Form 1023-EZ (6-2014)
Your Specific Activities
1 Enter the appropriate 3-character NTEE Code that best describes your activities (See the instructions):
To qualify for exemption as a section 501(c)(3) organization, you must be organized and operated exclusively to further one or more of the
following purposes. By checking the box or boxes below, you attest that you are organized and operated exclusively to further the purposes
indicated. Check all that apply.
Charitable Religious Educational
Scientific Literary Testing for public safety
To foster national or international amateur sports competition Prevention of cruelty to children or animals
3 To qualify for exemption as a section 501(c)(3) organization, you must:
• Refrain from supporting or opposing candidates in political campaigns in any way.
• Ensure that your net earnings do not inure in whole or in part to the benefit of private shareholders or individuals (that is, board members,
officers, key management employees, or other insiders).
• Not further non-exempt purposes (such as purposes that benefit private interests) more than insubstantially.
• Not be organized or operated for the primary purpose of conducting a trade or business that is not related to your exempt purpose(s).
• Not devote more than an insubstantial part of your activities attempting to influence legislation or, if you made a section 501(h) election, not
normally make expenditures in excess of expenditure limitations outlined in section 501(h).
• Not provide commercial-type insurance as a substantial part of your activities.
Check this box to attest that you have not conducted and will not conduct activities that violate these prohibitions and restrictions.
4 Do you or will you attempt to influence legislation? ......................
(If yes, consider filing Form 5768. See the instructions for more details.)
5 Do you or will you pay compensation to any of your officers, directors, or trustees? ............
(Refer to the instructions for a definition of compensation.)
6 Do you or will you donate funds to or pay expenses for individual(s)? ................
Do you or will you conduct activities or provide grants or other assistance to individual(s) or organization(s) outside the
United States? ................................
Do you or will you engage in financial transactions (for example, loans, payments, rents, etc.) with any of your officers,
directors, or trustees, or any entities they own or control? ....................
9 Do you or will you have unrelated business gross income of $1,000 or more during a tax year? .........
10 Do you or will you operate bingo or other gaming activities? ...................
11 Do you or will you provide disaster relief? ........................
Part IV is designed to classify you as an organization that is either a private foundation or a public charity. Public charity
status is a more favorable tax status than private foundation status.
1 If you qualify for public charity status, check the appropriate box (1a – 1c below) and skip to Part V below.
Check this box to attest that you normally receive at least one-third of your support from public sources or you normally receive at least 10
percent of your support from public sources and you have other characteristics of a publicly supported organization. Sections 509(a)(1) and
Check this box to attest that you normally receive more than one-third of your support from a combination of gifts, grants, contributions,
membership fees, and gross receipts (from permitted sources) from activities related to your exempt functions and normally receive not more
than one-third of your support from investment income and unrelated business taxable income. Section 509(a)(2).
Check this box to attest that you are operated for the benefit of a college or university that is owned or operated by a governmental unit.
Sections 509(a)(1) and 170(b)(1)(A)(iv).
If you are not described in items 1a – 1c above, you are a private foundation. As a private foundation, you are required by section 508(e) to have
specific provisions in your organizing document, unless you rely on the operation of state law in the state in which you were formed to meet
these requirements. These specific provisions require that you operate to avoid liability for private foundation excise taxes under sections
Check this box to attest that your organizing document contains the provisions required by section 508(e) or that your organizing document
does not need to include the provisions required by section 508(e) because you rely on the operation of state law in your particular state to
meet the requirements of section 508(e). (See the instructions for explanation of the section 508(e) requirements.)
Form 1023-EZ (6-2014)
Form 1023-EZ is filed electronically only on Pay.gov.
You must complete the Form 1023-EZ Eligibility Worksheet in the Instructions for Form 1023-EZ to
determine if you are eligible to file this form. Form 1023-EZ is filed electronically only on Pay.gov.
Go to www.irs.gov/form1023ez for additional filing information.