EFTA00311012

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 Barbara Mignon Weatherly BMW:lb Enclosures cc: Mrs. Cecile R. de Jongh (w/encl.) EFTA00311012 user ree run Exempt.uryanlcauvn Form (Rev. 8713 Determination Letter Request Contra number January 1998) In Attach this form to determination letter application. Amami paid onsarunsat ate Traestry Use lea scream Memel Reams Simla (Form 8718 is NOT a determination letter application.) 1 Name or organization 2 Employer Identification Number J F-425 tein Tcancld. PonHA 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 Fed 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 ► $15 Note: If you checked box 3a. you must complete the Certification below. 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 . ► SSC c 0 Group exemption letters SEC Instructions Attach to Form 8718 a check or Send the determination letter money order payable to the Internal application and Form 8718 to: The law requires payment of a user fee Revenue Service for the full amount of with each application for a determination Internal Revenue Service the user fee. If you do not include the P.O. Box 192 letter. The user fees are listed on line 3 full amount. your application will be Covington, KY 41012.0192 above. For more information, see Rev. returned. Attach Form 8718 to your Proc. 98-8. 1998.1. I.R.B. 225. determination letter application. If you are using express mail or a Check the box on line 3 for the type delivery service. Send the application of application you are submitting. If you and Form 8718 to: check box 3a. you must complete and Internal Revenue Service scc the carhresticn statemert that 201 West Rivercenter Blvd. appears under line 3a. RECEIVED WITH REMITTANCE Attn: Extracting Stop 312 PROCESS & ACCT. BRAWL Covington. KY 41011 SEP 1 3 2000 Inv; ISLANDS BUREAU OF INTERNAL REVENUE ST, THOMAS VI FINANCIAL TRUST COMPANY, INC. SCOTIABANK THE BANK OF NOVA SCOTIA 5127 6100 RED HOOK QUARTERS, SUITE B-3 CHARLOTTE AMALIE ST. THOMAS. USVI 00802 ST. THOMAS. USVI HD -605/216 9/I II2000 PAY TO Internal Revenue Service j $ "500.00 ORDER OFTHE Five Hundred and 00/100 DOLLARS SKvmiau Internal Revenue Service r Den en or. THOMAS. LIEU! MEMO PIP EFTA00311013 ,„,1023 Application for Recognition of Exemption OMB No. 1545-0056 le September 19981 Under Section 501(c)(3) of the Internal Revenue Code Note: If exempt ;fetus is appmvert this lesionent of the henry Iran Reventit Set•Ne 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) 2 Employer identification number (EIN) PI none. see page 3 of the Specific Instrecifons.1 _ti7 EDatelb Virstin Islands Foundation. Inc b c/o Name applicable) 3 Name and telephone number of person to be contacted if additional information is needed c Address (number and street) Room/Suite Suite Jeffrey Schantz d City, town, or post office. state. and ZIP • 4. If you have a foreign address. 4 nnua accounting period ends see Specific Instructions for Part I, page 3. December S Date inconprategbfermed St Thomas. 00102 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 0 Yes al No 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 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 gong tn. accompanying scneeuies and attachments. and to the test of my knowledge *I is true. correct i hare clammed inn application 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 Trustee s 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 Presiden t, Asst. None Treasurer and Asst. Secretary 41-42 Kongens Gade, St. Thomas, U.S. Jeffrey Schantz - Trustee, Vice Presiden V.I. 00802 t 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? If 'Yes.' name those persons and explain the basis of their selection or O Yes No appointment. —> a U.S.V.I. corporation which is the init contibutor to the Foundation. Mr. ial donor and a substant Schantz is an employee of a ial entity controlled by Mr. Epstein. business d Are any members of the organization's governing body 'disqualified persons" with respect to the organization (other than by reason of being a member of the governing body) or do any of the members have either a business or family relationship with 'disqualified persons"? (See Specific Instructions for Part II, Line 4d. on page 3 ) if -res.- explain. Jeffrey Epstein, Trus co Yes O No tee, President and Treasure Schantz, Trustee, Vice President r, and Jeffrey and Secretary, of the Foundati disqualified persons. Mr. Epstein on, are is a principal, a director and Pr door ann Mr- ccnanta }s the a director Does the organization control or is it controlled by any other organization" C. is the organization the outgrowth of (or successor to) another organi zation, or does it have a special relationship with another organization by reason of interlo cking 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 of The C.0.U.Q. Foundation, Inc. and President a Trustee of the J. Epstein both of which are already qualified Foundation under Section 501(c)(3) of the Internal Revenue Code. It is not intended that there will be any between either of these organization dealings s and the Foundation. 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, memb ership, or fundraising solicitations; or (g) sharing of facilities. equipment, marling lists or other assets. or paid employees' ❑ Yes 'Yes: explain fully and identify the other organizations involved. No 7 Is the organization financially accountable to any other organization ' if - Yes," explain and identify the other organization. Include details concerning accountability or attach O Yes )p No copies of reports if any have been submitted 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' O Yes No 1/ Yes,' ?)i plain fully 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 ❑ 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? ❑ Yes ❑ 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? ❑ Yes ❑ 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' . ❑ Yes ❑ 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 ► ❑ 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.) ❑ 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? ❑ 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 bnx below that most appropriately applies: requesting by checking the THE ORGANIZATION IS NOT A PRIVATE FOUNDATION BECAUSE IT QUALIFIES: a ❑ 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 ❑ As a school (MUST COMPLETE SCHEDULE B.) and 170(3)(1)(Allii) e ❑ As a hospital or a cooperative hospital service organization, or a medical research organization operated in conjunction with a Sections 509(a)(1) hospital (These organizations, except for hospital service and 170(b)(1)(A)(iii) organizations. MUST COMPLETE SCHEDULE C.) Sections S09(a)(1) d ❑ As a governmental unit described in section 110(c)(1). and 170(b)(1)(A)(v) e ❑ 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.) Section 509(a)(3) I ❑ As being organized and operated exclusively for testing for public safety. Section S09(a)(4) g ❑ As being operated for the benefit of a college or university that is Sections S09(a)(1) owned or operated by a governmental unit. and 170())(1)(A)(ivl h ❑ As receiving a substantial pail of its support in the form of contributions from publicly supported organizations. from a Sections S09(a)(1) governmental unit, or from the general public. and 1701b1110)(vd ❑ 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 ❑ The organization is a publicly supported organization but is not sure Sections sos(a)(1) whether it meets the public support test of h or i. The organization and I 7 0021(1)(Allvil would like the 'RS to decide the proper classification. 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.) ❑ 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 Expenses, attach a list for each year showing the name of the contributor: the date and of Revenue 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 supported" organization) whose total gifts, grants, contributions. etc., were more than the amount or "publicly above. entered on line 12a 13 If you are requesting a definitive ruling under section 509(a)(2). check here ► O and: 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 from each 'disqualified person.' (For a definition of 'disqualified person,' see Specific Instructions, Part received 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 payer (other than a 'disqualified person') whose payments to the organization were more than SS,000. For from each 'payer" includes, but is not limited to. any organization described in sections 110(b)(1)(A)(i) through this purpose. governmental agency or bureau. i) and any 14 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, A X is the organization. or any part of it, a school? B is the organization. or any part of it. a hospital or medical research organization? . C is the organization a section 509(a)(3) supporting organization? X 0 is the organization a private operating foundation? X E 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? 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 Staterran of Reueruo ad BA:tenses Current 3 prior tax years or proposed budget for 2 years tax year I Gifts. grants, and contributions (*from 6J15 (b) 2001 (c) 2002 reamed (not including unusual (dl grants-see page 6 of the to 4/13 (e) TOTAL instructions) 1$7,son 25411111 25,OOO 237, 500 2 Membership fees received 3 Gross investment income (see instructions for definition) 10, 000 10,000 20, 00 0 4 Net income from organization's unrelated business activities not included on line 3 Tax revenues levied for and 5 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) 187,500 35,000 35,000 257,5OO 14 Fundranng expenses . . . 15 Contributions. gifts. grants. and similar amounts paid (attach schedule) 37, 500 37,500 16 Disbursements to or for benefit of members (attach schedule) . 17 Compensation of officers. directors. and trustees (attach schedule) 2, 18 PC Other salaries and wages- LI 19 Interest 20 Occupancy (rent, utilities. etc.) 21 Depreciation and depletion 22 Other (attach schedule) . 23 Total ”roenses ladd Ines L1 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 1 187,500 2 Accounts receivable. net 2 1 Inventories 3 4 Bonds and notes receivable (attach schedule) 4 5 Corporate stocks (attach schedule) 6 Mortgage loans (attach schedule) 6 7 Other investments (attach schedule) 7 8 Depreciable and depletable assets (attach schedule) 8 9 Land 9 0 Other assets (attach schedule) 10 1 Total assets (add tines 1 through 10) 11 187,500 Liabilities Accounts payable 12 3 Contributions. gills. grants. etc . payable 13 4 Mortgages and notes payable (attach schedule) 14 5 Other liabilities (attach schedule) 15 6 Total liabilities (add lines 12 through 15) 16 Fund Balances n Net Assets 7 Total fund balances or net assets 17 187,500 8 Total liabilities and fund balances or net assets (add line 16 and line 17) 18 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 EFTA00311022 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. Jeffrey E. Epstein EFTA00311023 ARTICLES OF INCORPORATION OF RECEIVED LT. li0V. OFFICE J. EPSTEIN VIRGIN ISLANDS FOUN DATION, W M 13 P 1: 48' ::;:.T!nt13 We. the undersigned natural persons of the age of twenty-one years or more. all of whom tide residents of the Virgin Islands of the United Stat are bona es, acting as incorporators of a corp be named J. Epstein Virgin Islands Foundation.Inc.. do oration to adopt the following Articles of for such corporation pursuant to the Nonprofit Corpor Incorporation ations Law of the Virgin Islands Title 13. Sections 491 et seq. of the Virgin Isla (Chapter 3. nds Code), as the same may be to time, do make and tile these Articles ofIncorpo ame nde d from time ration in writing and do certify: ARTICLE I The name of the corporation (hereinafter referred to as the "Corporation") is VIRGIN ISLANDS FOUNDATION, INC J. EPSTEIN . ARTICLE II The principal office of the Corporation in the Virg in Islands is located at 41-42 Kongen St. Thomas. Virgin Islands. and the name of the resi s Gade. dent agent of the Corporation at Paul Hoffman. that address is ARTICLE III A. The Corporation is organized exclusively for cha ritable, educational and scientifi purp within the meaning of section 501(c)(3) of the Inte c oses rnal Revenue Code of 1986 (or the provision of subsequent tax law). Notwith corr esp onding standing any other provision of Corporation shall not carry on any activitie these Articles. the s not permitted to be carried on 0) exempt from federal income tax under Section by a corporation 501(c)(3). or (ii) by a corporation. which are deductible under Sections 170 contributions to (c)(2). 