Vacancies. Any Trustees may be removed by a majority vote of the Board of Trustees or by the written consent of the member, and vacancies in the Board of Trustees shall be filled by the member or by the remaining members of the Board and each person so elected shall be a Trustee until his successor is elected. SECTION 7. Compensation. No Trustee shall receive any salary or compensation for his services as a trustee. unless otherwise especially ordered by the Board of Trustees or these By-Laws. EFTA00311031 By-Laws Page 3 ARTICLE IV OFFICERS SECTION 1. Election. The Board of Trustees shall select a President, a Secretary and a Treasurer and may select one (1) or more Vice-Presidents, Assistant Secretaries or Assistant Treasurers, who shall be elected by the Board of Trustees at their regular annual meeting held annually on a date from time to time specified by the Board. The term of office shall be for one (1) year and until their successors are chosen. No one of such officers, except the President, need be a Trustee, but a Vice-President who is not a Trustee, cannot succeed to or fill the office of President. Any two (2) of the above-named offices, except those of President and Secretary, may be held by the same person, but no officer shall execute, acknowledge or verify any instrument in more than one (1) capacity. The Board of Trustees may fix the salaries of the officers of the Corporation. SECTION 2. The Board of Trustees may also appoint such other officers and agents as they may deem necessary for the transaction of the business of the Corporation. All officers and agents shall respectively have such authority and perform such duties in the management of the property and affairs of the Corporation as may be designated by the Board of Trustees. Any officer or agent may be removed, or any vacancies filled by the Board of Trustees whenever, in their judgment, the business interests of the Corporation will be served thereby. SECTION 3. The Board of Trustees may secure the fidelity of any or all such officers by bond or otherwise. ARTICLE V DUTIES OF OFFICERS SECTION 1. President. The President shall be the chief executive officer of the Corporation. and in the recess of the Board of Trustees shall have the general control and management of its business and affairs subject. however. to the right of the Board of Trustees to delegate any specific power. except such as may be by statute exclusively conferred upon the President, to any other officer or officers of the Corporation. He shall preside at all meetings of the Trustees and all meetings of the member. unless otherwise determined by the member. SECTION 2. Vice-President. In case the office of President shall become vacant by death. resignation or otherwise. or in case of the absence of the President or his inability to discharge the duties of his office. such duties shall, for the time being, devolve upon the Vice-President, who shall EFTA00311032 By-Laws Page 4 do and perform such other acts as the Board of Trustees may, from time to time, authorize him to do, but a Vice-President who is not a Trustee cannot succeed to or fill the office of President. SECTION 3. Treasurer. The Treasurer shall have custody and keep account of all money, funds and property of the Corporation, unless otherwise determined by the Board of Trustees, and he shall render such accounts and present such statement to the Board of Trustees and President as may be required of him. He shall deposit all funds of the Corporation which may come into his hands in such bank or banks as the Board of Trustees may designate. He shall keep the bank accounts in the name of the Corporation and shall exhibit his books and accounts, at all reasonable times, to any trustee of the Corporation upon application at the office of the Corporation during business hours. He shall pay out money as the business may require upon the order of the properly constituted officer or officers of the Corporation, taking proper vouchers therefor; provided, however, that the Board of Trustees shall have power by resolution to delegate any of the duties of the Treasurer to other officers, and to provide by what officers, if any, all bills, notes, checks, vouchers, orders or other instruments shall be countersigned. He shall perform, in addition, such other duties as may be delegated to him by the Board of Trustees. SECTION 4. Secretary. The Secretary of the Corporation shall keep the minutes of all the meetings of the member of the Corporation and Board of Trustees in books provided for that purpose; he shall attend to the giving and receiving of all notices of the Corporation; he shall sign, with the President or Vice-President, in the name of the Corporation, all contracts authorized by the Board of Trustees and when necessary shall affix the corporate seal of the Corporation thereto; he shall have charge of such books and papers as the Board of Trustees may direct; all of which shall at all reasonable times be open to the examination of any Trustee upon application at the office of the Secretary. and in addition, he shall have such other duties as may be delegated to him by the Board of Trustees. ARTICLE VI AMENDMENT The member or the Board of Trustees may alter, amend, add to or repeal these By-Laws. including the fixing and altering of the number of members of the Board of Trustees; provided that the Board of Trustees shall not make or alter any By-Laws fixing their qualifications, classifications or term of office. EFTA00311033 Vg Department of the Treasury Internal Revenue Service Application for Recognition of Exemption Under Section 501(c)(3) of the Internal Revenue Code Contents: Form 1023 and Instructions Form 872-C Note: For the addresses for filing Form 1023, see Form 8718, User Fee for Exempt Organization Determination Letter Request. For obtaining an employer identification number (E1N), see Form SS-4, Application for Employer Identification Number. Package 1023 (Rev. September 1998) Cat Nu <Mt: EFTA00311034 Department of the Treasury Internal Revenue Service Instructions for Form 1023 (Revised September 1998) Application for lecogition of Exerrption Under Section 5O1(c)(3) of the Internal Revenue Code Note: Retain a copy of the completed form 7013 m the organization's permanent records. See Public Inspection of Form 1021 regarding public inspection of approved applications. General Instructions Section references are to the Internal Revenue Code unless otherwise noted. User Fee.— Submit with the Form 1023 application for a determination letter. a Form 8718, User Fee for Exempt Organization Determination t elver Request, and the user fee called for in the Form 8118. You may obtain Form 8718. and additional forms and publications, through your local IRS office or by calling 1.800.829.3676 (1.800 -TAX -FORM). User fees are subject to change on an annual basis. Thetelore, be sure that you use the most current Form 8718. Helpful information.—For additional information. see: • Pub. 557, Tax•E rem pt Status for Your Organization • Pub. 598, Tax on Unrelated Business Income of Exempt Organizations • Pub. 578, Tax Information for Private Foundations and foundation Managers • Internet site, www rs.ustreas.govitrus_inforeor Purpose of Form 1. Completed Form 1023 required for section S01(c)(3) exemption.—Unless it meets one of the exceptions in 2 below, any organization formed alter October 9. 1969. must he a Form 1023 to qualify as a section 501lc)(31 organization the IRS determines if an organization is a private foundation from the information entered on a Form 1023. 2. Organizations not required to tile Form 1023.—The following types of organizations may be considered tax-exempt under section 5011c93) even rf they do not hie Form 1023: 1. Churches. 2. Integrated auxiliaries of churches. and conventions or associations of churches. or 3. Any organization that: (a) Is not a private foundation (as defined in section 509(a)), and (b) Has gross receipts in each taxable year of normally not more than 55.000. Even d the above organizations are not required to file Form 1023 to be tax•exempt. these organizations may choose to file form 1023 in order to receive a determination letter that recognizes thew section 501(c)(3) status. Section 501)03) status provides certain incidental benefits such as: • Public recognition of lax -exempt status. • Advance assurance to donors of deductibility of contributions. • Exemption horn certain state taxes. • Exemption from certain Federal excise taxes. • Nonprofit mailing privileges. etc. 3. Other organizations.— Section 501(e) and 9) cooperative service organizations. section 501(k) child care organizations, and section 501(n) charitable risk pools use Form 1023 to apply for a determination letter under section 5011013). 4. Group exemption letter.—Generally. Form 1023 is not used to apply for a group exemption letter. See Pub. 557 for information on how to apply for a group exemption letter. 1A,hat To File All applicants must complete pages I through 9 of Form 1023. These organizations must also complete the schedules or form indicated: 1. Churches Schedule A 2. Schools Schedule 8 3. Hospitals and Medical Research Schedule C 4. Supporting Organizations (5091a931) Schedule S. Private Operating Foundations Schedule E 6. Homes for the Aged or Handicapped . . Schedule F 7. Child Care Schedule G B. Scholarship Benefits or Student Aid Schedule H 9. Organizations that have taken over or will take over a "lot prole institution Schedule I 10. Organizations requesting an advance ruling in Part lit line 10 Form 872-C Attachments.— For any attachments submitted with Form 1023.— • Show the organization's name. address. and employer identification number (FIN). • Identify the Part and line item number to which the attachment relates. • Use 81/2 x 11 inch paper for any attachments. • Include any court decisions. rulings, opinions, etc.. that will expedite processing of the application. Generally. attachments rn the form of tape recordings are not acceptable unless accompanied by a transcript. When To File An organization formed after October 9, 1969. must file Form 1023 to be recognized as an organization described in section 501(c)(3). Generally. if an organization files its application within 15 months after the end of the month in which it was formed. and if the IRS approves the application, the effective date of the organization's section 501(c)(3) status will be the date it was organized. Generally, if an organization does not file its application (Form 1023) within 15 months after the end of the month in which it was formed, it will not qualify for exempt status during the period before the date of its application. For exceptions and special rules. including 23. automatic extensions in some cases, see Part Ill of Form 10 The date of receipt of the Form 1023 is the date of the U.S. postmark on the cover in which an exemption application is mailed or. if no postmark appears on the cover, the date the application is stamped as received by the IRS. Private delivery services.—See the instructions for your income tax return for information on certain private delivery services designated by the IRS to meet the 'timely mailing as timely filing/paying rule? The private delivery service can tell you how to get written proof of the mailing date. Caution: Private delivery services cannot deliver items to P.O. boxes. You must use the U. S. Postal Service to mail any item to an IRS P.O. box address. See the FOOD 8718 for the P.O. box address as well as the express mail or a delivery service address. lAhere To File Eire the completed Form 1023 application. and all required information, with the IRS at the address shown in Form 8718. The IRS will determine the organization's tax-exempt status and whether any annual returns must be filed. Signature ReqUierrents An officer. a trustee who is authorized to sign. or another person authorized by a power of attorney. must sign the Form 1023 application. Attach a power of attorney to the application. You may use Form 2114e, Power of Attorney and Declaration of Representative. lot this purpose. EFTA00311035 Deductibility of Conbibttions Donors can take a charitable contribution deduction if their gift or bequest is made to a section 501(0(31 organization. The effective date of an organization's section 501(c)(3) status determines the date that contributions to it are deductible by donors (See When To File on page 1.) Contributions by U.S. residents to foreign organizations generally are not deductible. Tax treaties between the U.S. and certain foreign countries provide limited exceptions. Foreign organizations (other than those in Canada or Mexico) that claim eligibility to receive contributions deductible by U.S. residents must attach an English copy of the U.S. tax treaty that provides for such deductibility. Appeal Priccectres The organization's application will be considered by the IRS which will either: 1. Issue a favorable determination letter; 2. Issue a proposed adverse determination letter denying the exempt status requested; or 3. Refer the case to the National Office. If the IRS sends you a proposed adverse determination, it will advise you of your appeal rights at that time. Language and Currency ReqUrements Language requirements.