Form 1024 - Application For Recognition Of Exemption Under Section 501(A) Page 18

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Form 1024 (Rev. 1-2018)

Page

Schedule J

Organizations described in section 501(c)(17) (Trusts providing for the payment of supplemental

unemployment compensation benefits)

If benefits are provided for individual proprietors, partners, or self-employed persons under the plan, explain in detail.

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.

Give the following information as of the last day of the most recent plan year and enter that date here .

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.) .

Number of other employees covered by the plan .

Number of employees not covered by the plan

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.

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.

Borrow any part of the trust’s income or corpus?