2055(ai(2). 2106ta it21( A )( ii). 25.2203)(2). 2522(aif 2) or B. No part of the net earnings of the Corporatio n shall inure to the benefit of any The Corporation shall. however. be authorized individual. and empowered to pay reasonable services rendered and to make payments in com pensation for furtherance of its purposes. The on propaganda or otherwise attempt to influenc Cor por atio n may cam e legislation but only to the exte Internal Revenue Code. The Corporation sha nt permitted by the ll not participate in. or intervene publishing or distributing of statements t. any in (including the political campaign on behalf of or in candidate for public office. opposition to any EFTA00311024 Articles of Incorporation Page 2 ARTICLE IV The member of the Corporation shall be Jeffrey E. Epstein or such perso n 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 6100 Red Hook Quarter. Suite B-3 American Yacht Harbor St. Thomas. VI 00802 Jeffrey Schantz 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-L aws. 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 Corp oration 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 6100 Red Hook Quarter. Suite 13-3 American Yacht Harbor St. Thomas. VI 00802 Jeffrey Schantz 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 Jeffrey Schantz 6100 Red Hook Quarter. Suite B-3 American Yacht Harbor St. Thomas, VI 00802 Vice President Paul Hoffman 4142 Kongens Gade St. Thomas. VI 00802 Secretary Jeffrey Schantz 6100 Red Hook Quarter. Suite 8-3 American Yacht Harbor St. Thomas. VI 00802 Treasurer Jeffrey Epstein 6100 Red Hook Quarter. Suite B-3 American Yacht Harbor St. Thomas. VI 00802 Assistant Secretary Paul Hoffman 41-42 Koneens Gade St. Thomas. VI 00802 Assistant Treasurer Paul Hoffman 4142 Koneens Gade St. Thomas. VI 00802 E. The officers of the Corporation shall be elected at an annual meet ing 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 ofTrusieeiTihich 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 2-21 Bonne Esperance St. Thomas. Virgin Islands Paul Hoffman 4142 Kongens Gade St. Thomas. VI 00802 Jeffrey Epstein 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 2000 by Barbara Mignon Weatherly and Paul Hoffman. Notary Public X/ Linos it Pubic No. STATE OF NEW YORK 81 'Munn!'Ira John, 13.8. Icon hip Commission expires Lela aA )ss: COUNTY OF N The foregoing instrument was acknowledged before me this it. day of June 2000 by Jeffrey Epstein. Notary Public LAUREN J. Notary Public, KWINTNER State of New No. York 02KW6016686 Oualified in New Commission Expires York Count). November 30, 20 U+ 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 ofall money, funds and property of the Corporation, unless otherwise determined by the Board ofTrustees, 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 ofthe 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 501(n) charitable risk pools use Form 1023 to apply for a Department of the Treasury determination letter under section 5011013). Internal Revenue Service 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. Instructions for 1A,hat To File Form 1023 All applicants must complete pages I through 9 of Form 1023. These organizations must also complete the schedules or form indicated: (Revised September 1998) 1. Churches Schedule A 2. Schools Schedule 8 Application for lecogition of Exerrption 3. Hospitals and Medical Research Schedule C Under Section 5O1(c)(3) of the Internal 4. Supporting Organizations (5091a931) Schedule Revenue Code S. Private Operating Foundations Schedule E 6. Homes for the Aged or Handicapped . . Schedule F Note: Retain a copy of the completed form 7013 m the 7. Child Care organization's permanent records. See Public Inspection of Form Schedule G 1021 regarding public inspection of approved applications. B. Scholarship Benefits or Student Aid Schedule H 9. Organizations that have taken over or will take General Instructions over a "lot prole institution 10. Organizations requesting an advance ruling in Schedule I Section references are to the Internal Revenue Code unless Part lit line 10 otherwise noted. Form 872-C Attachments.— For any attachments submitted with Form 1023.— User Fee.— Submit with the Form 1023 application for a • Show the organization's name. address. and employer determination letter. a Form 8718, User Fee for Exempt Organization identification number (FIN). Determination t elver Request, and the user fee called for in the Form 8118. You may obtain Form 8718. and additional forms and • Identify the Part and line item number to which the attachment publications, through your local IRS office or by calling relates. 1.800.829.3676 (1.800 -TAX -FORM). User fees are subject to change • Use 81/2 x 11 inch paper for any attachments. on an annual basis. Thetelore, be sure that you use the most current • Include any court decisions. rulings, opinions, etc.. that will Form 8718. expedite processing of the application. Generally. attachments rn the Helpful information. —For additional information. see: form of tape recordings are not acceptable unless accompanied by a • Pub. 557, Tax•E rem pt Status for Your Organization transcript. • Pub. 598, Tax on Unrelated Business Income of Exempt When To File Organizations • Pub. 578, Tax Information for Private Foundations and An organization formed after October 9, 1969. must file Form 1023 to be recognized as an organization described in section 501(c)(3). foundation Managers Generally. if an organization files its application within 15 months • Internet site, www rs.ustreas.govitrus_inforeor 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 Purpose of Form section 501(c)(3) status will be the date it was organized. 1. Completed Form 1023 required for section S01(c)(3) Generally, if an organization does not file its application (Form exemption.—Unless it meets one of the exceptions in 2 below, any 1023) within 15 months after the end of the month in which it was organization formed alter October 9. 1969. must he a Form 1023 to formed, it will not qualify for exempt status during the period before qualify as a section 501lc)(31 organization the date of its application. For exceptions and special rules. the IRS determines if an organization is a private foundation from including automatic extensions in some cases, see Part Ill of Form the information entered on a Form 1023. 10 23. 2. Organizations not required to tile Form 1023.—The following The date of receipt of the Form 1023 is the date of the U.S. types of organizations may be considered tax-exempt under section postmark on the cover in which an exemption application is mailed 5011c93) even rf they do not hie Form 1023: or. if no postmark appears on the cover, the date the application is stamped as received by the IRS. 1. Churches. Private delivery services. —See the instructions for your income tax 2. Integrated auxiliaries of churches. and conventions or return for information on certain private delivery services designated associations of churches. or by the IRS to meet the 'timely mailing as timely filing/paying rule? 3. Any organization that: The private delivery service can tell you how to get written proof of (a) Is not a private foundation (as defined in section 509(a)), and the mailing date. (b) Has gross receipts in each taxable year of normally not more Caution: Private delivery services cannot deliver items to P.O. boxes. than 55.000. You must use the U. S. Postal Service to mail any item to an IRS Even d the above organizations are not required to file Form 1023 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. 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. lAhere To File Section 501)03) status provides certain incidental benefits such Eire the completed Form 1023 application. and all required as: information, with the IRS at the address shown in Form 8718. • Public recognition of lax -exempt status. The IRS will determine the organization's tax-exempt status and • Advance assurance to donors of deductibility of contributions. whether any annual returns must be filed. • Exemption horn certain state taxes. Signature ReqUierrents • Exemption from certain Federal excise taxes. An officer. a trustee who is authorized to sign. or another person • Nonprofit mailing privileges. etc. authorized by a power of attorney. must sign the Form 1023 3. Other organizations.— Section 501(e) and 9) cooperative service application. Attach a power of attorney to the application. You may organizations. section 501(k) child care organizations, and section use Form 2114e, Power of Attorney and Declaration of Representative. lot this purpose. EFTA00311035 Deductibility of Conbibttions 2. Any other information that would adversely affect the national Donors can take a charitable contribution deduction if their gift or defense. bequest is made to a section 501(0(31 organization. IMPORTANT: Applicants must identify this information by clearly The effective date of an organization's section 501(c)(3) status marking it, 'NOT SUBJECT TO PUBLIC INSPECTION,' and must determines the date that contributions to it are deductible by donors attach a statement to explain why the organization asks that the (See When To File on page 1.) information be withheld. If the IRS agrees. the information will be withheld. Contributions by U.S. residents to foreign organizations generally are not deductible. Tax treaties between the U.S. and certain foreign Organization's responsibilities for public inspection.—The countries provide limited exceptions. Foreign organizations (other organization must make available a copy of its approved application than those in Canada or Mexico) that claim eligibility to receive and supporting documents. along with any document or letter issued contributions deductible by U.S. residents must attach an English by the IRS for public inspection. copy of the U.S. tax treaty that provides for such deductibility. These documents must be available during regular business hours at the organization's principal office and at each of its regional or Appeal Priccectres district offices having at least three paid employees. See Notice 88.120.1988.2 C.B. 454 The organization's application will be considered by the IRS which will either: 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 1. Issue a favorable determination letter; a failure to comply continues. 