— Prepare the Form 1023 and attachments in English. Provide an English translation if the organizational document or bylaws are in any other language. You may be asked to provide English translations of foreign language publications that the organization produces or distributes and that are submitted with the application. Financial requirements.—Report all financial information in U.S. dollars (specify the conversion rate usedl. Combine amounts from within and outside the United States and report the total for each item on the financial statements. For example: Gross Investment Income From U.S. sources 54,000 From non•U.S. sources 1,000 Amount to report on income statement $5,000 Annual Inforretion Return II an annual information return is due whde the organization's application for recognition of exempt status is pending with the IRS (including any appeal of a proposed adverse determination), the organization should Me at the follow mg address: Internal Revenue Service Ogden Service Center Ogden, Utah 84201.0027 • Form 990, Return of Organization Exempt From Income Tax, or • Form 99042, Short Form Return of Organization Exempt From Income Tax, and, • Schedule A (Form 990), Organization Exempt Under Section 5011c)(31. or • Form 990•PF, Return of Private Foundation, if the organization acknowledges it is a private foundation, and Indicate that an application is pending. II an organization has unrelated business income of more than SI 000. 'ite Form 990.T, (rem Cirocimiric Business Income Tax Public Inspection of Form 1023 Caution: Note the discussion below for the potential effect of the Taxpayer Bill of Rights 2 (TBOR2)on these instructions. IRS responsibilities for public inspection.—If the organization's application for section 5011C)(3) status is approved, the following items will be open to public inspection in any District office and at the National Office of the IRS (section 6104). 1. The organization's application and any supporting documents. 2. Any letter or other document issued by the IRS with regard to the application. Note that the following items are not available for public inspection: 1. Any information relating to a trade secret, patent. style of work, or apparatus that, if released. would adversely affect the organization. or 2. Any other information that would adversely affect the national defense. IMPORTANT: Applicants must identify this information by clearly marking it, 'NOT SUBJECT TO PUBLIC INSPECTION,' and must attach a statement to explain why the organization asks that the information be withheld. If the IRS agrees. the information will be withheld. Organization's responsibilities for public inspection.—The organization must make available a copy of its approved application and supporting documents. along with any document or letter issued by the IRS for public inspection. These documents must be available during regular business hours at the organization's principal office and at each of its regional or district offices having at least three paid employees. See Notice 88.120.1988.2 C.B. 454 A penalty of $20 a day will be imposed on any person under a duty to comply with the public inspection requirements for each day a failure to comply continues. Furnishing copies of documents under TBOR2.—The Taxpayer Bill of Rights 2 (TBOR2I. enacted July 30. 1996. modified prospectively the section 6685 penally and the rules for the public inspection of returns and exemption applications. An organization must furnish a copy 01 its Form 990. Form 990-E2. or exemption application, and certain related documents. d a request is made in writing or in person. For a request made in person, the organization must make an immediate response. For a response to a written request. the organization must provide the requested copies within 30 days. The organization must furnish copies of its Forms 990. or Forms 990-El. for any of its 3 most recent taxable years. No charge is to be made other than charging a reasonable fee for reproduction and actual postage costs. An organization need not provide copies if: 1. The organization has made the requested documents widely available in a manner provided in Treasury regulations, or 2. The Secretary of the Treasury determined. upon application by the organization, that the organization was subject to a harassment campaign such that a waiver of the obligation to provide copies would be in the public interest. Penalty for failure to allow public inspection or provide copies.— The section 6685 penalty for willful failure to allow public inspections or provide copies is increased from the present-law level of $1,000 to 55.000 by TBOR2. Effective date of TBOR2.— These public inspection provisions governing tax-exempt organizations under TBOR2 generally apply to requests made no earlier than 60 days after the date on which the Treasury Department publishes the regulations required under the provisions. However. Congress. in the legislative history of TBOR2. indicated that organizations would comply voluntarily with the public inspection provisions prior to the issuance of such regulations. Special I%Ae for Canadian Colleges and Universities A Canadian college or university that received Form T2051, Notification of Registration. from Revenue Canada (Department of National Revenue. Taxation) and whose registration has not been revoked. does not need to complete all parts of Form 1023. Such an organization must complete only Part I of Form 1023 and Schedule B (Schools, Colleges. and Universities). It must attach a copy of as Form T2050. Application for Registration, together with all the required attachments submitted to Revenue Canada. It must furnish an English translation if any attachments were prepared in French. Other Canadian organizations.—Other Canadian organizations that seek a determination of section 501(c)13) status must complete Form 1023 in the same manner as U.S. organizations. Specific Instructions The following instructions are keyed to the line items on the application form: Part I. Identification of Applicant Line 1. Full name and address of organization.—Enter the organization's name exactly as it appears in its creating document mckiding amendments. Show the other name in parentheses. it the organization will be operating under another name. Page 2 EFTA00311036 For a foreign address. enter the information in the following order: city. province of state, and country. Follow the country's practice m placing the postal code in the address. Do not abbreviate the country name. Line 2. Employer identification number (EIN).—All organizations must have an EIN. Enter the nine-digit EIN the IRS assigned to the organization. See Form S5.4, Application for Employer Identification Number, for information on how to obtain an EIN immediately by telephone. if the organization does not have an EIN. Enter. 'applied for.' if the organization has applied for an EIN number previously. Attach a statement giving the date of the application and the office where it was filed. Do not apply for an EIN more than once. Line 3. Person to contact —Enter the name and telephone number of the person to contact during business hours if more information is needed. The contact person should be an officer. director, or a person with power of attorney who is familiar with the organization's activities and is authorized to act on its behalf. Attach Form 2848 or other power of attorney. Line 4. Month the annual accounting period ends.—Enter the month the organization's annual accounting period ends. The accounting period is usually the 12.month period that is the organization's tax year. The organization's fest tax year depends on the accounting period chosen. The hist tax year could be less than 12 months. Line S. Date formed.—Enter the date the organization became a legal entity. For a corporation. this Is the date that the articles of incorporation were approved by the appropriate state official. For an unincorporated organization, it is the date its constitution or articles of association were adopted. Line 6.—Indicate if the organization is one of the following: • 501(e) Cooperative hospital service organization • 501(0 Cooperative service organization of operating educational organization • 501(k) Organization providing child care • 501(n) Charitable risk pool If none of the above applies, make no entry on line 6. Line 7.—Indicate if the organization has ever filed a Form 1023 or Form 1024, Application for Recognition of Exemption Under Section 501(a), with the IRS. Line 8.-11 the organization for which this application is being filed is a private foundation. answer -NM? If the organization is not required to file Form 990 (or Form 990.EZ) and is not a private foundation. answer lie and attach an explanation. See the Instructions for Form 990 and Form 990-EZ for a discussion of organizations not required to file Form 990 (or Form 990.E21. Otherwise, answer 'Yes.' Line 9.—Indicate if the organization has ever filed Federal income tax returns as a taxable organization or filed returns as an exempt organization (e.g.. Form 990. 990.E7. 99OPF. or 990.T). Line 10. Type of organization and organizational documents.— Organizing instrument.—Submit a conformed copy of the organizing instrument. If the organization does not have an organizing instrument, it will not qualify for exempt status. A conformed copy is one that agrees with the original and all amendments to A. The conformed copy may be: • A photocopy of the original signed and dated organizing document. OR • A copy of the organizing document that is unsigned but is sent with a written declaration, signed by an authorized individual, that states that the copy is a complete and accurate copy of the original signed and dated document. Corporation.—In the case of a corporation. a copy of the articles of incorporation, approved and dated by an appropriate state official, is sufficient by itself. If an unsigned copy of the articles of incorporation is submitted, it must be accompanied by the written declaration discussed above. Signed. or unsigned, copies of the articles of incorporation must be accompanied by a declaration stating that the original copy of the articles was fled with. and approved by. the state. The date filed must be specified. Unincorporated association.—In the case of an unincorporated association. the conformed copy of the constitution, articles of association. or other organizing document must indicate, in the document itself. or in a written declaration, that the organization was formed by the adoption of the document by Iwo or more persons. Bylaws.—If the organization has adopted bylaws, include a current copy. The bylaws do not need to be signed if they are submitted as an attachment to the Form 1023 application. The bylaws of an organization alone are not an organizing instrument. They are merely the internal rules and regulations of the organization. Trust.—In the case of a trust, a copy of the signed and dated trust instrument must be furnished. Dissolution clause.—For an organization to qualify for exempt status, its organizing instrument must contain a proper dissolution clause, or state law must provide lot distribution of assets for one or more section 501(c)l3) purposes upon dissolution. If the organization is relying on state law, provide the citation for the law and briefly state the law's provisions in an attachment. Foreign organizations must provide the citation for the foreign statute and attach a copy of the statute along with an English language translation. See Pub. 557 for a discussion of dissolution clauses under the heading. Articles of Organization, Dedication and Distribution of Assets. Examples of dissolution clauses are shown in the sample organizing instruments given in that publication. Organizational purposes.— The organizing instrument must specify the organizational purposes of the organization. The purposes specified must be limited to one or more of those given in section 5011c)(3). See Pub. 557 for detailed instructions and for sample organizing instruments that satisfy the requirements of section 501(03) and the related iegulat orc. Pat II. Activities aid Operational Intemation Line 1.—It is important that you report all activities carried on by the organization to enable the IRS to make a proper determination of the organization's exempt status. Line 2.-11 it is anticipated that the organization's principal sources of support will increase or decrease substantially in relation to the organization's total support. attach a statement describing anticipated changes and explaining the basis for the expectation. Line 3 —For purposes of providing the information requested on line 3. 