Department of the Treasury - Internal Revenue Service
14414
OMB Number
Form
Group Rulings Questionnaire
1545-2071
(October 2012)
This questionnaire asks for information concerning your organization’s group exemption ruling, including your relationship with your
subordinates and the manner in which you and your subordinates satisfy applicable Form 990-series filing requirements. The
questionnaire asks about a range of practices that some group ruling holders engage in with their subordinates. Some questions may
not be applicable to your organization. If a question does not apply to your organization, answer “N/A” (not applicable).
Part I - Information About Your Organization
Name of organization
Employer Identification Number (EIN)
Organization’s website address (URL)
Group exemption number
Full name and title of person completing this form
Contact phone number
1. Indicate under which section of the Internal Revenue Code you are tax exempt
Section 501(c)(3)
Section 501(c)(4)
Section 501(c)(5)
Section 501(c)(6)
Section 501(c)(7)
Section 501(c)(8)
Section 501(c)(9)
Section 501(c)(10)
Section 501(c)(14)
Section 501(c)(19)
Don’t know
Other (describe)
2. If you selected section 501(c)(3) in question 1, indicate your private foundation or public charity classification from the list below.
Skip to question 5 if you did not select section 501(c)(3) in question 1
Section 509(a)(1)
Section 509(a)(2)
Section 509(a)(3)
Section 509(a)(4)
Private foundation
Don’t know
Other (describe)
3. If you selected section 509(a)(1) in question 2, indicate the subsection under which you qualify below. Skip to question 4 if you did
not select section 509(a)(1) in question 2
Section 170(b)(1)(A)(i)
Section 170(b)(1)(A)(ii)
Section 170(b)(1)(A)(iii)
Section 170(b)(1)(A)(iv)
Section 170(b)(1)(A)(v)
Section 170(b)(1)(A)(vi)
Don’t know
4. If you selected section 509(a)(3) in question 2, indicate the type of status that applies to your organization below. Skip to question 5
if you did not select section 509(a)(3) in question 2
Type I
Type II
Type III
(Functionally Integrated)
Type III
Don’t know
(Non-Functionally Integrated)
5. Has your tax-exempt status ever been revoked based on an examination
Yes
No
Don’t know
a. If "yes" to question 5, provide the date your tax-exempt status was revoked in the format MM/DD/YYYY, for example 06/01/2009
(for June 1, 2009). If you don’t know the exact date your organization was revoked, write “Don’t know”
Date
(MM/DD/YYYY)
6. Has your tax-exempt status ever been automatically revoked for not filing a required return (Form 990-series) or notice (Form 990-N)
for three consecutive years
Yes
No
a. If "yes" to question 6, provide the date that your tax-exempt status was revoked in the format MM/DD/YYYY, for example
11/15/2010 (for November 15, 2010). The date should be no earlier than 05/15/2010
Date
(MM/DD/YYYY)
14414
Catalog Number 59845N
Form
(Rev. 10-2012)