2. Issue a proposed adverse determination letter denying the Furnishing copies of documents under TBOR2.—The Taxpayer Bill exempt status requested; or of Rights 2 (TBOR2I. enacted July 30. 1996. modified prospectively 3. Refer the case to the National Office. the section 6685 penally and the rules for the public inspection of If the IRS sends you a proposed adverse determination, it will returns and exemption applications. An organization must furnish a advise you of your appeal rights at that time. copy 01 its Form 990. Form 990-E2. or exemption application, and certain related documents. d a request is made in writing or in Language and Currency ReqUrements person. For a request made in person, the organization must make an Language requirements.— Prepare the Form 1023 and attachments in English. Provide an English translation if the organizational immediate response. document or bylaws are in any other language. For a response to a written request. the organization must provide the requested copies within 30 days. You may be asked to provide English translations of foreign language publications that the organization produces or distributes The organization must furnish copies of its Forms 990. or Forms and that are submitted with the application. 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 Financial requirements.—Report all financial information in U.S. actual postage costs. dollars (specify the conversion rate usedl. Combine amounts from within and outside the United States and report the total for each An organization need not provide copies if: item on the financial statements. 1. The organization has made the requested documents widely For example: available in a manner provided in Treasury regulations, or Gross Investment Income 2. The Secretary of the Treasury determined. upon application by the organization, that the organization was subject to a harassment From U.S. sources 54,000 campaign such that a waiver of the obligation to provide copies From non•U.S. sources 1,000 would be in the public interest. Amount to report on income statement $5,000 Penalty for failure to allow public inspection or provide copies.— The section 6685 penalty for willful failure to allow public inspections Annual Inforretion Return or provide copies is increased from the present -law level of $1,000 II an annual information return is due whde the organization's to 55.000 by TBOR2. application for recognition of exempt status is pending with the IRS Effective date of TBOR2.— These public inspection provisions (including any appeal of a proposed adverse determination), the governing tax-exempt organizations under TBOR2 generally apply to organization should Me at the follow mg address: requests made no earlier than 60 days after the date on which the Internal Revenue Service Treasury Department publishes the regulations required under the Ogden Service Center provisions. However. Congress. in the legislative history of TBOR2. Ogden, Utah 84201.0027 indicated that organizations would comply voluntarily with the public • Form 990, Return of Organization Exempt From Income Tax, or inspection provisions prior to the issuance of such regulations. • Form 99042, Short Form Return of Organization Exempt From Income Tax, and, Special I%Ae for Canadian Colleges and • Schedule A (Form 990), Organization Exempt Under Section Universities 5011c)(31. or A Canadian college or university that received Form T2051, • Form 990•PF, Return of Private Foundation, if the organization Notification of Registration. from Revenue Canada (Department of acknowledges it is a private foundation, and National Revenue. Taxation) and whose registration has not been revoked. does not need to complete all parts of Form 1023. Indicate that an application is pending. II an organization has unrelated business income of more than Such an organization must complete only Part I of Form 1023 and Schedule B (Schools, Colleges. and Universities). It must attach a SI 000. 'ite Form 990.T, (rem Cirocimiric Business Income Tax 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 Public Inspection of Form 1023 French. Caution: Note the discussion below for the potential effect of the Other Canadian organizations.—Other Canadian organizations that Taxpayer Bill of Rights 2 (TBOR2)on these instructions. seek a determination of section 501(c)13) status must complete Form IRS responsibilities for public inspection.—If the organization's 1023 in the same manner as U.S. organizations. 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). Specific Instructions The following instructions are keyed to the line items on the 1. The organization's application and any supporting documents. application form: 2. Any letter or other document issued by the IRS with regard to the application. Part I. Identification of Applicant Note that the following items are not available for public Line 1. Full name and address of organization. —Enter the inspection: organization's name exactly as it appears in its creating document 1. Any information relating to a trade secret, patent. style of work, mckiding amendments. Show the other name in parentheses. it the or apparatus that, if released. would adversely affect the organization will be operating under another name. organization. or Page 2 EFTA00311036 For a foreign address. enter the information in the following order: Bylaws.—If the organization has adopted bylaws, include a current city. province of state, and country. Follow the country's practice m copy. The bylaws do not need to be signed if they are submitted as placing the postal code in the address. Do not abbreviate the an attachment to the Form 1023 application. The bylaws of an country name. organization alone are not an organizing instrument. They are merely Line 2. Employer identification number (EIN).—All organizations the internal rules and regulations of the organization. must have an EIN. Enter the nine -digit EIN the IRS assigned to the Trust.—In the case of a trust, a copy of the signed and dated trust organization. See Form S5.4, Application for Employer Identification instrument must be furnished. Number, for information on how to obtain an EIN immediately by telephone. if the organization does not have an EIN. Enter. 'applied Dissolution clause.—For an organization to qualify for exempt for.' if the organization has applied for an EIN number previously. status, its organizing instrument must contain a proper dissolution Attach a statement giving the date of the application and the office clause, or state law must provide lot distribution of assets for one or where it was filed. Do not apply for an EIN more than once. more section 501(c)l3) purposes upon dissolution. If the organization is relying on state law, provide the citation for the law and briefly Line 3. Person to contact —Enter the name and telephone number state the law's provisions in an attachment. Foreign organizations of the person to contact during business hours if more information is must provide the citation for the foreign statute and attach a copy of needed. The contact person should be an officer. director, or a the statute along with an English language translation. 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 See Pub. 557 for a discussion of dissolution clauses under the other power of attorney. heading. Articles of Organization, Dedication and Distribution of Assets. Examples of dissolution clauses are shown in the sample Line 4. Month the annual accounting period ends.—Enter the organizing instruments given in that publication. month the organization's annual accounting period ends. The accounting period is usually the 12.month period that is the Organizational purposes.— The organizing instrument must specify organization's tax year. The organization's fest tax year depends on the organizational purposes of the organization. The purposes the accounting period chosen. The hist tax year could be less than specified must be limited to one or more of those given in section 12 months. 5011c)(3). See Pub. 557 for detailed instructions and for sample organizing instruments that satisfy the requirements of section Line S. Date formed.—Enter the date the organization became a 501(03) and the related iegulat orc. legal entity. For a corporation. this Is the date that the articles of incorporation were approved by the appropriate state official. For an Pat II. Activities aid Operational unincorporated organization, it is the date its constitution or articles of association were adopted. Intemation Line 6.—Indicate if the organization is one of the following: Line 1.—It is important that you report all activities carried on by the • 501(e) Cooperative hospital service organization organization to enable the IRS to make a proper determination of the organization's exempt status. • 501(0 Cooperative service organization of operating educational organization Line 2.-11 it is anticipated that the organization's principal sources • 501(k) of support will increase or decrease substantially in relation to the Organization providing child care organization's total support. attach a statement describing • 501(n) Charitable risk pool anticipated changes and explaining the basis for the expectation. If none of the above applies, make no entry on line 6. Line 3 —For purposes of providing the information requested on Line 7.—Indicate if the organization has ever filed a Form 1023 or line 3. 'fundraising activity' includes the solicitation of contributions Form 1024, Application for Recognition of Exemption Under Section and both functionally related activities and unrelated business 501(a), with the IRS. activities. Include a description of the nature and magnitude of the Line 8.-11 the organization for which this application is being filed is activities. a private foundation. answer -NM? If the organization is not required Line 4a.—Furnish the mailing addresses of the organization's to file Form 990 (or Form 990.EZ) and is not a private foundation. principal officers, directors. or trustees. Do not give the address of answer lie and attach an explanation. See the Instructions for the organization. Form 990 and Form 990-EZ for a discussion of organizations not Line 4b.— The annual compensation includes salary, bonus. and any required to file Form 990 (or Form 990.E21. Otherwise, answer 'Yes.' other form of payment to the individual for services while employed Line 9.—Indicate if the organization has ever filed Federal income by the organization. tax returns as a taxable organization or filed returns as an exempt Line Ie.—Public officials include anyone holding an elected position organization (e.g.. Form 990. 990.E7. 99OPF. or 990.T). or anyone appointed to a position by an elected official. Line 10. Type of organization and organizational documents.— line Id.—For purposes of this application, a 'disqualified person' is Organizing instrument.—Submit a conformed copy of the any person who. rf the applicant organization were a private organizing instrument. If the organization does not have an foundation, is: organizing instrument, it will not qualify for exempt status. 