'fundraising activity' includes the solicitation of contributions and both functionally related activities and unrelated business activities. Include a description of the nature and magnitude of the activities. Line 4a.—Furnish the mailing addresses of the organization's principal officers, directors. or trustees. Do not give the address of the organization. Line 4b.— The annual compensation includes salary, bonus. and any other form of payment to the individual for services while employed by the organization. Line Ie.—Public officials include anyone holding an elected position or anyone appointed to a position by an elected official. line Id.—For purposes of this application, a 'disqualified person' is any person who. rf the applicant organization were a private foundation, is: 1. A 'substantial contributor' to the foundation (defined below!: 2. A foundation manager: 3. An owner of more than 20% of the total combined voting power of a corporation that is a substantial contributor to the foundation; 4. A 'member of the lamely' of any person described in 1, 2, or 3 above; 5. A corporation. partnership, or trust in which persons described in 1, 2, 3, or 1 above, hold more than 35% of the combined voting power. the profits interest. or the beneficial interests: and 6. Any other private foundation that is effectively controlled by the same persons who control the fast-mentioned private foundation or any other private foundation substantially all of whose contributions were made by the same contributors. A substantial contributor is any person who gave a total of more than 35,000 to the organization. and those contributions are more than 2% of all the contributions and bequests received by the organization from the date it was created up to the end of the year the contributions by the substantial contributor were received. A creator of a trust is treated as a substantial contributor regardless of the amount contributed by that person or others. See Pub. 578 lot more information on 'disqualified persons.' Page 3 EFTA00311037 Line 5.—II your organization controls of is controlled by another exempt organization or a taxable organization. answer 'Yes.' 'Control' means that 1. Fifty percent (50%) or more of the filing organization's officers. diectors, trustees, or key employees are also officers, directors. trustees. or key employees of the second organization being tested for control: 2. The filing organization appoints 50% or more of the officers. directors. trustees, or key employees of the second organization: or 3. Fifty percent (SO%) or more of the filing organization's officers. directors, trustees. or key employees are appointed by the second organization. Control exists if the 50% test is met by any one group of persons even if collectively the 50% test is not met. Examples of special relationships ale common officers and the sharing of office space or employees. Line 6.—If the organization conducts any financial transactions (either receiving or distributing cash or other assets). or nonfinancial activities with an exempt organization [other than a 501(c)(3) organization). or with a political organization. answer 'Yes." and explain. Line 7.—II the organization must report its income and expense activity to any other organization (tax exempt or taxable entity). answer 'Yes.' Line 8.—Examples of assets used to perform an exempt function are: land, building, equipment. and publications. Do not include cash or property producing investment income. II you have no assets used in performing the organization's exempt function. answer 'N/A' Line 10a.—If the organization is managed by another exempt organization, a taxable organization, or an individual, answer 'Yes' Line 10b.—If the organization leases properly Irom anyone or leases any of its property to anyone. answer 'Yes.' Line 11.—A membership organization for purposes of this question is an organization that is composed of individuals or organizations who: 1. Share in the common goal for which the organization was created, 2. Actively participate in achieving the organization's purposes: and 3. Pay dues. Line 12.—Examples of benefits. services, and products are: meals to homeless people. home for the aged. a museum open to the public. and a symphony orchestra giving public performances. Note: Organtlations that provide low-income housing should see Rev. Proc. 96-32. 1996.1 C.B. 717, fora 'safe harbor' and an alternative facts and circumstances test to be used in completing line 12. Line 13.—An organization is attempting to influence legislation if it contacts or urges the public to contact members of a legislative body. for the purpose of proposing, supporting, or opposing legislation. or if it advocates the adoption or rejection of legislation. If you answer 'Yes,' you may want to file Form 5768, Fledge/Revocation of Election by an Eligible Section 501(cl(3) Organization To Make Expenditures To Influence Legislation. Line 14.—An organization is intervening in a political campaign if a promotes or opposes the candidacy or prospective candidacy of an individual for public office. Pat III. Techical Requirerrerts Line 1.—II you check "Yes.' proceed to line 7. If you check -No.' proceed to line 2. Line 2a.—To qualify as an integrated auxiliary. an organization must not be a private foundation and must satisfy the affthation and support tests of Regulations section 1.6033-2(h). Line 3.—Reliel from the 15.month tiling requirement is granted automatically if the organization submits a completed Form 1023 within 12 months from the end or the 15 -month period. To get this extension, an organization must add the following statement at the top of its application: 'Filed Pursuant to Section 301.91001.' No request for a letter ruling is required to obtain an automatic extension. Line 4.—See Regulation sections 301.9100.1 and 301.91003 for information about a discretionary extension beyond the 27.month period. Under these regulations. the IRS will allow an organization a reasonable extension of time to file a Form 1023 4 it submits evidence to establish that: (a) It acted reasonably and in good faith, and Granting relief will not prejudice the interests of the government Showing reasonable action and good faith.—An organization acted reasonably and showed good faith if at least one of the following is true. 1. The organization filed its application before the IRS discovered its failure to file. 2. The organization failed to file because of intervening events beyond its cannot 3. The organization exercised reasonable diligence but was not aware of the hung requirement. To determine whether the organization exercised reasonable diligence, it is necessary to take into account the complexity of filing and the organization's experience in these matters. 4. The organization reasonably relied upon the written advice of the IRS. S. The organization reasonably relied upon the advice of a qualified tax professional who failed to file or advise the organization to file Form 1023. An organization cannot rely on the advice of a qualified tax professional if it knows or should know that he or she is not competent to render advice on thing exemption applications or is not aware of an the relevant facts. Not acting reasonably and in good faith.—An organization has not acted reasonably and in good faith if it chose not to file after being informed of the requirement to file and the consequences of failure to do so. Furthermore, an organization has not acted reasonably and in good faith if it used hindsight to request an extension of time to file. That is, if after the original deadline to file passes, specific facts have changed so that Ming an application becomes advantageous to an organization. the IRS will not ordinarily grant an extension. To qualify for an extension in this situation, the organization must prove that its decision to file did not involve hindsight. No prejudice to the interest of the government—Prejudge to the interest of the government results if granting an extension of time to file to an organization results in a lower total tax liability for the years to which the filing applies than would have been the case if the organization had applied on time. Before granting an extension, the IRS may require the organization requesting it to submit a statement from an independent auditor certifying that no prejudice will result if the extension is granted. Procedure for requesting extension.— To request a discretionary extension, an organization must submit the following with its Form 1D23: • A statement showing the date Form 1023 should have been bled and the date it was actually filed. • An affidavit describing in detail the events that led to the fadure to apply and to the discovery of that failure. II the organization relied on a qualified tax professional's advice. the affidavit must describe the engagement and responsibilities of the professional and the extent to which the organization relied on him or her. • All documents relevant to the election application • A dated declaration, signed by an individual authorized to act for the organization, that includes the following statement: 'Under penalties of perjury. I declare that I have examined this request. including accompanying documents, and. to the best of my knowledge and belief. the request contains all the relevant facts relating to the request, and such facts are true, correct, and complete.' • A detailed affidavit from individuals having knowledge or information about the events that led to the failure to make the application and to the discovery of that failure. These individuals include accountants or attorneys knowledgeable in tax matters who advised the organization concerning the application. Any affidavit from a tax professional must describe the engagement and responsibilities of the professional as well as the advice that the professional provided to the organization. The affidavit must also include the name, current address. and taxpayer identification number of the individual making the affidavit (the Milani). The affront must also forward with the affidavit a dated and signed declaration that states: 'Under penalties of perjury. I declare that I have examined this request. including accompanying documents, and. to the best of my knowledge and belief. the request contains all the relevant facts relating to the request. and such facts are true. correct, and complete.' The reasons for late filing should be specific to your particular organization and situation. Regulation section 101.9100-3 (see above) lists the factors the IRS will consider in determining if good cause exists for granting a discretionary extension of time to file the application. lo address these facto's. your response for line 4 should provide the following information: Page 4 EFTA00311038 1. Whether the organization consulted an attorney or accountant knowledgeable in tax matters or communicated with a responsible IRS employee (before or alter the organization was created) to ascertain the organization's Federal filing requirements and. if so. the names and occupations or titles of the persons contacted, the approximate dates. and the substance of the information obtained: 2. liow and when the organization learned about the 15-month deadline for filing Form 1023, 3. Whether any significant intervening circumstances beyond the organization's control prevented it from submitting the application timely or within a reasonable period of time after it learned of the requirement to file the application within the 15.month period; and 4. Any other information that you believe may establish reasonable action and good faith and no prejudice to the interest of the government for not filing timely or otherwise justly granting the relief sought. A request for relief under this section is treated as part of the request for the exemption determination letter and is covered by the user fee submitted with Form 8718. Liam 5.—II you answer 'No.* the organization may receive an adverse letter limiting the effective date of its exempt status to the date its application was received. Line 6.—The organization may still be able to qualify for exemption under section $01(c)(4) for the period preceding the effective date of its exemption as a section 501(c)(3) organization. If the organization is qualified under section 501(c))41 and page 1 of Form 1024 is filed as directed. the organization will not be liable for income tax returns as a taxable entity. Contributions to section 501(c)(4) organizations are generally not deductible by donors as charitable contributions. Line 7.