Form 1n - Nonprofit Organization Status Report & Election Of Payment Method

DWS-UI

Page 4

Form 1N

INSTRUCTIONS

The Utah Employment Security Act provides that the Department of Workforce Services must determine the status, under the Act, of each business and

each person independently established in a trade, occupation, or profession. This report is to be completed immediately and returned to P.O. Box

45288, Salt Lake City, Utah 84145-0288.

All items must be completed. If an item does not apply to your organization, enter N/A (Not Applicable).

Indicate the type of ownership entity for your organization.

Item 1.

/ I tem 2.

Provide the complete legal name of your organization. If the organization is referred to commonly by some other name or initial, please

provide the name. Provide the address where all official correspondence should be mailed.

Item 6.

If there is more than one permanent worksite, please attach a separate sheet listing the name, address and telephone number of each site.

Item 7.

Provide address, telephone and FAX numbers of location which is able to provide wage data, weeks of employment and other information

about employees separated from your employment, if different from item 2.

Item 8.

Provide the physical location in Utah (street address, city, & zip code), telephone and FAX numbers if different from item 2.

Item 11. Please describe in detail the nature of your organization’s activities.

Item 15. The definition of wages is currently defined by Section 3306(b), of the Internal Revenue Code of 1986, with modifications, subtractions, and

adjustments provided in Section 35A-4-208 Subsections (2), (3), and (4), of the Utah Employment Security Act with regard to how the wage

base is determined. “Wages” means all remuneration for employment including commissions, bonuses, salaries or draws to corporate officers,

tips and the cash value of all remuneration in any medium other than cash.

Item 16. If you acquired (in whole or in part) the activity previously conducted by another entity, please complete Items 16 - 16f. “Acquired” means

to have obtained the use of the assets through any legal means. It is not necessary to purchase the assets in order to have acquired them nor

is it necessary for your predecessor to have actually owned the assets for you to acquire the assets from him. An acquisition can include

repossession, foreclosure, gift, sale, lease or sublease.

Item 19. This election is available only to nonprofit organizations which have received the exemption from Federal Income Tax under Section 501(c)(3)

of the Internal Revenue Code. If you are subject to the Act and have received the Federal Income Tax exemption, you must elect a method of

payment.

Item 19A. Selection of this option will require that your organization reimburse the Unemployment Insurance Fund for the actual amount of

unemployment benefits paid to your former employees. You will receive a detailed billing each month showing the benefits paid to each

individual for the prior month.

Item 19B. Selection of this option requires that your organization submits a quarterly contribution (tax) report and pays a quarterly

contribution to the Unemployment Insurance Fund. The contribution (tax) is calculated by multiplying the taxable wages paid during the

quarter by the contribution rate. The rate is initially determined by using an existing rate, which prevails for employers in your general

business classification. After a fiscal year of experience (July 1 - June 30), your rate for the next calendar year will be determined by the

experience or history of benefits being paid to your former employees, taxable wages from your organization for the same benefit period and

unrecoverable benefit cost rate for fiscal year.

If additional information is needed, please call 801-526-9400 or 1-800-222-2857 ext. 9400 (Instate toll free number). FAX 801-526-9377.

Form 1n - Nonprofit Organization Status Report & Election Of Payment Method - 2001 Page 4