1. A 'substantial contributor' to the foundation (defined below!: A conformed copy is one that agrees with the original and all 2. A foundation manager: amendments to A. The conformed copy may be: • A photocopy of the original signed and dated organizing 3. An owner of more than 20% of the total combined voting power of a corporation that is a substantial contributor to the document. OR foundation; • A copy of the organizing document that is unsigned but is sent 4. A 'member of the lamely' of any person described in 1, 2, or 3 with a written declaration, signed by an authorized individual, that above; states that the copy is a complete and accurate copy of the original signed and dated document. 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 Corporation.—In the case of a corporation. a copy of the articles of power. the profits interest. or the beneficial interests: and incorporation, approved and dated by an appropriate state official, is sufficient by itself. 6. Any other private foundation that is effectively controlled by the same persons who control the fast-mentioned private foundation or If an unsigned copy of the articles of incorporation is submitted, it any other private foundation substantially all of whose contributions must be accompanied by the written declaration discussed above. were made by the same contributors. Signed. or unsigned, copies of the articles of incorporation must A substantial contributor is any person who gave a total of more be accompanied by a declaration stating that the original copy of the than 35,000 to the organization. and those contributions are more articles was fled with. and approved by. the state. The date filed than 2% of all the contributions and bequests received by the must be specified. organization from the date it was created up to the end of the year Unincorporated association.—In the case of an unincorporated the contributions by the substantial contributor were received. A association. the conformed copy of the constitution, articles of creator of a trust is treated as a substantial contributor regardless of association. or other organizing document must indicate, in the the amount contributed by that person or others. document itself. or in a written declaration, that the organization was formed by the adoption of the document by Iwo or more persons. See Pub. 578 lot more information on 'disqualified persons.' Page 3 EFTA00311037 Line 5.—II your organization controls of is controlled by another Granting relief will not prejudice the interests of the exempt organization or a taxable organization. answer 'Yes.' government 'Control' means that Showing reasonable action and good faith.—An organization 1. Fifty percent (50%) or more of the filing organization's officers. acted reasonably and showed good faith if at least one of the diectors, trustees, or key employees are also officers, directors. following is true. trustees. or key employees of the second organization being tested for control: 1. The organization filed its application before the IRS discovered its failure to file. 2. The filing organization appoints 50% or more of the officers. directors. trustees, or key employees of the second organization: or 2. The organization failed to file because of intervening events beyond its cannot 3. Fifty percent (SO%) or more of the filing organization's officers. directors, trustees. or key employees are appointed by the second 3. The organization exercised reasonable diligence but was not organization. aware of the hung requirement. Control exists if the 50% test is met by any one group of persons To determine whether the organization exercised reasonable even if collectively the 50% test is not met. Examples of special diligence, it is necessary to take into account the complexity of filing relationships ale common officers and the sharing of office space or and the organization's experience in these matters. employees. 4. The organization reasonably relied upon the written advice of Line 6.—If the organization conducts any financial transactions the IRS. (either receiving or distributing cash or other assets). or nonfinancial S. The organization reasonably relied upon the advice of a activities with an exempt organization [other than a 501(c)(3) qualified tax professional who failed to file or advise the organization organization). or with a political organization. answer 'Yes." and to file Form 1023. An organization cannot rely on the advice of a explain. qualified tax professional if it knows or should know that he or she is Line 7.—II the organization must report its income and expense not competent to render advice on thing exemption applications or is activity to any other organization (tax exempt or taxable entity). not aware of an the relevant facts. answer 'Yes.' Not acting reasonably and in good faith.—An organization has not Line 8.—Examples of assets used to perform an exempt function acted reasonably and in good faith if it chose not to file after being are: land, building, equipment. and publications. Do not include cash informed of the requirement to file and the consequences of failure or property producing investment income. II you have no assets to do so. Furthermore, an organization has not acted reasonably and used in performing the organization's exempt function. answer in good faith if it used hindsight to request an extension of time to 'N/A' file. That is, if after the original deadline to file passes, specific facts have changed so that Ming an application becomes advantageous to Line 10a.—If the organization is managed by another exempt an organization. the IRS will not ordinarily grant an extension. To organization, a taxable organization, or an individual, answer 'Yes' qualify for an extension in this situation, the organization must prove Line 10b.—If the organization leases properly Irom anyone or leases that its decision to file did not involve hindsight. any of its property to anyone. answer 'Yes.' No prejudice to the interest of the government —Prejudge to the Line 11.—A membership organization for purposes of this question interest of the government results if granting an extension of time to is an organization that is composed of individuals or organizations file to an organization results in a lower total tax liability for the years who: to which the filing applies than would have been the case if the 1. Share in the common goal for which the organization was organization had applied on time. Before granting an extension, the created, IRS may require the organization requesting it to submit a statement from an independent auditor certifying that no prejudice will result if 2. Actively participate in achieving the organization's purposes: the extension is granted. and Procedure for requesting extension.— To request a discretionary 3. Pay dues. extension, an organization must submit the following with its Line 12.—Examples of benefits. services, and products are: meals to Form 1D23: homeless people. home for the aged. a museum open to the public. • A statement showing the date Form 1023 should have been bled and a symphony orchestra giving public performances. and the date it was actually filed. Note: Organtlations that provide low-income housing should see • An affidavit describing in detail the events that led to the fadure to Rev. Proc. 96-32. 1996.1 C.B. 717, fora 'safe harbor' and an apply and to the discovery of that failure. II the organization relied on alternative facts and circumstances test to be used in completing line a qualified tax professional's advice. the affidavit must describe the 12. engagement and responsibilities of the professional and the extent Line 13.—An organization is attempting to influence legislation if it to which the organization relied on him or her. contacts or urges the public to contact members of a legislative • All documents relevant to the election application body. for the purpose of proposing, supporting, or opposing legislation. or if it advocates the adoption or rejection of legislation. • A dated declaration, signed by an individual authorized to act for the organization, that includes the following statement: 'Under If you answer 'Yes,' you may want to file Form 5768, penalties of perjury. I declare that I have examined this request. Fledge/Revocation of Election by an Eligible Section 501(cl(3) including accompanying documents, and. to the best of my Organization To Make Expenditures To Influence Legislation. knowledge and belief. the request contains all the relevant facts Line 14.—An organization is intervening in a political campaign if a relating to the request, and such facts are true, correct, and promotes or opposes the candidacy or prospective candidacy of an complete.' individual for public office. • A detailed affidavit from individuals having knowledge or information about the events that led to the failure to make the Pat III. Techical Requirerrerts application and to the discovery of that failure. These individuals Line 1.—II you check "Yes.' proceed to line 7. If you check -No.' include accountants or attorneys knowledgeable in tax matters who proceed to line 2. advised the organization concerning the application. Any affidavit Line 2a.—To qualify as an integrated auxiliary. an organization must from a tax professional must describe the engagement and not be a private foundation and must satisfy the affthation and responsibilities of the professional as well as the advice that the support tests of Regulations section 1.6033-2(h). professional provided to the organization. The affidavit must also include the name, current address. and taxpayer identification Line 3.—Reliel from the 15.month tiling requirement is granted number of the individual making the affidavit (the Milani). The affront automatically if the organization submits a completed Form 1023 must also forward with the affidavit a dated and signed declaration within 12 months from the end or the 15 -month period. that states: 'Under penalties of perjury. I declare that I have To get this extension, an organization must add the following examined this request. including accompanying documents, and. to statement at the top of its application: 'Filed Pursuant to Section the best of my knowledge and belief. the request contains all the 301.91001.' No request for a letter ruling is required to obtain an relevant facts relating to the request. and such facts are true. automatic extension. correct, and complete.' Line 4.—See Regulation sections 301.9100.1 and 301.91003 for The reasons for la te filing should be specific to your particular information about a discretionary extension beyond the 27.month organization and situation. Regulation section 101.9100-3 (see period. Under these regulations. the IRS will allow an organization a above) lists the factors the IRS will consider in determining if good reasonable extension of time to file a Form 1023 4 it submits cause exists for granting a discretionary extension of time to file the evidence to establish that: application. lo address these facto's. your response for line 4 (a) It acted reasonably and in good faith, and should provide the following information: Page 4 EFTA00311038 1. Whether the organization consulted an attorney or accountant Box OB. A governmental unit —This category includes a state. a knowledgeable in tax matters or communicated with a responsible possession of the United States, or a political subdivision of any of IRS employee (before or alter the organization was created) to the foregoing. or the United States, or the District of Columbia. ascertain the organization's Federal filing requirements and. if so. the names and occupations or titles of the persons contacted, the Box (e). Organizations operated Sr connection with or solely for approximate dates. and the substance of the information obtained: organizations described in (a) through (d) or (g). (h). and (0.