—Private foundations are subject to various requirements, restrictions, and excise taxes under Chapter 42 of the Code that do not apply to public charities. Also, contributions to private foundations may receive less favorable treatment than contributions to public charities. See Pub. 578. Therefore. it is usually to an organization's advantage to show that it qualifies as a public charity rather than as a private foundation if its activities or sources of support permit it to do so. Unless an organization meets one of the exceptions below. A is a private foundation. In general, an organization is not a private foundation if it is: 1. A church, school, hospital, or governmental unit 2. A medical research organization operated in conjunction with a hospital; 3. An organization operated for the benefit of a college or university that rs owned or operated by a governmental unit; 4. An organization that normally receives a substantial part of its support in the form of contributions from a governmental unit or from the general public as provided in section 170(b)(1)(A)(vi); S. An organization that normally receives not more than one-third of its support Flom gross investment income and more than one-third of its support from contributions, membership fees, and gross receipts related to its exempt functions (subject to certain exceptions) as provided m section 509(a)(21: 6. An organization operated solely for the benefit of, and in connection with, one or more organizations described above (or for the benefit of one or more of the organizations described in section 501(c)(4), (5), or (8) of the Code and also described in 5 above). but not controlled by disqualified persons other than foundation managers. as provided in section 509(03); or T. An organization organized and Operated to test for public safety as provided in section 509(4(4). Line 8.—Basis for private operating foundation status: (Complete this line only it you answered 'Yes' to the question on line T.) A 'private operating foundation' is a private loundation that spends substantially all of its adjusted net income or its minimum investment return, whichever is less, directly for the active conduct of the activities constituting the purpose or function for which it is organized and operated. The foundation must satisfy the income test and one of the three supplemental tests: (1) the assets test (2) the endowment test; or (3) the support test. For additional information. see Pub. 578. Line 9.—Basis for nonprwate foundation status: Check the box that shows why your organization is not a private foundation. Box (a). A church or convention or association of churches. Box (0). A school.—See the definition in the instructions for Schedule B. Box (c). A hospital or medical research organization.-See the instructions for Schedule C. Page 5 Box OB. A governmental unit—This category includes a state. a possession of the United States, or a political subdivision of any of the foregoing. or the United States, or the District of Columbia. Box (e). Organizations operated Sr connection with or solely for organizations described in (a) through (d) or (g). (h). and (0.—The organization must be organized and operated for the benefit of. to perform the functions of. or to carry out the purposes of one or more specified organizations described in section 509(a)(1) or (2). It must be operated. supervised. or controlled by or in connection with one or more of the organizations described in the instructions for boxes (a) through (d) or (g). (h). and (6. It must not be controlled (Wetly or indirectly by disqualified persons (other than foundation managers or organizations described in section 509(a)(1) or (2)). To show whether the organization satisfies these tests, complete Schedule D. Box (I). An organization testing for public safety.-An organization in this category is one that tests products to determine their acceptability for use by the general public. It does not include any organization testing for the benefit of a manufacturer as an operation or control in the manufacture of its product. Box (9). Organization for the benefit of a college or university owned or operated by a governmental unit.—The organization must be organized and operated exclusively for the benefit of a college or university that: • Is an educational organization within the meaning of section 170(b)(1)(A)00 and is an agency or instrumentality of a state or political subdivision of a state: • Is owned or operated by a state or political subdivision of a state: OR • Is owned or operated by an agency or instrumentality of one or more states or political subdivisions. The organization must also normally receive a substantial part of its support from the United States or any state or political subdivision of a state, or from direct or indirect contributions from the general public or from a combination of these sources. An organizston described in section 170(b)(1)(A)(W) will be subject to the same publicly supported rules that are applicable to 170(b)(1)A)Ivi) organizations described in box 01) below. Box N. Organization receiving support from a governmental unit or from the general public.-The organization must receive a substantial part of its support from the United States or any state or political subdivision, or from direct or indirect contributions from the general public, or from a combination of these sources. The organization may satisfy the support requirement in either of two ways. (1) It will be treated as publicly supported if the support it normally receives from the above-described governmental units and the general public equals at feast one-third of its total support (2) It will also be treated as publicly supported it the support it normally receives from governmental or public sources equals at Mast 10% of total support and the organization is set up to attract new and additional public or governmental support on a continuous basis. If the organization's governmental and pubic support is at least 10%. but not over one-third of its total support, the questions on lines 1 through 14 of Part II will apply to determine bath the organization's claim of exemption and whether it is publicly supported. Preparers should exercise care to assure that those questions are answered in detail. Box Organization described in section 509(a)(2).—The organization must satisfy the support test under section SIT9(a)(2)(A) and the gross investment income test under section 509(a)(2)(8). To satisfy the support test, the organization must normally receive more than one-third of its support from: (a) gifts, grants. contributions. or membership fees, and (b) gross receipts from admissions. sales of merchandise, performance of services, or furnishing of facilities, in an activity that is not an unrelated trade or business (subject to certain limitations discussed below). This one-thiid of support must be from organizations described in section 509(a)(1). governmental sources, or persons other than disqualified persons. In computing gross receipts from admissions, sales of merchandise, performance of services, or furnishing of facilities in an activity that is not an unrelated trade or business, the gross receipts from any one person or from any bureau or similar agency of a governmental unit are includible only to the extent they do not exceed the greater of $5,000 or 1% of the organization's total support. To satisfy the gross investment income test, the organization must not receive more than one-third of its support Irom gross investment income. EFTA00311039 Box (1).—II you believe the organization meets the public support test of section 170(bI(l)(A)(w) or 509(a)(2) but are uncertain as to which public support test it satisfies. check box (j). By checking this box. you are claiming that the organization is not a private foundation and are agreeing to let the IRS compute the public support of your organization and determine the correct foundation status. Line 10.—An organization must complete a tax year consisting of at least 8 months to receive a definitive Mal) ruling under sections 1/0(bl(ll(Allvd and 509(a)(11, or under section 509(a)(21. However, organizations that checked bOX (h), (i). or (j) on line 9 that do not meet the 8.month requirement must request an advance ruling that covers their first 5 tax years instead of requesting a definitive ruling. An organization that meets the 8.month requirement has two options: 1. II may request a definitive ruling. The organization's pubic support computation will be based on the support the organization has received to date; or 2. It may request an advance ruling. The organization's public support computation will be based on the support it receives during its first 5 tax years. An organization should consider the advance ruling option if it has not received significant public support during its first tax year or during its first and second tax years. but it reasonably expects to receive such support by the end of its filth tax year. An organization that receives an advance ruling is treated. during the 5 -year advance ruling period, as a public charity (rather than a private foundation) for certain purposes, including those relating to the deductibility of contributions by the general public. Line 11.—For definition of an unusual grant. see instructions for Part IV•A. line 12. Line 12.—Answer this question only if you checked box (g), (hi. or Won line 9. Line 13.—Answer the question on this line only if you checked box (i) or (j) on line 9 and are requesting a definitive ruing on line 10. Line 14.—Answer "Yes" or 'No' on each line. If 'Yes.' you must complete the appropriate schedule. Each schedule is included in this application package with accompanying instructions. For a brief definition of each type of organization. see the appropriate schedule. Part Anancial Data Complete the Statement of Revenue and Expenses for the current year and each of the 3 years immediately before it (or the years the organization has existed, if less than 4). Any applicant that has existed for less than 1 year must give financial data for the current year and proposed budgets for the following 2 years. The IRS may request financial data for more than 4 years if necessary. All financial information for the current year must cover the period beginning on the first day of the organization's established annual accounting period and ending on any day that is within 60 days of the date of this application. If the date of this application is less than 60 days after the first day of the current accounting period, no financial information is required for the current year. Financial information is required for the 3 preceding years regardless of the current year requirements. Please note that if no financial information is required for the current year. the preceding year's financial information can end on any day that is within 60 days of the date of this application. Prepare the statements using the method of accounting and the accounting period (entered on line 4 of Part I) the organization uses in keeping its books and records. If the organization uses a method other than the cash receipts and disbursements method. attach a statement explaining the method used. A Staternent of Revenue and Expenses Line 1.—Do not include amounts received from the general public or a governmental and for the exercise or performance of the organization's exempt function. However, include payments made by a governmental unit to enable the organization to provide a service to the general public. Do not include unusual grants. See the explanation for unusual grants in Line 12 of this section. Line 2.—Include amounts received from members for the purpose of providing support to the organization. These ale considered as contributions. Do not include payments to purchase admissions. merchandise. services, or use of facilities. Line 3.—Include on this line the income received from dividends. interest. and payments received on securities loans. rents. and royalties. tine 4.—Enter the organization's net income from any activities that are regularly carried on and are not related to the organization's exempt purposes. Examples of such income include fees from the commercial testing of products; income from renting office equipment or other personal property: and income from the sale of advertising in an exempt organization's periodical. See Pub. 598 for information about unrelated business income and activities. Line 5.—Enter the amount collected by the local tax authority from the general public that has been allocated for your organization. Line 6.— To report the value of services and/or facilities furnished by a governmental unit, use the law market value at the time the service/facility was furnished to your organization. Do not include any other donated services or facilities in Part IV. Line 7.—Enter the total income from all sources that is not reported on lines 1 through 6. or lines 9, 11. and 12. Attach a schedule that lists each type of revenue source and the amount derived from each. Line 9.—Include income generated by the organization's exempt function activities (charitable. educational. etc.I and its nontaxable fundraising events (excluding any contributions received). Examples of such income include the income derived by a symphony orchestra from the sale of tickets to its performances: and raffles, bingo. or other fundraising-event income that is not taxable as unrelated business income because the income.pioducing activities are not regularly carried on or because they are conducted with substantially all (at least 85%) volunteer labor. Record related cost of sales on line 22, Other. Line 11.