Instructions For Form 1024-A - Application For Recognition Of Exemption Under Section 501(C)(4) Of The Internal Revenue Code Page 5

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light, power, and other utilities, outside
by the organization in conducting its
Line 5. Include the amount collected by
janitorial services, mortgage interest, real
exempt activities. Attach a schedule listing
any local tax authority from the public on
estate taxes, and similar expenses.
these assets held at the end of the current
your behalf.
tax-year period and the cost or other
Line 19. Submit an itemized list showing
Line 6. To determine the value of
basis.
the type and amount of each significant
services or facilities furnished by a
expense for which a separate line is not
Line 9. Enter the book value of land not
governmental unit, use the fair market
provided.
held for investment.
value of the services or facilities furnished
to you. Do not include the value of
Line 20. Add lines 13 through 19 and
Line 10. Enter the book value of each
services or facilities generally provided to
enter the amount on line 20.
category of assets not reported on lines 1
the public without charge.
through 9. Attach a schedule listing each.
B. Balance Sheet
Line 7. Enter the total income from all
Line 11. Add lines 1 through 10 and enter
sources not reported on lines 1 through 6,
Line 1. Enter the total interest and non-
the amount on line 11.
or lines 9 and 11. Submit an itemized list
interest-bearing cash in checking and
Line 12. Enter the total of accounts
showing each type and amount of income
savings accounts, temporary cash
payable to suppliers and others, such as
included on this line. Also, briefly describe
investments (money market funds, CDs,
salaries payable, accrued payroll taxes,
each type of income.
treasury bills, or other obligations that
and interest payable.
mature in less than 1 year), change funds,
Line 8. Add lines 1 through 7 and enter
and petty cash funds.
Line 13. Enter the unpaid portion of
the amount.
grants and contributions that the
Line 2. Enter the total accounts
Line 9. “Gross receipts” is income from
organization has made a commitment to
receivable that arose from the sale of
activities that you conduct to further your
pay to other organizations or individuals.
goods and/or performance of services.
exempt purposes (excluding amounts
Line 14. Enter the total of mortgages and
listed on other lines). It includes payments
Line 3. Enter the amount of materials,
other notes payable at the end of the year.
by a governmental unit that may be called
goods, and supplies purchased or
Attach a schedule that shows each item
a “grant,” but that is actually payment for a
manufactured by the organization and
separately and the lender's name,
service or facility for the use of the
held to be sold or used in some future
purpose of loan, repayment terms, interest
government payer, rather than for the
period.
rate, and original amount.
direct benefit of the public.
Line 4. Attach a schedule that shows the
Line 15. Enter the amount of each liability
Line 10. Add lines 8 and 9 and enter the
name of the borrower, a brief description
not reported on lines 12 through 14.
amount.
of the obligation, the rate of return on the
Attach a separate schedule.
principal indebtedness, the due date, and
Line 11. Attach a schedule with total
the amount due.
Line 16. Add lines 12 through 15 and
amounts entered (rather than each
enter the amount on line 16.
individual transaction) for each category.
Line 5. Attach a schedule listing the
organization's corporate stock holdings.
Line 17. Under fund accounting, an
Line 12. Combine lines 10 and 11 and
organization segregates its assets,
For stock of closely held corporations,
enter the amount.
liabilities, and net assets into separate
the schedule should show the name of the
Line 13. Fundraising expenses include
funds according to restrictions on the use
corporation, a brief summary of the
the total expenses incurred by you for
of certain assets. Each fund is like a
corporation's capital structure, the number
soliciting gifts, grants, and contributions
separate entity in that it has a
of shares held, and their value as carried
included on line 1. Where you allocate a
self-balancing set of accounts showing
on the organization's books. If such
portion of your other expenses to
assets, liabilities, equity (fund balance),
valuation doesn't reflect current fair market
fundraising, submit an itemized list
income, and expenses. If the organization
value, also include fair market value.
describing the amounts allocated. Include
uses fund accounting, report the total of all
For stock traded on an organized
fees paid to professional fundraisers for
fund balances on line 17.
exchange or in substantial quantities over
soliciting gifts, grants, and contributions.
If the organization doesn't use fund
the counter, the schedule should show the
Line 14. If distributions have been made,
accounting, report only the “net assets”
name of the corporation, a description of
submit an itemized list showing the name
account balances, such as capital stock,
the stock and the principal exchange on
of each recipient, a brief description of the
paid-in capital, and retained earnings or
which it is traded, the number of shares
purposes or conditions of payment, and
accumulated income.
held, and their value as carried on the
the amount paid.
organization's books.
Line 18. Add lines 16 and 17 and enter
Line 15. If payments have been made,
the amount on line 18.
Line 6. Attach a schedule that shows the
submit an itemized list showing the name
borrower's name, purpose of loan,
Part VII. Annual Filing
of each recipient, a brief description of the
repayment terms, interest rate, and
Requirements
purposes or condition of payment, and
original amount of loan. Report each loan
amount paid. Do not include any amounts
Certain organizations aren't required to file
separately, even if more than one loan
on line 14.
was made to the same person.
an information return (Form 990 or Form
990-EZ) or notice (Form 990-N).
Line 16. Enter the total amount of
Line 7. Enter the book value of U.S.,
Generally, organizations not required to
compensation. Be consistent with
state, or municipal government securities
file Form 990, or Form 990-EZ, or Form
information provided in Part IV, lines 3a,
held. Also enter the book value of
990-N include churches, certain church
3b, and 3c.
buildings and equipment held for
affiliated organizations, and certain
investment purposes. Attach a schedule
Line 17. Enter the total amount of
affiliates of a governmental unit. Note that
identifying each.
employees’ salaries and wages not
organizations that are exempt from filing
reported on line 16 above.
Form 990 or Form 990-EZ because of
Line 8. Enter the book value of buildings
and equipment not held for investment.
gross receipts are generally required to
Line 18. Enter the amount paid for the
This includes plant and equipment used
submit Form 990-N if they choose not to
use of office space or other facilities, heat,
Instructions for Form 1024-A
-5-

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