Form Uct-673 - Nonprofit Organization Employer'S Report - 2013
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1
2NONPROFIT ORGANIZATION
EMPLOYER'S REPORT FOR
Complete 1-5 If different from address at left,
2013
then go to #6:
Required to determine your employer status under the
Wisconsin Unemployment Insurance Act, (CHAPTER 108,
1. Legal Name
WIS. STATS.) COMPLETE AND RETURN THIS REPORT
WITHIN 10 DAYS, UNLESS INSTRUCTED OTHERWISE,
EVEN IF THERE ARE NO EMPLOYEES.
UI ACCOUNT NUMBER
2. Trade Name
3. Mailing Address
c/o (If required for correct delivery)
4. Street or P.O. Box
5. City
State
Zip Code
6. Federal Identification Number (9 digits)
7. Person To Contact For Additional
information:
Name/Email Address
Send to:
Department of Workforce Development
Division of Unemployment Insurance
P.O. Box 7942
Madison, Wisconsin 53707-7942
Telephone Number
Telephone: (608) 261-6700
FAX: (608) 267-1400
(
)
email: taxnet@dwd.wisconsin.gov
9. Number of
8. Date you first had paid employees in Wisconsin (Mo/Day/Yr):
employees on payroll:
If "0" entered, stop here.
Go to reverse
side. Sign and date report, then return.
Nonprofit organizations are required to comply with the Wisconsin Unemployment Insurance Law as of
10.
the beginning of any calendar year if they employed at least 4 individuals on at least one day in 20
different calendar weeks in either the current or preceding calendar year. Section 108.02(19) defines
a "nonprofit organization" as an organization described in s.501(c)(3) of the Internal Revenue Code.
Is your organization a nonprofit organization?
Yes
No
If "yes," you must submit a copy of your determination letter from the Internal Revenue Service,
establishing your nonprofit status, if you have not already done so with earlier correspondence with the
Division. If you have not received your 501 (c)(3) ruling, submit a copy of your application for 501
(c)(3) status and a copy of your articles of incorporation. (Failure to submit a copy will mean your
organization cannot be treated as a nonprofit organization for purposes of the Wisconsin U.I. Law):
11.
Indicate whether you had 20 weeks during a prior year in which there were 4 or more employees
working on the same day. (Do not count employees working in excluded employment.) If you answer
"yes," give the date the 20th week ended (mo/day/yr):
In 2011
Yes
No
Yes
No If yes, date: _______
If yes, date: _______
In 2012
12. Briefly describe the services provided by your organization:
13. Location where the organization conducts business if different from mailing address:
Ÿ
CONTINUE
UCT-673 (R. 11/19/2012) (U00606)
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Parent category: Financial