— Attach a schedule that shows a description of each asset, the name of the person to whom sold, and the amount received. In the case of publicly traded securities sold through a broker, the name of the purchaser is not requited. Line 12.—Unusual grants generally consist of substantial contributions and bequests from disinterested persons that: 1. Are attracted by reason of the publicly supported nature of the organization; 2. Are unusual and unexpected as to the amount; and 3. Would, by reason of their size. adversely affect the status of the organization as normally meeting the support test of section 170(0)(1)(A)(vd or section 509(a)(2l. as the case may be. If the organization is awarded an unusual giant and the terms of the granting instrument provide that the organization will receive the funds over a period of years. the amount received by the organization each year under the giant may be excluded. See the regulations under sections 170 and 509. Line 14.—Fundraising expenses represent the total expenses incurred in soliciting contributions. gifts. grants. etc. Line 15.—Attach a schedule showing the name of the recipient. a brief description of the purposes or conditions of payment. and the amount paid. The following example shows the format and amount of detail required for this schedule. Recipient Purpose Amount Museum of Natural History General operating budget 529.000 State University Books for needy students 14.500 Richard Roe Educational scholarship 12.200 Colleges. universities, and other educational institutions and agencies subject to the Family Educational Rights and Privacy Act (20 U.S.C. 1232g1 are not required to list the names of individuals who were provided scholarships or other financial assistance where such disclosure would violate the privacy provisions of the law. Instead. such organizations should group each type of financial aid provided. indicate the number of individuals who received the aid. and specify the aggregate dollar amount. Line 16.— Attach a schedule showing the name of each recipient, a brief description of the purposes or condition of payment, and amount paid. Do not include any amounts that are on line 15. The schedule should be similar to the schedule shown in the line 15 instructions above. Line 17.—Allach a schedule that shows the name of the person compensated; the office or position: the average amount of time devoted to the organization's affairs per week. month. etc.; and the amount of annual compensation. The lollowing example shows the format and amount of detail required: Page 6 EFTA00311040 Name Position Time devoted Annual salary Philip Poe President and general manager 16 his. per wk. S27.500 Line 18.—Enter the total of employ es' salaries not reported on line 17. Line 19.—Enter the total interest expense for the year, excluding mortgage interest treated as if an occupancy expense on line 20. Line 20.—Enter the amount paid for the use of office space or other lactlities, heal, light, power. and other utilities, outside janitorial services, mortgage interest, real estate taxes. and similar expenses. Line 21.—If your organization records depreciation. depletion. and similar expenses. enter the total. Line 22.—Attach a schedule listing the type and amount of each significant expense for which a separate line is not provided. Report other miscellaneous expenses as a single total d not substantial in amount. B. Balance Shut Line 1.— E nter the Iota r cash in checking and savings accounts. tem pulary 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 the total accounts receivable that arose from the sale al goods and/or performance of services, less any reserve for bad debt. Line 3.—Enter the amount of materials. goods. and supplies purchased or manufactured by the organization and held to be sold or used in some future period. Line 4.—Attach a schedule that shows the name of the borrower. a brief description of the obligation, the rate of return on the principal indebtedness, the due date. and the amount due. The following example shows the format and amount of detail required: Name of borrower Description of obhgation Rate of t reurn Due date Amount Hope Soap Corporation Debenture bond (no senior issue outstanding) 8% Jan. 2004 $37.500 Big Spool Company Collateral note secured by company's fleet of 20 delivery trucks 10% Jan. 2003 262,000 Line 5 —Attach a schedule listing the organization's corporate stock holdings. For stock of closely held corporations. the statement should show the name of the corporation. a brief summary of the corporation's capital structure. and the number of shares held and their value as carried on the organization's books. II such valuation does not reflect current fair market value, also include far market value. For stock traded on an organized exchange or in substantial quantities over the counter. the statement 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. the following example shows the format and the amount of detail requited: Name of corporation Capital structure (or exchange on which traded) Shares Book amount Fair market value Little Spool Corporation 100 shares nonvoting preferred issued and outstanding. no par value: 50 shares common issued and outstanding. no par value. Preferred shares: SO 520.000 $24.000 Common shares 10 25.000 30.000 Flintlock Class A common 80 6.000 6.500 Corporation NYSE Line 6.—Report each loan separately. even if more than one loan was made to the same person. Attach a schedule that shows the borrower's name. purpose of loan. repayment terms. interest rate. and original amount of loan. Line 7.—Enter the book value of government securities held (U.S.. state, or municipal). Also enter the book value of buildings and equipment held for investment purposes. Attach a schedule identifying and reporting the book value of each. Line 8.—Enter the book value of buildings and equipment not held for investment. This includes plant and equipment used by the organization in conducting its exempt activities. Attach a schedule listing these assets held at the end of the current tax year/period and the cost or other basis. Line 9.—Enter the book value of land not held for investment. Line 10.—Enter the book value of each category of assets not reported on lines 1 through 9. Attach a schedule listing each. Line 12.— Enter the total of accounts payable to suppliers and others, such as salaries payable, accrued payroll taxes. and interest payable. Line 13.—Enter the unpaid portion of grants and contributions that the organization has made a commitment to pay to other organizations or individuals. Line 14.—Enter the total of mortgages and other notes payable outstanding al the end of the current tax yearlperiod. Attach a schedule that shows each item separately and the lender's name. purpose of loan, repayment terms, interest rate. and original amount. Line 15.—Enter the amount of each liability not reported on lines 12 through 14. Attach a separate schedule. Line 17.—Under fund accounting. an organization segregates es 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. II the organization does not use fund accounting. report only the 'net assets' account baiances, such as: capital stock. paid-in capital. and retamed earnings or accumulated income. Paperwork Reduction Act Notice.—We ask for the information on this form to carry out the Internal Revenue laws of the United States. II you want your 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 is not required to provide the information requested on a form that is subject to the Paperwork Reduction Act unless the form displays a valid OMB control number. Books or records relating to a form or its instructions must be retained as long as their contents may become material in the administration of any Internal Revenue law. The rules governing the confidentiality of the Form 1023 application are covered in Code section 6104. The time needed to complete and file these forms will vary depending on individual circumstances. The estimated average times are: Form 1023 Paris Ito ry 1023 5th. A 1023 Sch. 8 1023 Sch. C 1023 Sch. 0 1023 Sch. E 1023 Sch. F 1023 Sch. G 1023 Sch. H 1023 Sch. I 872-C If you have comments concerning the accuracy of these time estimates or suggestions for making these forms simpler. we would be happy to hear from you. You can write to the Tax Forms Committee. Western Area Distribution Center. Rancho Cordova. CA 9574343001. DO NOT send the application to this address. Instead. see Where To File on page I. Reeordkeeping 55 hr., Se min 7 hr.. 10 mm, 4 ht. 47 min. S hr.. 1 min 4 hr.. 4 min. 9 hr.. 20 min. 2 fit.. 39 TM 2 hr., 38 mm. 1 hr., 55 min 3 hr.. 35 mm 1 hr. 26 min Learning Preparing, and about the law sending the or the form form to IRS 5 hr., 7 min a hi.. 31 min. .0. min. 7 min 30 min 36 min. 35 min. 43 min. 42 min 41 min. hr., S min. 1 hr_ 17 min. 2 hr., 53 min. 3 hr.. 3 min. -0. min. 2 min. 42 min. 46 min -0. min. 4 min. 24 min. 26 min. Page 7 EFTA00311041 Procedural Checklist Make sure the application is complete. If you do not con-dete all applicable parts a do not provide all required attachments, we n-ay return the ii w [fide application to yoLr crgarizaticn for resuarission with the missing irfarration a- attachments. Tlis will delay the accessing of the application and rrey delay the effective date d you- organization's exeript status. The aganizaticn nay also incur adciticnel user fees. Have you . - Attached Form 8718 (User Fee fa Exempt Crgarization Deterrrination Letter Request) and the appropriate fee? - Repined the application fa rrailing? (See Mere To Ale addnesses ai Fcrm 8718.) Co not file the application with ya.r local Internal Revenue Service Cater. - Completed Pats I through IV ad any other schedules that apply to the cigarizeticri? - Shown the orgarization's Employer Identification NLmber (Elf*? a. If you- organization has an ON, vvite it in the space provided. b. If the is a neviy faired organization and does not have ai Errployer Identification NJ i Liu, obtain an ON by telephone. (See Specific Instructias, Pat I, Line 2, on page 3.) - Described your orgarization's specific activities as cirected in Pat II, line 1, of the application? - Included a conformed copy of the carplete agrizing instill-rent? (See Specific Instructions, Fat I, Lire 10, cn pege 3.) - Had the application signed by one of the folloving? a. An officer a- trustee who is authorized to sign (e.g., president, treasurer): b. A person authorized by a power of attorney (Subrrit Fan,2848, a other poorer of attorney.) - Enclosed fine idol statements (Part IV)? a. arrent year (must indude period Lp to Wthin e3 days of the date the application is filed aid 3 emceeing yeas. b. Detailed treakdann of revenue aid expenses (no lurrp sum). c. If the organization hes been in existence less than 1 yea, you met also subrrit proposed budgets for 2 shoving the al-runts aidtypes cf recalls and expencitires anticipated.yzftas Note aring the techrical revie w of a carpeted application it trey be necessary to contact the orgarization for acre specific cr adcitional information Do not send this cheddist with the application. Piga 8 EFTA00311042 F0.872-C Rev September 1998) Depanment e the Ireastny Went Revenue Service Consent Fixing Period of Limitation Upon Assessment of Tax Under Section 4940 of the Internal Revenue Code (See instructions on reverse side.) OMB No. 1545.0056 To be used with Form 1023. Submit in duplicate. Under section 650 (c)(4) of We Internal Revenue Coda and as pert of a request filed with Form 1023 that the agarizaticn namad below be treated as a publidy supported orgarization order section 170(b)(1)(A)(v0 °- section 509(a)(2) doing an advance sting period, (Exact legal name of organization as shown in organizing document) (Number. wen city or town, slate, and ZIP code) District Director or Internal Reverue, and the Assistart Contrissioner (Employee Rare and — Cigarizations) co-sent and agree that the period for assessing tax (imposed under section 49400 the Code) fa any cf the 5 tax years in the advance ruing period will extend 8 yeas, 4 months. and 15 days beyond the at of the first tax year Hovtever, if a rake d deficiency in tax fir any of these yeas is sat to the agarization before the period expires, the tine for rreldng en assess-rat WO be father extended by the nurrber of days the assessntrt is prohibited, plus 60 days. Erring date cf first tax year (Mon lb. day, and year) Name of organization (as shown in organizing document) Date Officer or trustee having authority to sign Signature ► Type or print name and title For IRS use only District Director or Assistant Commissioner (Employee Plans and Exempt Organizations) Date By ► For Paperwork Reduction Act Notice, see page 7 of the Form 1D23 Instructions. Car. No. 169050 EFTA00311043 2 You must complete Form 872-C and attach it to the Form 1023 if you checked box h, i, or j of Part III, question 9, and the organization has not completed a tax year of at least 8 months. For example: If the organization incorporated May 15 and its year ends December 31, it has completed a tax year of only 772 months. Therefore, Form 872-C must be submitted. (a) Enter the name of the organization. This must be entered exactly as it appears in the organizing document. Do not use abbreviations unless the organizing document does. (b) Enter the current address. (c) Enter the ending date of the first tax year. For example: (1) If the organization was formed on June 15 and it has chosen December 31 as its year end, enter December 31, (2) If the organization was formed June 15 and it has chosen June 30 as its year end, enter June 30, In this example, the organization's first tax year consists of only 15 days. (d) The form must be signed by an authorized officer or trustee, generally the president or treasurer. The name and title of the person signing must be typed or printed in the space provided. (e) Enter the date that the form was signed. DO NOT MAKE ANY OTHER ENTRIES. EFTA00311044 form 1023 Rev. 9.98) Page 11 Schedule A. Churches 1 Provide a brief history of the development cf the crgarization, inducing the reasons for its fcrrretion. 