—The organization must be organized and operated for the benefit of. to 2. liow and when the organization learned about the 15 -month perform the functions of. or to carry out the purposes of one or more deadline for filing Form 1023, specified organizations described in section 509(a)(1) or (2). It must 3. Whether any significant intervening circumstances beyond the be operated. supervised. or controlled by or in connection with one organization's control prevented it from submitting the application or more of the organizations described in the instructions for boxes timely or within a reasonable period of time after it learned of the (a) through (d) or (g). (h). and (6. It must not be controlled (Wetly or requirement to file the application within the 15.month period; and indirectly by disqualified persons (other than foundation managers or 4. Any other information that you believe may establish reasonable organizations described in section 509(a)(1) or (2)). To show whether action and good faith and no prejudice to the interest of the the organization satisfies these tests, complete Schedule D. government for not filing timely or otherwise justly granting the relief Box (I). An organization testing for public safety.-An organization sought. in this category is one that tests products to determine their A request for relief under this section is treated as part of the acceptability for use by the general public. It does not include any request for the exemption determination letter and is covered by the organization testing for the benefit of a manufacturer as an operation user fee submitted with Form 8718. or control in the manufacture of its product. Liam 5.—II you answer 'No.* the organization may receive an Box (9). Organization for the benefit of a college or university adverse letter limiting the effective date of its exempt status to the owned or operated by a governmental unit. —The organization must date its application was received. be organized and operated exclusively for the benefit of a college or university that: 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 • Is an educational organization within the meaning of section its exemption as a section 501(c)(3) organization. If the organization 170(b)(1)(A)00 and is an agency or instrumentality of a state or is qualified under section 501(c))41 and page 1 of Form 1024 is filed political subdivision of a state: as directed. the organization will not be liable for income tax returns • Is owned or operated by a state or political subdivision of a state: as a taxable entity. Contributions to section 501(c)(4) organizations OR are generally not deductible by donors as charitable contributions. • Is owned or operated by an agency or instrumentality of one or Line 7.—Private foundations are subject to various requirements, more states or political subdivisions. restrictions, and excise taxes under Chapter 42 of the Code that do The organization must also normally receive a substantial part of not apply to public charities. Also, contributions to private its support from the United States or any state or political foundations may receive less favorable treatment than contributions subdivision of a state, or from direct or indirect contributions from to public charities. See Pub. 578. Therefore. it is usually to an the general public or from a combination of these sources. organization's advantage to show that it qualifies as a public charity rather than as a private foundation if its activities or sources of An organizston described in section 170(b)(1)(A)(W) will be subject support permit it to do so. Unless an organization meets one of the to the same publicly supported rules that are applicable to exceptions below. A is a private foundation. In general, an 170(b)(1)A)Ivi) organizations described in box 01) below. organization is not a private foundation if it is: Box N. Organization receiving support from a governmental unit 1. A church, school, hospital, or 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 2. A medical research organization operated in conjunction with a political subdivision, or from direct or indirect contributions from the hospital; general public, or from a combination of these sources. 3. An organization operated for the benefit of a college or The organization may satisfy the support requirement in either of university that rs owned or operated by a governmental unit; two ways. 4. An organization that normally receives a substantial part of its (1) It will be treated as publicly supported if the support it normally support in the form of contributions from a governmental unit or from receives from the above-described governmental units and the the general public as provided in section 170(b)(1)(A)(vi); general public equals at feast one-third of its total support S. An organization that normally receives not more than one-third (2) It will also be treated as publicly supported it the support it of its support Flom gross investment income and more than normally receives from governmental or public sources equals at one-third of its support from contributions, membership fees, and Mast 10% of total support and the organization is set up to attract gross receipts related to its exempt functions (subject to certain new and additional public or governmental support on a continuous exceptions) as provided m section 509(a)(21: basis. 6. An organization operated solely for the benefit of, and in If the organization's governmental and pubic support is at least connection with, one or more organizations described above (or for 10%. but not over one-third of its total support, the questions on the benefit of one or more of the organizations described in section lines 1 through 14 of Part II will apply to determine bath the 501(c)(4), (5), or (8) of the Code and also described in 5 above). but organization's claim of exemption and whether it is publicly not controlled by disqualified persons other than foundation supported. Preparers should exercise care to assure that those managers. as provided in section 509(03); or questions are answered in detail. T. An organization organized and Operated to test for public safety Box Organization described in section 509(a)(2).—The as provided in section 509(4(4). organization must satisfy the support test under section SIT9(a)(2)(A) Line 8.—Basis for private operating foundation status: (Complete and the gross investment income test under section 509(a)(2)(8). this line only it you answered 'Yes' to the question on line T.) To satisfy the support test, the organization must normally receive A 'private operating foundation' is a private loundation that more than one-third of its support from: (a) gifts, grants. spends substantially all of its adjusted net income or its minimum contributions. or membership fees, and (b) gross receipts from investment return, whichever is less, directly for the active conduct admissions. sales of merchandise, performance of services, or of the activities constituting the purpose or function for which it is furnishing of facilities, in an activity that is not an unrelated trade or organized and operated. business (subject to certain limitations discussed below). The foundation must satisfy the income test and one of the three This one-thiid of support must be from organizations described in supplemental tests: (1) the assets test (2) the endowment test; or section 509(a)(1). governmental sources, or persons other than (3) the support test. For additional information. see Pub. 578. disqualified persons. Line 9.—Basis for nonprwate foundation status: Check the box that In computing gross receipts from admissions, sales of shows why your organization is not a private foundation. merchandise, performance of services, or furnishing of facilities in an Box (a). A church or convention or association of churches. 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 Box (0). A school.—See the definition in the instructions for governmental unit are includible only to the extent they do not Schedule B. exceed the greater of $5,000 or 1% of the organization's total Box (c). A hospital or medical research organization.-See the support. instructions for Schedule C. To satisfy the gross investment income test, the organization must not receive more than one-third of its support Irom gross investment Page 5 income. EFTA00311039 Box (1). —II you believe the organization meets the public support Line 3.—Include on this line the income received from dividends. test of section 170(bI(l)(A)(w) or 509(a)(2) but are uncertain as to interest. and payments received on securities loans. rents. and which public support test it satisfies. check box (j). By checking this royalties. box. you are claiming that the organization is not a private foundation tine 4.—Enter the organization's net income from any activities that and are agreeing to let the IRS compute the public support of your organization and determine the correct foundation status. are regularly carried on and are not related to the organization's exempt purposes. Line 10.—An organization must complete a tax year consisting of at least 8 months to receive a definitive Mal) ruling under sections Examples of such income include fees from the commercial 1/0(bl(ll(Allvd and 509(a)(11, or under section 509(a)(21. testing of products; income from renting office equipment or other personal property: and income from the sale of advertising in an However, organizations that checked bOX (h), (i). or (j) on line 9 exempt organization's periodical. See Pub. 598 for information about that do not meet the 8.month requirement must request an advance unrelated business income and activities. ruling that covers their first 5 tax years instead of requesting a definitive ruling. Line 5.—Enter the amount collected by the local tax authority from the general public that has been allocated for your organization. An organization that meets the 8.month requirement has two options: 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 1. II may request a definitive ruling. The organization's pubic service/facility was furnished to your organization. Do not include support computation will be based on the support the organization any other donated services or facilities in Part IV. has received to date; or Line 7.—Enter the total income from all sources that is not reported 2. It may request an advance ruling. The organization's public on lines 1 through 6. or lines 9, 11. and 12. Attach a schedule that support computation will be based on the support it receives during lists each type of revenue source and the amount derived from each. its first 5 tax years. Line 9.