Form 1024 - Application For Recognition Of Exemption Under Section 501(A) Page 4
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204
Form 1024 (Rev. 1-2018)
Page
Part II. Activities and Operational Information (continued)
9 Has the organization made or does it plan to make any distribution of its property or surplus funds to shareholders or
members?
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Yes
No
If “Yes,” state the full details, including: (1) amounts or value; (2) source of funds or property distributed or to be distributed;
and (3) basis of, and authority for, distribution or planned distribution.
10 Does, or will, any part of your organization’s receipts represent payments for services performed or to be performed? .
Yes
No
If “Yes,” state in detail the amount received and the character of the services performed or to be performed.
11 Has the organization made, or does it plan to make, any payments to members or shareholders for services performed or
to be performed?
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Yes
No
If “Yes,” state in detail the amount paid, the character of the services, and to whom the payments have been, or will be,
made.
12 Does the organization have any arrangement to provide insurance for members, their dependents, or others (including
provisions for the payment of sick or death benefits, pensions, or annuities)? .
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Yes
No
If “Yes,” describe and explain the arrangement’s eligibility rules and attach a sample copy of each plan document and each
type of policy issued.
13 Is the organization under the supervisory jurisdiction of any public regulatory body, such as a social welfare agency, etc.?
Yes
No
If “Yes,” submit copies of all administrative opinions or court decisions regarding this supervision, as well as copies of
applications or requests for the opinions or decisions.
14 Does the organization now lease or does it plan to lease any property? .
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Yes
No
If “Yes,” explain in detail. Include the amount of rent, a description of the property, and any relationship between the
applicant organization and the other party. Also, attach a copy of any rental or lease agreement. (If the organization is a
party, as a lessor, to multiple leases of rental real property under similar lease agreements, please attach a single
representative copy of the leases.)
15 Has the organization spent or does it plan to spend any money attempting to influence the selection, nomination, election,
or appointment of any person to any federal, state, or local public office or to an office in a political organization?
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Yes
No
If “Yes,” explain in detail and list the amounts spent or to be spent in each case.
16 Does the organization publish pamphlets, brochures, newsletters, journals, or similar printed material?
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If “Yes,” attach a recent copy of each.
1024
Form
(Rev. 1-2018)
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