2 Does the organization have a written creed a- statement of faith?. . . Yes O No If "Yes," attach a copy. 3 Does the orgarization require proepective weir s to renounce other religious beliefs or their nen Lest ip in other chtithes cr religious ciders to become nee Ler J.7 O WS K No 4 Does the agarization have a fund code of doctrine and cisciplire fcr its rrenters? O Yes O No If "Yes," describe. 5 Describe the form of worship and attach a schedule of worship services. 6 Pre the services open to the public? CI Yes O No If "Yes," describe how the agarization publicizes its services and explain the criteria fa- adrrittance. 7 Explain how the organization attradS new rreaters. 8 (a) How mary active r er are currently enrolled in the church? (b) Wiat is the average attendance at the worship services? 9 In acklition to worship services, what other religious services (such as teptisrrs, wedcings, ftrierals, etc.) does the agarization conduct? EFTA00311045 Form 1023 Ohm 9.98) one 12 Schedule A. Churches (Continued) 10 Does the organization have a school for the religicxe instruction of the Wuxi? O Yes ONE) 11 Ware the current deacons, rdrister, atVor pasta- formally ordained after a presaibed carse of sb.ichfr O Yes O No 12 Describe the organ zati on's nal igrous hierarchy cr ecdesiasfical govemrrent. 13 Does the organization have an established place of wcrship, O Yes O No If "Yes," provide the me e and address of the owner cr lessor cf the property and the address and a desaiplion of the facility. If the organization has no regiar place of Acrslip, state where the services are held and low the site is selected. 14 Does (cr WIQ the orgy-Izabal license a- othentise ordain rriristers (or their equivalent) a- issue church charters? O rtes O No If "Yes," describe in detail the requirements and qualifications needed to be so licensed, ordained, a- chartered. 15 Did the organization pay a fee for a chich doter) O Yes O No If "Yes," state the nacre and ackiess of the orgarizaion to Mich the fee Niles paid, attach a copy cf the charter, acrd desaibe the circurrsta-ces su-rarcing the chartering. 16 Show holy rrany haxs a %oak the rrinister/pastor and officers each devote to chinch work and the arrourt of compensation paid to each of them If the rrinister a - pasta- is cthemise errplayeci, inchoate by whore enployed, the nature of the employment, and the hairs deviated to that en-plop-lent. EFTA00311046 Form 1023 (Rev. 9.981 Page 13 Schedule A. Churches (Continued) 17 Vblll arryfunds a property of the agarizalion be used try any officer, cirecta, en-plcyee, rrinister, a pasta fa his a her persorel needs or converience? K Yes K No If "Yes," describe the nature and cirarrstances of such use. 18 List any officers, cirectcrs, a - trustees related by blood a rrerriacge. 19 Gve the narre of anyone who has assigned income to the agarization rrede substantial catributions of r rnr ley a other property. Specify the arrarts involved. Instructions Although a church, its irtegated auxiliaries, a a convention a association d chiches is nct required to file Form 1023 to be exempt from Federal imam tax a to receive tax-dsduaitle contributions, such an organization rrey find it advantageous to obtain reccgrition of exemption In this event, you should st.brit inforrretion shafting that you ogarization is a cinch. sYrogogie, association a convention of dudes, religious order a religcus orgarization ttet is an integal pat d a church and that it is carrying at the functions of a church. In determining Abet/ter an adrrittedy religous organization is also a church, the IRS does not accept any and every assertion that suit an orgarizaticn is a darch. Because beliefs and practices vay so widely, there is no singe definition of the wad "church" fa tax arpoc . The IRS ccreiders the facts aid cirarrstarces d each orgarization applying fa church status. The IRS rreintaire two basic guidelines in deterrriring that an organization rreets the religious puposes test: 1. That the particular religas beliefs of the organization are truly and sincerely held. and 2. That the practices and rituals associated with the agarizations refigous beliefs a creed are not illegal a contray to dearly defined pudic pdicy. In ceder for the IRS to properly evaluate your organization's activities ad naligous purposes, it is irrpdtart that all questions in Sthedule A be The information subrritted with Schedule A will be a determining facia in granting the "church" status requested by you organization In completing the schedule, consider the following pants: 1. lie crgarization's activities in furtherance of its beliefs must be adusively religous, and 2. An orgarization will not qualify fa excerption if it has a substartial nonexempt purpose cf serving the private interests d its founder a the founder's family. EFTA00311047 Form 1023 (Rev 9.98; 11.,:e 15 Schedule B. Schools, Colleges, and Universities 1 Does, or will, the organization normally have: (a) a regularly scheduled curriculum, (b) a regular faculty of qualified teachers, (c) a regularly enrolled student body, and (d) facilities where its educational activities are regularly carried on" K Yes K No If "No,' do not complete the rest of Schedule B. 2 Is the organization an instrumentality of a state or political subdivision of a state? K Yes K No If "Yes." document this in Part II and do not complete items 3 through 10 of Schedule B. (See instructions on the back of Schedule 8.1 3 Does or will the organization (or any department or division within it) discriminate in any way on the basis of race with respect to: a Admissions? K Yes K No b Use of facilities or exercise of student privileges? K Yes K No c Faculty or administrative staff' K Yes K No d Scholarship or loan programs' K Yes K No If "Yes" for any of the above, explain 4 Does the organization include a statement in its charter, bylaws. or other governing instrument, or in a resolution of its governing body, that it has a racially nondiscriminatory policy as to students?. . . . K Yes K No Attach whatever corporate resolutions or other official statements the organization has made on this subject. 5a Has the organization made its racially nondiscriminatory policies known in a manner that brings the policies to the attention of all segments of the general community that it serves' K Yes K No If "Yes: describe how these policies have been publicized and how often relevant notices or announcements have been made. If no newspaper or broadcast media notices have been used, explain. b II applicable, attach clippings of any relevant newspaper notices or advertising, or copies of tapes or scripts used for media broadcasts. Also attach copies of brochures and catalogs dealing with student admissions, programs, and scholarships, as well as representative copies of all written advertising used as a means of informing prospective students of the organization's programs. 6 Attach a numerical schedule showing the racial composition. as of the current academic year, and projected to the extent feasible for the next academic year, of: (a) the student body. and (b) the faculty and administrative staff. 7 Attach a list showing the amount of any scholarship and loan funds awarded to students enrolled and the racial composition of the students who have received the awards. 8a Attach a list of the organization's incorporators. founders, board members, and donors of land or buildings, whether individuals or organizations. b State whether any of the organizations listed in 8a have as an objective the maintenance of segregated public or private school education, and, if so. whether any of the individuals listed in 8a are officers or active members of such organizations. 9a Enter the public school district and county in which the organization is located. b Was the organization formed or substantially expanded at the time of public school desegregation in the above district or county" K Yes K No 10 Has the organization ever been determined by a state or Federal administrative agency or judicial body to be racially discriminatory? K Yes K No If "Yes.' attach a detailed explanation identifying the parties to the suit, the forum in which the case was heard, the cause of action, the holding in the case, and the citations (if any) for the case. Also describe in detail what changes in the organization's operation, if any. have occurred since then. For more information, see back of Schedule B. EFTA00311048 Form 1023 Rev. 9.981 Page 16 Instructions A "school" is an organization that has the printery fectiondpreserting formal instruction, normally maintains a reglar laxity and arriculun narrally has a regularly enrolled student body, and has a place where its educational activities are carried on. The term generally corresponds to the definition of an "educational orgarizaticn" in section 170(b)(1)(A)0). This, the tam includes prirrery, secondary, preparatory and tigi schools, and colleges and universities. The tam does nct include organizations engaged in both educational and noneducational activities mess the later are merely Madera to the educational activities. A school fa handicapped dilden is included within the tern but an orgarizaticn rrelely provicing hancicappeid thildren vtith custodial care is not. Fa ptrpm of Schedule a "Sunday schools" that are conducted by a ditch are not included in the tern "schools" but separately organized sands (such as parochial schools triversities, and sirrilar institutions) are induded in the term. A pivate schod that chemise rreets the requirements of section 501(O(3) as an educational institution mill not qualify fa ecerrption eider section 501(a) mess it has a racially nondsairrinatory policy as to students. This policy rrears that the school adrits stixients of any race to all the rights, privileges, programs, aid activities generally accorded a trade available to students at that school and that the school does not cisairrinate on the basis of race in the adninistration of its ecLoatiorel pdides, adrrissions pdides, scholarship and loan progarra and athletic a other schod-adrriristered programs. The IRS OO nsiders dscrininaticn al the basis ot race to include ciscrirrination ai the basis cif cola and national a ethic origin. A policy of a scrod that favors racial ninaity gaps in adnissiors. facilities, progarrs, and financial assistance will not cartitute ciscrirrination on the basis of race when the purpose ard effect is to prarcte the establistrrent and rreintenance cf that school's racially nondisairrinatcry policy as to students See Rev. Proc. 75-50, 1975-2 ca 587, for gidelines and reloonliceeping requirerrerts fa deteniring Metter private schools that are applying fa reccgritiondecerrption have racially nonciscrirrinatory policies as to studerts. Line 2 An instnrnentality cf a state a political stlocivision of a state rrey qualify under section 501(c)(3) if it is organized as a separate entity from the governmental wit that created it and if it otherwise rreets the agarizaticrel aid operational tests of section 501(c)(3). See Rev. Rd. 60.384, 1960-2 ca 172. Arty such agarizaticn that is a school is not a private school aid, therefore, is net subject to the provisions cf Rev. Proc. 75-50. Schools that incomactly answer "Yes" to lire 2 %ill be contacted to fumish the infcrrretion called fa by lines 3 through 10 in at to establish that they urea the naquinamerts for exemption. To prevent delay in the processing cf you application, be are to answer lire 2 correctly and =Vote lines 3 through 10, if applicable. EFTA00311049 Schedule C. Hospitals and Medical Research Organizations K Check here if claiming to be a hospital; complete the questions in Section I of this schedule; and write 'N/A' in Section II. K Check here if claiming to be a medical research organization operated in conjunction with a hospital; complete the uestions in Section II of this schedule; and write "N/A" in Section I. • Section I Hospitals 1a How many doctors are on the hospital's courtesy staff? b Are all the doctors in the community eligible for staff privileges? K Yes K No If "No,' give the reasons why and explain how the courtesy staff is selected. 