—Include income generated by the organization's exempt An organization should consider the advance ruling option if it has function activities (charitable. educational. etc.I and its nontaxable not received significant public support during its first tax year or fundraising events (excluding any contributions received). during its first and second tax years. but it reasonably expects to receive such support by the end of its filth tax year. Examples of such income include the income derived by a symphony orchestra from the sale of tickets to its performances: and An organization that receives an advance ruling is treated. during raffles, bingo. or other fundraising-event income that is not taxable the 5 -year advance ruling period, as a public charity (rather than a as unrelated business income because the income.pioducing private foundation) for certain purposes, including those relating to activities are not regularly carried on or because they are conducted the deductibility of contributions by the general public. with substantially all (at least 85%) volunteer labor. Record related Line 11.—For definition of an unusual grant. see instructions for Part cost of sales on line 22, Other. IV•A. line 12. Line 11.— Attach a schedule that shows a description of each asset, Line 12.—Answer this question only if you checked box (g), (hi. or the name of the person to whom sold, and the amount received. In Won line 9. the case of publicly traded securities sold through a broker, the Line 13.—Answer the question on this line only if you checked box name of the purchaser is not requited. (i) or (j) on line 9 and are requesting a definitive ruing on line 10. Line 12.—Unusual grants generally consist of substantial Line 14.—Answer "Yes" or 'No' on each line. If 'Yes.' you must contributions and bequests from disinterested persons that: complete the appropriate schedule. Each schedule is included in this 1. Are attracted by reason of the publicly supported nature of the application package with accompanying instructions. For a brief organization; definition of each type of organization. see the appropriate schedule. 2. Are unusual and unexpected as to the amount; and 3. Would, by reason of their size. adversely affect the status of the Part Anancial Data organization as normally meeting the support test of section Complete the Statement of Revenue and Expenses for the current 170(0)(1)(A)(vd or section 509(a)(2l. as the case may be. year and each of the 3 years immediately before it (or the years the If the organization is awarded an unusual giant and the terms of organization has existed, if less than 4). the granting instrument provide that the organization will receive the Any applicant that has existed for less than 1 year must give funds over a period of years. the amount received by the financial data for the current year and proposed budgets for the organization each year under the giant may be excluded. See the following 2 years. regulations under sections 170 and 509. The IRS may request financial data for more than 4 years if Line 14.—Fundraising expenses represent the total expenses necessary. incurred in soliciting contributions. gifts. grants. etc. All financial information for the current year must cover the period Line 15.—Attach a schedule showing the name of the recipient. a beginning on the first day of the organization's established annual brief description of the purposes or conditions of payment. and the accounting period and ending on any day that is within 60 days of amount paid. The following example shows the format and amount the date of this application. of detail required for this schedule. If the date of this application is less than 60 days after the first Recipient Purpose Amount day of the current accounting period, no financial information is required for the current year. Museum of Natural History General operating budget 529.000 Financial information is required for the 3 preceding years State University Books for needy students 14.500 regardless of the current year requirements. Please note that if no Richard Roe financial information is required for the current year. the preceding Educational scholarship 12.200 year's financial information can end on any day that is within 60 Colleges. universities, and other educational institutions and days of the date of this application. agencies subject to the Family Educational Rights and Privacy Act Prepare the statements using the method of accounting and the (20 U.S.C. 1232g1 are not required to list the names of individuals accounting period (entered on line 4 of Part I) the organization uses who were provided scholarships or other financial assistance where in keeping its books and records. If the organization uses a method such disclosure would violate the privacy provisions of the law. other than the cash receipts and disbursements method. attach a Instead. such organizations should group each type of financial aid statement explaining the method used. provided. indicate the number of individuals who received the aid. and specify the aggregate dollar amount. A Staternent of Revenue and Expenses Line 16.— Attach a schedule showing the name of each recipient, a Line 1.—Do not include amounts received from the general public or brief description of the purposes or condition of payment, and a governmental and for the exercise or performance of the amount paid. Do not include any amounts that are on line 15. The organization's exempt function. However, include payments made by schedule should be similar to the schedule shown in the line 15 a governmental unit to enable the organization to provide a service instructions above. to the general public. Line 17.—Allach a schedule that shows the name of the person Do not include unusual grants. See the explanation for unusual compensated; the office or position: the average amount of time grants in Line 12 of this section. devoted to the organization's affairs per week. month. etc.; and the amount of annual compensation. The lollowing example shows the Line 2.—Include amounts received from members for the purpose of format and amount of detail required: providing support to the organization. These ale considered as contributions. Do not include payments to purchase admissions. merchandise. services, or use of facilities. Page 6 EFTA00311040 Name Position Time devoted Annual salary Line 6.—Report each loan separately. even if more than one loan was made to the same person. Attach a schedule that shows the Philip Poe President and borrower's name. purpose of loan. repayment terms. interest rate. 16 his. per wk. S27.500 general manager and original amount of loan. Line 7.—Enter the book value of government securities held (U.S.. Line 18.—Enter the total of employ es' salaries not reported on line state, or municipal). Also enter the book value of buildings and 17. equipment held for investment purposes. Attach a schedule Line 19.—Enter the total interest expense for the year, excluding identifying and reporting the book value of each. mortgage interest treated as if an occupancy expense on line 20. Line 8.—Enter the book value of buildings and equipment not held Line 20.—Enter the amount paid for the use of office space or other for investment. This includes plant and equipment used by the lactlities, heal, light, power. and other utilities, outside janitorial organization in conducting its exempt activities. Attach a schedule services, mortgage interest, real estate taxes. and similar expenses. listing these assets held at the end of the current tax year/period Line 21.—If your organization records depreciation. depletion. and and the cost or other basis. similar expenses. enter the total. Line 9.—Enter the book value of land not held for investment. Line 22.—Attach a schedule listing the type and amount of each Line 10.—Enter the book value of each category of assets not significant expense for which a separate line is not provided. Report reported on lines 1 through 9. Attach a schedule listing each. other miscellaneous expenses as a single total d not substantial in Line 12.— Enter the total of accounts payable to suppliers and amount. others, such as salaries payable, accrued payroll taxes. and interest payable. B. Balance Shut Line 13.—Enter the unpaid portion of grants and contributions that Line 1.— E nter the Iota r cash in checking and savings accounts. the organization has made a commitment to pay to other tem pulary cash investments (money market funds. CDs. treasury organizations or individuals. bills, or other obligations that mature in less than 1 year). change Line 14.—Enter the total of mortgages and other notes payable funds. and petty cash funds. outstanding al the end of the current tax yearlperiod. Attach a Line 2.—Enter the total accounts receivable that arose from the sale schedule that shows each item separately and the lender's name. al goods and/or performance of services, less any reserve for bad purpose of loan, repayment terms, interest rate. and original amount. debt. Line 15.—Enter the amount of each liability not reported on lines 12 Line 3.—Enter the amount of materials. goods. and supplies through 14. Attach a separate schedule. purchased or manufactured by the organization and held to be sold Line 17.—Under fund accounting. an organization segregates es or used in some future period. assets. liabilities. and net assets into separate funds according to Line 4.—Attach a schedule that shows the name of the borrower. a restrictions on the use of certain assets. Each fund is like a separate brief description of the obligation, the rate of return on the principal entity in that it has a self-balancing set of accounts showing assets. indebtedness, the due date. and the amount due. The following liabilities. equity (fund balance), income, and expenses. II the example shows the format and amount of detail required: organization does not use fund accounting. report only the 'net assets' account baiances, such as: capital stock. paid -in capital. Name of and retamed earnings or accumulated in come. Description of obhgation Rate of Due date Amount borrower reurn t Hope Soap Debenture bond (no senior 8% Jan. 2004 $37.500 Paperwork Reduction Act Notice.—We ask for the information on Corporation issue outstanding) 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 Big Spool Collateral note secured by 10% Jan. 2003 262,000 IRS. you are required to give us this information. We need it to Company company's fleet of 20 determine whether the organization meets the legal requirements for delivery trucks tax-exempt status. The organization is not required to provide the information Line 5 —Attach a schedule listing the organization's corporate stock requested on a form that is subject to the Paperwork Reduction Act holdings. unless the form displays a valid OMB control number. Books or For stock of closely held corporations. the statement should show records relating to a form or its instructions must be retained as long the name of the corporation. a brief summary of the corporation's as their contents may become material in the administration of any capital structure. and the number of shares held and their value as Internal Revenue la w. The rules governing the confidentiality of the carried on the organization's books. II such valuation does not Form 1023 application are covered in Code section 6104. reflect current fair market value, also include far market value. The time needed to complete and file these forms will vary For stock traded on an organized exchange or in substantial depending on individual circumstances. The estimated average times quantities over the counter. the statement should show the name of are: the corporation. a description of the stock and the principal exchange on which it is traded. the number of shares held. and their Learning Preparing, and value as carried on the organization's books. about the law sending the Form Reeordkeeping or the form form to IRS the following example shows the format and the amount of detail 1023 Paris Ito ry 55 hr., Se min 5 hr., 7 min a hi.. 31 min. requited: 1023 5th. A 7 hr.. 10 mm, .0. min. 7 min Name of Capital structure (or Book Fair 1023 Sch. 8 4 ht. 47 min. 30 min 36 min. corporation exchange on which traded) Shares amount market 1023 Sch. C S hr.. 1 min 35 min. 43 min. value 1023 Sch. 0 4 hr.. 4 min. 42 min 41 min. Little Spool 100 shares nonvoting Corporation preferred issued and 1023 Sch. E 9 hr.. 20 min. hr., S min. 1 hr_ 17 min. outstanding. no par 1023 Sch. F 2 fit.. 39 TM 2 hr., 53 min. 3 hr.. 3 min. value: 50 shares 1023 Sch. G 2 hr., 38 mm. -0. min. 2 min. common issued and 1023 Sch. H 1 hr., 55 min 42 min. 46 min outstanding. no par value. 