Form 1024 - Application For Recognition Of Exemption Under Section 501(A) Page 17
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1918
Form 1024 (Rev. 9-98)
Page
Schedule J
Organizations described in section 501(c)(17) (Trusts providing for the payment of
supplemental unemployment compensation benefits)
1
If benefits are provided for individual proprietors, partners, or self-employed persons under the plan, explain in detail.
2
If the plan provides other benefits in addition to the supplemental unemployment compensation benefits, explain in detail and state
whether the other benefits are subordinate to the unemployment benefits.
3
Give the following information as of the last day of the most recent plan year and enter that date here
a
Total number of employees covered by the plan who are shareholders, officers, self-employed persons, or highly
compensated (See Schedule F instructions for line 3a on page 14.)
b
Number of other employees covered by the plan
c
Number of employees not covered by the plan
*
d
Total number employed
*
Should equal the total of a, b, and c—if not, explain the difference. Describe the eligibility requirements that prevent
those employees not covered by the plan from participating.
4
At any time after December 31, 1959, did any of the following persons engage in any of the transactions listed below with the trust: the
creator of the trust or a contributor to the trust; a brother or sister (whole or half blood), a spouse, an ancestor, or a lineal descendant of
such a creator or contributor; or a corporation controlled directly or indirectly by such a creator or contributor?
Note: If you know that the organization will be, or is considering being, a party to any of the transactions (or activities) listed below, check the
“Planned” box. Give a detailed explanation of any “Yes” or “Planned” answer in the space below.
a
Borrow any part of the trust’s income or corpus?
Yes
No
Planned
b
Receive any compensation for personal services?
Yes
No
Planned
c
Obtain any part of the trust’s services?
Yes
No
Planned
d
Purchase any securities or other properties from the trust?
Yes
No
Planned
e
Sell any securities or other property to the trust?
Yes
No
Planned
f
Receive any of the trust’s income or corpus in any other transaction?
Yes
No
Planned
5
Attach a copy of the Supplemental Unemployment Benefit Plan and related agreements.
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