2a Does the hospital maintain a full-time emergency room? K Yes K No b What is the hospital's policy on administering emergency services to persons without apparent means to pay? c Does the hospital have any arrangements with police, fire, and voluntary ambulance services for the delivery or admission of emergency cases? Explain. K Yes K No 3a Does or will the hospital require a deposit from persons covered by Medicare or Medicaid in its admission practices? K Yes K No If 'Yes,' explain. b Does the same deposit requirement, if any, apply to all other patients? K Yes K No If "No,- explain. 4 Does or will the hospital provide for a portion of its services and facilities to be used for charity patients? K Yes K No Explain the policy regarding charity cases. Include data on the hospital's past experience in admitting charity patients and arrangements it may have with municipal or government agencies for absorbing the cost of such care. 5 Does or will the hospital carry on a formal program of medical training and research? K Yes K No If -Yes," describe. 6 Does the hospital provide office space to physicians carrying on a medical practice? K Yes K No If *Yes." attach a list setting forth the name of each physician, the amount of space provided, the annual rent, the expiration date of the current lease and whether the terms of the lease represent fair market value. Section II Niscical Research Organizations 1 Name the hospitals with which the organization has a relationship and describe the relationship. 2 Attach a schedule describing the organization's present and proposed (indicate which) medical research activities: show the nature of the activities, and the amount of money that has been or will be spent in carrying them out. (Making grants to other organizations is not direct conduct of medical research.) 3 Attach a statement of assets showing their fair market value and the portion of the assets directly devoted to medical research. For more information, see back of Schedule C. EFTA00311050 F -n 1023 Rev. 9.98) 18 Additional Information Hospitals lb be entitled to status as a "hospital," an organization mist have, as its principal purpose a function, the provicing of rectal a hospital care a - n-ecical education a research. "Macical care" includes the treat rent et any physical or rental rise:4[y a condition, the cost of Wich may be taken as a deduction alder section 213, mhether the treeerent is performed an an inpatient a outpatient basis. 71-us, a rehabilitation institUion, outpatient diric, a corrrnsity mental health a dug treatment cater rrey be a hospital if its principal function is providing the above-described services. On the other hand, a caualescert home a a home fa chilchan or the aged is net a hospital. Srrilarly, an institution whose principal purpose a ft.ncticn is to train handicapped individuals to pursue sane vocation is not a hospital. Moreover, a mechcal education a medical research institution is not a hospital, uriess it is also actively engaged in providing rrecical a hospital care to patients an its premises a in its facilities on an inpatient a - outpatient basis. Cooperative Hospital Service Organizations Cooperative hospital savice agarizations (section 5O1(e)) staid not complete Scheckie C. Maraca Research Orgarizaticns To qualify as a rrecical research orgarization, the principal ruction of the orgarization mast be the check continuots, and active conduct of medical research in corrction with a hospital that is described in section 501(O3), a Federal hospital, a an instrumentality of a governrrental u-it referred to in section 170(c)(1). Fa purposes of section 170(b)(1)(A)(ii) ally, the organization mist be set up to use the finds it receives in the active conduct of rredcal research by Jaruary 1 of the fifth calendar pa - after receipt lie arairgarat it has with donors to assay we of the finds v‘ittin the 5-yeer period cost be legally enforceable. As used here, "medical reattach" means investigations, ecerirrents. and stucies to ciscover, develop, a verify knowledge relating to the causes, diagnosis, treatment, preventim a introl hurren physical a mental dseases and irmeirmerts. Fa hither inforrmtion, see Reg 'aeons section 1.170A-9(c)(2). EFTA00311051 Form 1023 fRey 9.981 exile 19 Schedule D. Section 509(a)(3) Supporting Organizations la Organizations supported by the applicant organization; b Has the supported organization received a ruling or determination letter that it is not a private foundation by reason of section 509(a)(1) or 12)? Name and address of supported organization K Yes K No K Yes K No K Yes K No K Yes K No K Yes K No c If No for any of the organizations listed in la, explain. 2 Does the supported organization have tax-exempt status under section 501(c)(4), 501(C)(5). Or 501(c)(6)? K Yes K No II 'Yes.' attach: (a) a copy of its ruling or determination letter, and (b) an analysis of its revenue for the current year and the preceding 3 years. (Provide the financial data using the formats in Part IV-A Pines 1-13) and Part Ill (lines 11, 12, and 13).) 3 Does your organization's governing document indicate that the majority of its governing board is elected or appointed by the supported organizations? K Yes K No II 'Yes." skip to line 9. II'No,- you must answer the questions on lines 4 through 9. 4 Does your organization's governing document indicate the common supervision or control that it and the supported organizations share? K Yes K No If 'Yes.' give the article and paragraph numbers. If No, explain. 5 To what extent do the supported organizations have a significant voice in your organization's investment policies, in the making and timing of grants. and in otherwise directing the use of your organization's income or assets? 6 Does the mentioning of the supported organizations in your organization's governing instrument make it a trust that the supported organizations can enforce under state law and compel to make an accounting? K Yes K No II -Yes.- explain. 7a What percentage of your organization's income does it pay to each supported organization? b What is the total annual income of each supported organization? c How much does your organization contribute annually to each supported organization? For more information, see back of Schedule D. EFTA00311052 Form 1023 (Rev. 9.98) Schedule D. Section 509(a)(3) Supporting Organizations (Continued) 8 To what extent does your organization conduct activities that would otherwise be carried on by the supported organizations? Explain why these activities would otherwise be carried on by the supported organizations. 9 Is the applicant organization controlled directly or indirectly by one or more "disqualified persons' (other than one who is a disqualified person solely because he or she is a manager) or by an organization that is not described in section 509(8)(1) or (2)? 0 Yes 0 No If 'Yes.' explain. Instructions For an explanation of the types of organizations defined in section 5C0(aX3) as being excluded from the definition of a private foundation, see Rb. 557, Chapter 3. Line 1 List each organization that is supported by your organization and incicate in item lb if the supported aganization has received a letter recocjizing exempt status as a section 501(c)(3) attic charity as defined in section 509(a)(1) or 509(aX2). If you ansiner "kb" in lb to any of the listed organizations, please explain in lc. Line 3 \icy agarizaticris governing docurrent may be alides of it ILLA W attar, atides of association, constitution, trust indent re, or trust cur Line 9 Fa a definition of a "disqualified parson," see Specific Instructions, Pat II, Line 4d, on page 3 dale applications instructions. EFTA00311053 Fain 1023 !Rev. 9.98) 21 Schedule E. Private Operating Foundations Income Test la Adjusted net income, as defined in Regulations section 53.4942(0.2(d) b Minimum investment return, as defined in Regulations section 53.4942(a)•2(c) 2 Qualifying distributions: a Amounts (including administrative expenses) paid directly for the active conduct of the activities for which organized and operated under section 501(c)(3) (attach schedule) b Amounts paid to acquire assets to be used (or held for use) directly in carrying out purposes described in section 170(c)(1) or 170(c)(2)(B) (attach schedule) c Amounts set aside for specific projects that are for purposes described in section 170(c)(1) or 170(c)(2)(B) (attach schedule) d Total qualifying distributions (add lines 2a, b, and c) 3 Percentages: a Percentage of qualifying distributions to adjusted net income (divide line 2d by line la) h Percentage of qualifying distributions to minimum investment return (divide line 2d by line lb). . (Percentage must be at least 85% for 3a or 3b) Assets Test 4 Value of organization's assets used in activities that directly carry out the exempt purposes. Do not include assets held merely for investment or production of income (attach schedule) 5 Value of any stock of a corporation that is controlled by applicant organization and carries out its exempt purposes (attach statement describing corporation) 6 Value of all qualifying assets (add lines 4 and 5) 7 Value of applicant organization's total assets 8 Percentage of qualifying assets to total assets (divide line 6 by line 7 —percentage must exceed 65%) Endowment Test 9 Value of assets not used (or held for use) directly in carrying out exempt purposes: a Monthly average of investment securities at fair market value b Monthly average of cash balances c Fair market value of all other investment property (attach schedule) d Total (add lines 9a, b, and c) 10 Acquisition indebtedness related to line 9 items (attach schedule) 11 Balance (subtract line 10 from line 9d) 12 Multiply line 11 by 31/4% (F/J of the percentage for the minimum investment return computation under section 4942(e)). Line 2d above must equal or exceed the result of this computation Support Test 13 Applicant organization's support as defined in section 509(d) 14 Gross investment income as defined in section 509(e) 15 Support for purposes of section 49441130)(iii) (subtract line 14 from line 13) 16 Support received from the general public, five or more exempt organizations, or a combination of these sources (attach schedule) 17 For persons (other than exempt organizations) contributing more than 1% of line 15, enter the total amounts that are more than 1% of line 15 18 Subtract line 17 from line 16 19 Percentage of total support (divide line 18 by line 15 —must be at least 85%) 20 Does line 16 include support from an exempt organization that is more than 25% of the amount o line 15? Most recent tax year la 1b 2a 2b 2c 2d MEW 3a 3b 4 5 6 7 9a 9b 9c 9d 10 11 12 13 14 15 16 17 18 19 K Yes K No 21 Newly created organizations with less than 1 year's experience: Attach a statement explaining how the organization is planning to satisfy the requirements of section 4942(j)(3) for the income test and one of the supplemental tests during its first year's operation. Include a description of plans and arrangements, press clippings, public announcements, solicitations for funds, etc. 22 Does the amount entered on line 2a above include any grants that the applicant organization made? If "Yes," attach a statement explaining how those grants satisfy the criteria for 'significant involvement' grants described in section 53.4942(b)• 1(b)(2) of the regulations. For more information, see back of Schedule E. K Yes K No EFTA00311054 FOIT 1023 (Rev. 9.98) Page 22 Instructions If the organization claims to be an operating foundation described in section 49429(3) arid— a Bases its claim to private operating foundation status on normal and reglar operations over a period years; or b. Is newsy created, set up as a private operating fandatian and has at least 1 year's experience; provide the information under the income test and treler me of the ttree stypiernantal tests (ascac endowment, a- support). If the organization does not have at least 1 yea's experience, provide the irfcrmation called for an lire 21. If the organization's pivate operating foundation status depends an its normal and regla operations as described in a above, attach a scheale sirrilar to Schedule E showing the data in tabular form for the 3 years prececing the most recent tax yea (See Regulations section 53.494M-1 fa adcitional irformaticn before completing the "Ircome Test" section of his schectie) Crgarizaticns dairring section 49420)(5) status cost satisfy the inccrre test and the endowrrert test. A "Ovate operating foundation" described in section 49420)(3) is a private foundation that spends stbstantially all of the smeller el its acjusted net income (as defined below) or its rririmum 'mesh-rat rettrn drectiy for the active conduct cf the activities constituting the prpose a function for Wich it is organized and operated The foundation must satisfy the income test incier section 49429(3)(A), as modfied by Regiatiorts section 53.494M-1, and one cf the fdlowing three suppernartal tests (1) the assets test Liter section 49429(3)(640); (2) the erdowrent test urder section 49420)(3)049); a (3) the supped test under section 49429(3)(6)90. Certain long-term care facilities described in section 4942(0(5) are treated as private operating foundations for purposes of section 4942 arty. "Acjusted net incare" is the excess of goss income de err vtith the income rrocifications described below for the tax year over the sun of Melchor& determined with the deduction modifications described bean Items of gcss income from any trrelatepd trade a business and the deducticrts drectly corrected with the unrelated trade or business are taken into accotrt in computing the organization's adjusted net Irwin Nixifications The following ae income nrcifications (acjustrrents to gross incorre): 1. Section 103 (relating to interest on certain governmental obligation) does not apply. Thus, interest that otherwise world have been excluded should be included in goss income. 