Form Nys-100n - New York State Employer Registration For Unemployment Insurance, Withholding, And Wage Reporting For Nonprofit Organizations Page 3

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Enter legal name
NYS-100N (02/13)
Page 3
For office use only
11. List the name of any government agency from which you receive funds:
12. For each of your programs and locations in New York State, answer 12a and 12b below. Use a separate sheet for each.
a. Program name:
b. Location:
No. and street
City or town
County
Zip code
c. Approximately how many persons do you employ there?
13. Principle purpose for which you are organized and operate. Check applicable box:
Religious
Residential home
Fund raising organization
Library
Nursing home
Research foundation/trust
Museum
Health clinic
Homemaker service
School (indicate highest grade _______
Other (describe in detail)
I affirm that I have read the above questions and that the answers provided are true to the best of my knowledge and belief.
/
/
X _________________________________________________________________________
Signature of Officer, Partner, Proprietor, Member or Individual
(mm/dd/yyyy)
.: (
)
-
____________________________________________________________ Phone no
Official Position
Instructions
Item 1
Enter your nine digit Federal Identification Number. This number is used to certify your payments to the IRS under FUTA.
Item 3-4
Enter in item 3 the actual name of your organization and in item 4 any other program names, acronyms etc., used. If you are a
corporation, the exact corporate name as shown on your Certificate of Incorporation should be entered in item 3. If you are part of, or
sponsored by, another organization, please explain on a separate sheet.
Item 5
A nonprofit organization is defined as one that is organized and operated exclusively for religious, charitable, scientific, literary, or
educational purposes. Generally, this includes all organizations that qualify for exemption under Section 501 (C) (3) of the Internal
Revenue Code.
Organizations eligible for exemptions under other sections of the Internal Revenue Code or not organized and operated exclusively
for one or more of the above purposes cannot be considered nonprofit organizations for New York State Unemployment Insurance
purposes.
Item 5a
Any person or organization qualifying as an employer on the basis of instructions contained in federal Circular E that maintains an
office or transacts business in New York State is an employer for New York State withholding tax purposes and must withhold from
compensation paid to its employees.
Item 5b
Enter the first calendar quarter and the year in which you paid (or expect to pay) cash remuneration of $ 1,000 or more. Do not go
back beyond 3 years from January of the current year.
Consider as cash remuneration every form of compensation such as:
Salary
Commissions
Payments to corporate officers
Cash wages
Bonuses
Payments to part-time and temporary employees
Do not consider as cash remuneration:
1. Reasonable money value of board, rent, housing, lodging, or any similar advantage received. However, once an organization is
liable, the money value of such compensation is remuneration and must be reported.
2. Compensation paid to the following individuals whose services are not covered:
Duly ordained ministers in the exercise of their ministry
Members of religious orders in the performance of their required duties
Lay members engaged in religious functions
Persons employed at places of religious worship as caretakers or in the performance of religious duties, or both
Persons receiving rehabilitative services in a facility conducted for such purposes
Inmates of a custodial or penal institution working for a nonprofit organization
Students in regular attendance at an educational institution which employs them; a student’s spouse employed by the same
institution if the spouse was advised at time of hire that employment is under a program of financial assistance to the
student
Students enrolled in certain work study programs which combine academic instruction with work experience for credit

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