1023 Sch. I 3 hr.. 35 mm -0. min. 4 min. Preferred shares: SO 520.000 $24.000 872-C 1 hr. 26 min 24 min. 26 min. Common shares 10 25.000 30.000 If you have comments concerning the accuracy of these time estimates or suggestions for making these forms simpler. we would Flintlock Class A common 80 6.000 6.500 be happy to hear from you. You can write to the Tax Forms Corporation NYSE 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. 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 reviewofa 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 Consent Fixing Period of Limitation Upon OMB No. 1545.0056 Assessment of Tax Under Section 4940 of the Rev September 1998) Internal Revenue Code To be used with Form 1023. Submit Depanment e the Ireastny in duplicate. Went Revenue Service (See instructions on reverse side.) 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) District Director or Internal Reverue, and the Assistart Contrissioner (Number. wen city or town, slate, and ZIP code) (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 (Monlb. day, and year) Name of organization (as shown in organizing document) Date Officer or trustee having authority to sign Type or print name and title Signature ► 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 nenLest ip in other chtithes cr religious ciders to become neeLer J.7 O WS ❑ 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 organzation's naligrous hierarchy cr ecdesiasfical govemrrent. 13 Does the organization have an established place of wcrship, O Yes O No If "Yes," provide theme 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 Showholyrrany 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 beused try any officer, cirecta, en-plcyee, rrinister, a pasta fa his a her persorel needs or converience? ❑ Yes ❑ 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 The IRS rreintaire two basic guidelines in convention a association d chiches is nct required deterrriring that an organization rreets the religious to file Form 1023 to be exempt from Federal imam puposes test: tax a to receive tax-dsduaitle contributions, such an organization rrey find it advantageous to obtain 1. That the particular religas beliefs of the reccgrition of exemption In this event, you should organization are truly and sincerely held. and st.brit inforrretion shafting that you ogarization is a 2. That the practices and rituals associated with the cinch. sYrogogie, association a convention of agarizations refigous beliefs a creed are not illegal dudes, religious order a religcus orgarization ttet a contray to dearly defined pudic pdicy. is an integal pat d a church and that it is carrying In ceder for the IRS to properly evaluate your at the functions of a church. organization's activities ad naligous purposes, it is In determining Abet/ter an adrrittedy religous irrpdtart that all questions in Sthedule A be organization is also a church, the IRS does not accept any and every assertion that suit an orgarizaticn is a The information subrritted with Schedule A will be a darch. Because beliefs and practices vay so widely, determining facia in granting the "church" status there is no singe definition of the wad "church" fa requested by you organization In completing the tax arpoc . The IRS ccreiders the facts aid schedule, consider the following pants: cirarrstarces d each orgarization applying fa church status. 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" ❑ Yes ❑ 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? ❑ Yes ❑ 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? ❑ Yes ❑ No b Use of facilities or exercise of student privileges? ❑ Yes ❑ No c Faculty or administrative staff' ❑ Yes ❑ No d Scholarship or loan programs' ❑ Yes ❑ 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?. . . . ❑ Yes ❑ 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' ❑ Yes ❑ 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" ❑ Yes ❑ No 10 Has the organization ever been determined by a state or Federal administrative agency or judicial body to be racially discriminatory? ❑ Yes ❑ 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 The IRS OOnsiders dscrininaticn al the basis ot fectiondpreserting formal instruction, normally race to include ciscrirrination ai the basis cif cola and maintains a reglar laxity and arriculun narrally national a ethic origin. A policy of a scrod that has a regularly enrolled student body, and has a place favors racial ninaity gaps in adnissiors. facilities, where its educational activities are carried on. progarrs, and financial assistance will not cartitute The term generally corresponds to the definition of ciscrirrination on the basis of race when the purpose an "educational orgarizaticn" in section 170(b)(1)(A)0). ard effect is to prarcte the establistrrent and This, the tam includes prirrery, secondary, rreintenance cf that school's racially nondisairrinatcry preparatory and tigi schools, and colleges and policy as to students universities. The tam does nct include organizations See Rev. Proc. 75-50, 1975-2 ca 587, for engaged in both educational and noneducational gidelines and reloonliceeping requirerrerts fa activities mess the later are merely Madera to the deteniring Metter private schools that are applying educational activities. A school fa handicapped fa reccgritiondecerrption have racially dilden is included within the tern but an nonciscrirrinatory policies as to studerts. orgarizaticn rrelely provicing hancicappeid thildren vtith custodial care is not. Line 2 Fa ptrpm of Schedule a "Sunday schools" that An instnrnentality cf a state a political stlocivision of are conducted by a ditch are not included in the a state rrey qualify under section 501(c)(3) if it is tern "schools" but separately organized sands (such organized as a separate entity from the governmental as parochial schools triversities, and sirrilar wit that created it and if it otherwise rreets the institutions) are induded in the term. agarizaticrel aid operational tests of section A pivate schod that chemise rreets the 501(c)(3). See Rev. Rd. 60.384, 1960-2 ca 172. Arty requirements of section 501(O(3) as an educational such agarizaticn that is a school is not a private institution mill not qualify fa ecerrption eider section school aid, therefore, is net subject to the provisions 501(a) mess it has a racially nondsairrinatory policy cf Rev. Proc. 75-50. as to students. Schools that incomactly answer "Yes" to lire 2 %ill This policy rrears that the school adrits stixients of be contacted to fumish the infcrrretion called fa by any race to all the rights, privileges, programs, aid lines 3 through 10 in at to establish that they urea activities generally accorded a trade available to the naquinamerts for exemption. To prevent delay in the students at that school and that the school does not processing cf you application, be are to answer lire cisairrinate on the basis of race in the adninistration 2 correctly and =Vote lines 3 through 10, if of its ecLoatiorel pdides, adrrissions pdides, applicable. scholarship and loan progarra and athletic a other schod-adrriristered programs. EFTA00311049 Schedule C. Hospitals and Medical Research Organizations ❑ Check here if claiming to be a hospital; complete the questions in Section I of this schedule; and write 'N/A' in Section II. ❑ 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? ❑ Yes ❑ 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? ❑ Yes ❑ 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? ❑ Yes ❑ No Explain. 3a Does or will the hospital require a deposit from persons covered by Medicare or Medicaid in its admission practices? ❑ Yes ❑ No If 'Yes,' explain. b Does the same deposit requirement, if any, apply to all other patients? ❑ Yes ❑ 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? ❑ Yes ❑ 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? ❑ Yes ❑ No If -Yes," describe. 6 Does the hospital provide office space to physicians carrying on a medical practice? ❑ Yes ❑ 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 Cooperative Hospital Service Organizations lb be entitled to status as a "hospital," an organization Cooperative hospital savice agarizations (section mist have, as its principal purpose a function, the 5O1(e)) staid not complete Scheckie C. provicing of rectal a hospital care a - n-ecical education a research. "Macical care" includes the Maraca Research Orgarizaticns treat rent et any physical or rental rise:4[y a To qualify as a rrecical research orgarization, the condition, the cost of Wich may be taken as a principal ruction of the orgarization mast be the deduction alder section 213, mhether the treeerent is check continuots, and active conduct of medical performed an an inpatient a outpatient basis. 71-us, a research in corrction with a hospital that is rehabilitation institUion, outpatient diric, a corrrnsity described in section 501(O3), a Federal hospital, a an mental health a dug treatment cater rrey be a instrumentality of a governrrental u-it referred to in hospital if its principal function is providing the section 170(c)(1). above-described services. Fa purposes of section 170(b)(1)(A)(ii) ally, the On the other hand, a caualescert home a a home organization mist be set up to use the finds it fa chilchan or the aged is net a hospital. Srrilarly, an receives in the active conduct of rredcal research by institution whose principal purpose a ft.ncticn is to Jaruary 1 of the fifth calendar pa - after receipt lie train handicapped individuals to pursue sane vocation arairgarat it has with donors to assay we of the is not a hospital. Moreover, a mechcal education a finds v‘ittin the 5-yeer period cost be legally medical research institution is not a hospital, uriess it enforceable. is also actively engaged in providing rrecical a hospital care to patients an its premises a in its As used here, "medical reattach" means facilities on an inpatient a - outpatient basis. 