2. Except as protpided in 3 baton capital gars and losses are taken into accost only to the extern cf the ret shat-term gain Longterm gains and losses are cisregarded. The goss amount received from the sale or disposition of certain property should be included in goss insare to the extent that the aciaisition cf the property constituted a qualifying cistribution India section 4942(4(1)(6). 4. Repayrrents of prior qualifying cistributia-s (as defined in section 4942(g)(1)(A)) constitute item of gess it .. re. 5. Any arrant set aside under section 4942(8)(2) that is "not r utessay for the arposes for With it wes se aside" constitutes an item of goes income. Deduction Nixifications The fancying we deduction rrodficatiors (adtestrrerts to deducticnt 1. Expanses fa the gpaneral operation of the agarizaticri accacing to its charitable purposes (as contrasted Wit eq:erses for the production or collection cf income and rrenagerrert, conservation, or maintenance of inoone-prolong property) staid not be taken as deductiors. If oriy a portion of the property is wed for production cf income subject to section 4942 and the remainder is used for genera charitable pupa= the exposes compacted with that property should be chided aoxrcing to those procow. Cray expenses related to the income- producing portion staid be taken as deductions 2 Charitable cortritutims, deducible u -der section 170 a 642(4 shale, net be taken into aoxtnt as deductims fa acjusted net income. 3. The net operating loss deduction presaibed tinder section 172 should not be taken into moan as a deduction fa acksted net income. 4. The special deductions for corporations (such as the Miderds-received deduction) allowed under sections 241 Urn:ugh 249 stolid not be taken into account as dPeckaions fa accused net income. 5. Depreciatien and depletion staid be determined in the sarre n-on-er as under section 4940(c)(3)(0). Section 265 (relating to the expenses and interest connected with tax-exempt income) staid not be taken into accast. Nth rray find it easier to figre adjusted net income by completing colurrn (c). Pat 1. Farm 993-PF, accoreing to the instructiors for that form An organization that has been held to be a private operating fanclaticn will continue to be such an aganizaticn ally if it meets the income test and either the assets, endowment, or support test in later yeas. See Regiations section 53.4942(b) fa adpiticred intern-ration. Nat adciticnal request fa 'ding will be necessary a - appropriate for an ongarizaticn to rreirtain its status as a private operating foundation. However, data related to the above tests mist be submitted with the organization's annual information reign. Form 990-PE EFTA00311055 me 1023 (Rev 9-930 Page fl Schedule F. Homes for the Aged or Handicapped 1 What are the requirements for admission to residency? Explain fully and attach promotional literature and application forms. 2 Does or will the home charge an entrance or founders fee? K Yes K No If 'Yes: explain and specify the amount charged. 3 What periodic fees or maintenance charges are or will be required of its residents? 4a What established policy does the home have concerning residents who become unable to pay their regular charges? b What arrangements does the home have or will it make with local and Federal welfare units, sponsoring organizations, or others to absorb all or part of the cost of maintaining those residents? 5 What arrangements does or will the home have to provide for the health needs of its residents? 6 In what way are the home's residential facilities designed to meet some combination of the physical, emotional, recreational, social, religious, and similar needs of the aged or handicapped? 7 Provide a description of the home's facilities and specify both the residential capacity of the home and the current number of residents. 8 Attach a sample copy of the contract or agreement the organization makes with or requires of its residents. For more information, see back of Schedule F. EFTA00311056 Form 1023 (Rev. 9.98) ‘).tge 24 Instructions Line *I Rovide the criteria for adrrission to the hare and suarit brochLres, parrpHets, or other printed material used to inform the public about the horre's actrissions policy. Line 2 Incicate whether the fee charged is an entrance fee a a worthy charge, ac. Also, if the fee is an entrance fee, is it payable in a lump surn a on an installner it basis? Line 4 Incicate the crganization's policy reganing residents who are treble to pay. Also, indcate whether the agarization is subsicized fa all or pert of the oast of maintaining those residents who are usable to PaY Line 5 Indoate whether the organization provides health cae to the residents, either cfrectly a inirectly, ttrough sate confining alai mar ex t with other organizations, fadlities, a health personnel. If no health cae is provided, incicate 'WA" EFTA00311057 Form 1023 (Rer. 9.901 Page 25 Schedule G. Child Care Organizations Um 5 If your organization's services are not available to the general pudic, incicate the partialar gaup a - gaups that may utilize the services. 1 Is the crganizaticres prirrery activity the providng ci cae fa- children away from their hui rem)? 0 yes 0 No 2 l-bwrreny dildnen is the agarizaticn authorized to care fcr by the Stare (a local govemtnantal u -it), and what vtes the average attendance during the past 6 n A tl is, a- the number cf maths the agarization has been in erdstence if less than 6 months? 3 How many children are curentiy cared for by the agarization? 4 Is substantially all (at least 85°, of the care provided far the pupose of enabling parents to be gainfully employed a to seek errployrrent? . 0 Yes 0 No 5 Are the services provided available to the general public? 0 Yes 0 No If "No," explain. 6 Intl:ate the category, a - categaies, cf parents Wicse children are eligible for the thild care services (died< as many as apply): O low-ir 'Lure parents O any waking parents (a- parents locking fa- work) O anyone vtith the ability to pay O other (explain) Instructions REM NDER—If ttis crganization claims to operate a school, then it trust also fill al Schedule B EFTA00311058 form 1073 rem 9.98) Page 27 Schedule H. Organizations Providing Scholarship Benefits, Student Aid, etc., to Individuals la Describe the nature and the amount of the scholarship benefit, student aid, etc., including the terms and conditions governing its use, whether a gift or a loan, and how the availability of the scholarship is publicized. If the organization has established or will establish several categories of scholarship benefits, identify each kind of benefit and explain how the organization determines the recipients for each category. Attach a sample copy of any application the organization requires individuals to complete to be considered for scholarship grants, loans, or similar benefits. (Private foundations that make grants for travel, study, or other similar purposes are required to obtain advance approval of scholarship procedures. See Regulations sections 53.4945.4(c) and (d).) 0 II you want this application considered as a request for approval of grant procedures in the event we determine that the organization is a private foundation, check here c II you checked the box in lb above, check the boxles) for which you wish the organization to be considered. K 4945(g)(1) K 4945(9)(2) 0 4945(9113) 2 What limitations or restrictions are there on the class of individuals who are eligible recipients? Specifically explain whether there are, or will be, any restrictions or limitations in the selection procedures based upon race or the employment status of the prospective recipient or any relative of the prospective recipient. Also indicate the approximate number of eligible individuals. 3 Indicate the number of grants the organization anticipates making annually ► 4 If the organization bases its selections in any way on the employment status of the applicant or any relative of the applicant, indicate whether there is or has been any direct or indirect relationship between the members of the selection committee and the employer. Also indicate whether relatives of the members of the selection committee are possible recipients or have been recipients. 5 Describe any procedures the organization has for supervising grants (such as obtaining reports or transcripts) that it awards and any procedures it has for taking action if the terms of the grant are violated. For more information, see back of Schedule H. EFTA00311059 Form 1023 (312, 9.001 Page 28 Additional Information private far dations that nake pants to inclviduals fcr travel, study, a other sirrilar purper are reqired to obtain advance approval cf their gat procedures from the IRS. Such gents that are awarded wider selection procedures that have rut been approved by the IRS are subject to a 10% excise tax under section 4945. (See Regulations sections 53.4945-4(c) and (ck) If you are requesting advance approval of the organization's gent procedurs, the following sections apply to line lc 4945(g(1)—The grart constitutes a sd-clarship or fellowship gant that n-eets the provisions of section 117(a) prior to its arrendrrent by the Tax Reform /5d of 1986 and is to be used fcr study at an educational organization (school) described in section 170(b)(1)(A)0i). 4945(g)(2)—lhe grant constitutes a prize a award that is subject to the provisions of section 74(b), if the recipient of such a priæ cr award is selected frorntheganeral public. 4945(g(3)—The purpose of the gant is to adieve a specific objective, produce a report or other similar product, a irrprcne Cr erharce a literary, atistic, musical, scientific, teading or other smilar capacity, skill, or talent of the grantee. EFTA00311060 Fenn 1023 (Rev. 9.98) Page ra Schedule I. Successors to "For Profit" Institutions 1 What was the name of the predecessor organization and the nature of its activities? 2 Who were the owners or principal stockholders of the predecessor organization? (If more space is needed, attach schedule.) Name and address Share or interest 3 Describe the business or family relationship between the owners or principal stockholders and principal employees of the predecessor organization and the officers, directors, and principal employees of the applicant organization. 4a Attach a copy of the agreement of sale or other contract that sets forth the terms and conditions of sale of the predecessor organization or of its assets to the applicant organization. b Attach an appraisal by an independent qualified expert showing the fair market value at the time of sale of the facilities or property interest sold. S Has any property or equipment formerly used by the predecessor organization been rented to the applicant organization or will any such property be rented? K Yes K No If 'Yes,' explain and attach copies of all leases and contracts. 6 Is the organization leasing or will it lease or otherwise make available any space or equipment to the owners, principal stockholders, or principal employees of the predecessor organization? K Yes K No If 'Yes,' explain and attach a list of these tenants and a copy of the lease for each such tenant. 7 Were any new operating policies initiated as a result of the transfer of assets from a profit-making organization to a nonprofit organization? K Yes K No If "Yes," explain. Ackilimal Infarretion A -Tor profit" institution fa- purposes of Schecitle I includes any organization in vttich a person may have a proprietary a partnership interest, hold corporate stoat, a othervtise exercise an owes-ship irterest. The institution need not have operated fa the purpose of rnaking a profit. EFTA00311061