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 b Has the supported organization received a ruling la Organizations supported by the applicant organization; or determination letter that it is not a private Name and address of supported organization foundation by reason of section 509(a)(1) or 12)? ❑ Yes ❑ No ❑ Yes ❑ No ❑ Yes ❑ No ❑ Yes ❑ No ❑ Yes ❑ 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)? ❑ Yes ❑ 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? ❑ Yes ❑ 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? ❑ Yes ❑ 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? ❑ Yes ❑ 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 Line 3 defined in section 5C0(aX3) as being excluded from the definition of a private foundation, see Rb. 557, \icy agarizaticris governing docurrent may be Chapter 3. alides of it ILLA W attar, atides of association, constitution, trust indent re, or trust cur Line 1 Line 9 List each organization that is supported by your organization and incicate in item lb if the supported Fa a definition of a "disqualified parson," see Specific Instructions, Pat II, Line 4d, on page 3 dale aganization has received a letter recocjizing exempt status as a section 501(c)(3) attic charity as defined applications instructions. in section 509(a)(1) or 509(aX2). If you ansiner "kb" in lb to any of the listed organizations, please explain in lc. EFTA00311053 Fain 1023 !Rev. 9.98) 21 Schedule E. Private Operating Foundations Income Test Most recent tax year la Adjusted net income, as defined in Regulations section 53.4942(0.2(d) la b Minimum investment return, as defined in Regulations section 53.4942(a)•2(c) 1b 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) 2a 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) 2b c Amounts set aside for specific projects that are for purposes described in section 170(c)(1) or 170(c)(2)(B) (attach schedule) 2c d Total qualifying distributions (add lines 2a, b, and c) 2d 3 Percentages: MEW a Percentage of qualifying distributions to adjusted net income (divide line 2d by line la) 3a h Percentage of qualifying distributions to minimum investment return (divide line 2d by line lb). . 3b (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) 4 5 Value of any stock of a corporation that is controlled by applicant organization and carries out its exempt purposes (attach statement describing corporation) 5 6 Value of all qualifying assets (add lines 4 and 5) 6 7 Value of applicant organization's total assets 7 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 9a b Monthly average of cash balances 9b c Fair market value of all other investment property (attach schedule) 9c d Total (add lines 9a, b, and c) 9d 10 Acquisition indebtedness related to line 9 items (attach schedule) 10 11 Balance (subtract line 10 from line 9d) 11 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 12 Support Test 13 Applicant organization's support as defined in section 509(d) 13 14 Gross investment income as defined in section 509(e) 14 15 Support for purposes of section 49441130)(iii) (subtract line 14 from line 13) 15 16 Support received from the general public, five or more exempt organizations, or a combination of these sources (attach schedule) 16 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 17 18 Subtract line 17 from line 16 18 19 Percentage of total support (divide line 18 by line 15 —must be at least 85%) 19 20 Does line 16 include support from an exempt organization that is more than 25% of the amount o line 15? ❑ Yes ❑ 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? ❑ Yes ❑ No 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. EFTA00311054 FOIT 1023 (Rev. 9.98) Page 22 Instructions If the organization claims to be an operating foundation The goss amount received from the sale or described in section 49429(3) arid— disposition of certain property should be included in a Bases its claim to private operating foundation goss insare to the extent that the aciaisition cf the status on normal and reglar operations over a period property constituted a qualifying cistribution India years; or section 4942(4(1)(6). b. Is newsy created, set up as a private operating 4. Repayrrents of prior qualifying cistributia-s (as fandatian and has at least 1 year's experience; defined in section 4942(g)(1)(A)) constitute item of gess it .. re. provide the information under the income test and treler me of the ttree stypiernantal tests (ascac 5. Any arrant set aside under section 4942(8)(2) endowment, a- support). If the organization does not that is "not r utessay for the arposes for With it have at least 1 yea's experience, provide the wes se aside" constitutes an item of goes income. irfcrmation called for an lire 21. If the organization's pivate operating foundation status depends an its Deduction Nixifications normal and regla operations as described in a above, The fancying we deduction rrodficatiors (adtestrrerts attach a scheale sirrilar to Schedule E showing the to deducticnt data in tabular form for the 3 years prececing the most 1. Expanses fa the gpaneral operation of the recent tax yea (See Regulations section 53.494M-1 agarizaticri accacing to its charitable purposes (as fa adcitional irformaticn before completing the contrasted Wit eq:erses for the production or "Ircome Test" section of his schectie) Crgarizaticns collection cf income and rrenagerrert, conservation, dairring section 49420)(5) status cost satisfy the or maintenance of inoone-prolong property) staid inccrre test and the endowrrert test. not be taken as deductiors. If oriy a portion of the A "Ovate operating foundation" described in section property is wed for production cf income subject to 49420)(3) is a private foundation that spends section 4942 and the remainder is used for genera stbstantially all of the smeller el its acjusted net charitable pupa= the exposes compacted with that income (as defined below) or its rririmum 'mesh-rat property should be chided aoxrcing to those rettrn drectiy for the active conduct cf the activities procow. Cray expenses related to the income- constituting the prpose a function for Wich it is producing portion staid be taken as deductions organized and operated The foundation must satisfy 2 Charitable cortritutims, deducible u -der section the income test incier section 49429(3)(A), as modfied 170 a 642(4 shale, net be taken into aoxtnt as by Regiatiorts section 53.494M-1, and one cf the deductims fa acjusted net income. fdlowing three suppernartal tests (1) the assets test Liter section 49429(3)(640); (2) the erdowrent test 3. The net operating loss deduction presaibed tinder urder section 49420)(3)049); a (3) the supped test section 172 should not be taken into moan as a under section 49429(3)(6)90. deduction fa acksted net income. Certain long-term care facilities described in section 4. The special deductions for corporations (such as 4942(0(5) are treated as private operating foundations the Miderds-received deduction) allowed under for purposes of section 4942 arty. sections 241 Urn:ugh 249 stolid not be taken into account as dPeckaions fa accused net income. "Acjusted net incare" is the excess of goss income de err vtith the income rrocifications described 5. Depreciatien and depletion staid be determined below for the tax year over the sun of Melchor& in the sarre n-on-er as under section 4940(c)(3)(0). determined with the deduction modifications described Section 265 (relating to the expenses and interest bean Items of gcss income from any trrelatepd trade connected with tax-exempt income) staid not be a business and the deducticrts drectly corrected taken into accast. with the unrelated trade or business are taken into Nth rray find it easier to figre adjusted net income accotrt in computing the organization's adjusted net by completing colurrn (c). Pat 1. Farm 993-PF, accoreing to the instructiors for that form Irwin Nixifications An organization that has been held to be a private operating fanclaticn will continue to be such an The following ae income nrcifications (acjustrrents to aganizaticn ally if it meets the income test and either gross incorre): the assets, endowment, or support test in later yeas. 1. Section 103 (relating to interest on certain See Regiations section 53.4942(b) fa adpiticred governmental obligation) does not apply. Thus, intern-ration. Nat adciticnal request fa 'ding will be interest that otherwise world have been excluded necessary a - appropriate for an ongarizaticn to should be included in goss income. rreirtain its status as a private operating foundation. 2. Except as protpided in 3 baton capital gars and However, data related to the above tests mist be losses are taken into accost only to the extern cf the submitted with the organization's annual information ret shat-term gain Longterm gains and losses are reign. Form 990-PE cisregarded. 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? ❑ Yes ❑ 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 Line 4 Rovide the criteria for adrrission to the hare Incicate the crganization's policy reganing and suarit brochLres, parrpHets, or other residents who are treble to pay. Also, printed material used to inform the public indcate whether the agarization is about the horre's actrissions policy. subsicized fa all or pert of the oast of maintaining those residents who are usable to Line 2 PaY Incicate whether the fee charged is an entrance fee a a worthy charge, ac. Also, if Line 5 the fee is an entrance fee, is it payable in a Indoate whether the organization provides lump surn a on an installner it basis? health cae to the residents, either cfrectly a inirectly, ttrough sate confining alaimar 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 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 Um 5 REMNDER—If ttis crganization claims to If your organization's services are not available operate a school, then it trust also fill al to the general pudic, incicate the partialar Schedule B gaup a - gaups that may utilize the services. 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. ❑ 4945(g)(1) ❑ 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 4945(g)(2)—lhe grant constitutes a prize a inclviduals fcr travel, study, a other sirrilar award that is subject to the purper are reqired to obtain advance provisions of section 74(b), if the approval cf their gat procedures from the recipient of such a priæ cr award IRS. Such gents that are awarded wider is selected frorntheganeral public. selection procedures that have rut been approved by the IRS are subject to a 10% 4945(g(3)—The purpose of the gant is to excise tax under section 4945. (See adieve a specific objective, Regulations sections 53.4945-4(c) and (ck) produce a report or other similar product, a irrprcne Cr erharce a If you are requesting advance approval of literary, atistic, musical, scientific, the organization's gent procedurs, the teading or other smilar capacity, following sections apply to line lc skill, or talent of the grantee. 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). 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? ❑ Yes ❑ 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? ❑ Yes ❑ 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? ❑ Yes ❑ No If "Yes," explain. Ackilimal Infarretion A -Tor profit" institution fa- purposes of Schecitle I stoat, a othervtise exercise an owes-ship irterest. The includes any organization in vttich a person may have institution need not have operated fa the purpose of a proprietary a partnership interest, hold corporate rnaking a profit. EFTA00311061