Schedule G. Successors to Other Organizations 1a - Are you a successor to a for-profit organization? If “Yes,” explain the relationship with the
predecessor organization that resulted in your creation and complete line 1b. b - Explain why you took over the activities or assets of a for-profit organization or converted from
for-profit to nonprofit status. 2a - Are you a successor to an organization other than a for-profit organization? Answer “Yes” if you have
taken or will take over the activities of another organization; or you have taken or will take over 25%
or more of the fair market value of the net assets of another organization. If “Yes,” explain the
relationship with the other organzation that resulted in your creation. b - Provide the tax status of the predecessor organization. c - Did you or did an organization to which you are a successor previously apply for tax exemption
under section 501(c)(3) or any other section of the Code? If “Yes,” explain how the application was
resolved. d - Was your prior tax exemption or the tax exemption of an organization to which you are a successor
revoked or suspended? If “Yes,” explain. Include a description of the corrections you made to
re-establish tax exemption. e - Explain why you took over the activities or assets of another organization. 3 - Provide the name, last address, and EIN of the predecessor organization and describe its activities. Name EIN Address 4 - List the owners, partners, principal stockholders, officers, and governing board members of the predecessor organization.
Attach a separate sheet if additional space is needed. Name Address Share/Interest (If a for-profit) 5 - Do or will any of the persons listed in line 4, maintain a working relationship with you? If “Yes,”
describe the relationship in detail and include copies of any agreements with any of these persons or
with any for-profit organizations in which these persons own more than a 35% interest. 6a - Were any assets transferred, whether by gift or sale, from the predecessor organization to you?
If “Yes,” provide a list of assets, indicate the value of each asset, explain how the value was
determined, and attach an appraisal, if available. For each asset listed, also explain if the transfer
was by gift, sale, or combination thereof.
b - Were any restrictions placed on the use or sale of the assets? If “Yes,” explain the restrictions. c - Provide a copy of the agreement(s) of sale or transfer. 7 - Were any debts or liabilities transferred from the predecessor for-profit organization to you?
If “Yes,” provide a list of the debts or liabilities that were transferred to you, indicating the amount of
each, how the amount was determined, and the name of the person to whom the debt or liability is
8 - Will you lease or rent any property or equipment previously owned or used by the predecessor
for-profit organization, or from persons listed in line 4, or from for-profit organizations in which these
persons own more than a 35% interest? If “Yes,” submit a copy of the lease or rental agreement(s).
Indicate how the lease or rental value of the property or equipment was determined. 9 - Will you lease or rent property or equipment to persons listed in line 4, or to for-profit organizations
in which these persons own more than a 35% interest? If “Yes,” attach a list of the property or
equipment, provide a copy of the lease or rental agreement(s), and indicate how the lease or rental
value of the property or equipment was determined. Schedule H. Organizations Providing Scholarships, Fellowships, Educational Loans, or Other Educational
Grants to Individuals and Private Foundations Requesting Advance Approval of Individual Grant Procedures Section I Names of individual recipients are not required to be listed in Schedule H.
Public charities and private foundations complete lines 1a through 7 of this section. See the
instructions to Part X if you are not sure whether you are a public charity or a private
1a - Describe the types of educational grants you provide to individuals, such as scholarships, fellowships, loans, etc.
b - Describe the purpose and amount of your scholarships, fellowships, and other educational grants and loans that you
c - If you award educational loans, explain the terms of the loans (interest rate, length, forgiveness, etc.).
d - Specify how your program is publicized.
d - Provide copies of any solicitation or announcement materials. e - Provide a sample copy of the application used. 2 - Do you maintain case histories showing recipients of your scholarships, fellowships, educational
loans, or other educational grants, including names, addresses, purposes of awards, amount of each
grant, manner of selection, and relationship (if any) to officers, trustees, or donors of funds to you? If
“No,” refer to the instructions 3 - Describe the specific criteria you use to determine who is eligible for your program. (For example, eligibility selection
criteria could consist of graduating high school students from a particular high school who will attend college, writers of
scholarly works about American history, etc.)
4a - Describe the specific criteria you use to select recipients. (For example, specific selection criteria could consist of prior
academic performance, financial need, etc.)
b - Describe how you determine the number of grants that will be made annually.
c - Describe how you determine the amount of each of your grants. d - Describe any requirement or condition that you impose on recipients to obtain, maintain, or qualify for renewal of a grant.
(For example, specific requirements or conditions could consist of attendance at a four-year college, maintaining a certain
grade point average, teaching in public school after graduation from college, etc.) 5 - Describe your procedures for supervising the scholarships, fellowships, educational loans, or other educational grants.
Describe whether you obtain reports and grade transcripts from recipients, or you pay grants directly to a school under
an arrangement whereby the school will apply the grant funds only for enrolled students who are in good standing. Also,
describe your procedures for taking action if the terms of the award are violated. 6 - Who is on the selection committee for the awards made under your program, including names of current committee
members, criteria for committee membership, and the method of replacing committee members? 7 - Are relatives of members of the selection committee, or of your officers, directors, or substantial
contributors eligible for awards made under your program? If “Yes,” what measures are taken to
ensure unbiased selections? Note. - If you are a private foundation, you are not permitted to provide educational grants to disqualified
persons. Disqualified persons include your substantial contributors and foundation managers and
certain family members of disqualified persons. Section II Private foundations complete lines 1a through 4f of this section. Public charities do not
complete this section. 1a - If we determine that you are a private foundation, do you want this application to be
considered as a request for advance approval of grant making procedures?
b - For which section(s) do you wish to be considered? ● 4945(g)(1)—Scholarship or fellowship grant to an individual for study at an educational institution ● 4945(g)(3)—Other grants, including loans, to an individual for travel, study, or other similar
purposes, to enhance a particular skill of the grantee or to produce a specific product 2 - Do you represent that you will (1) arrange to receive and review grantee reports annually
and upon completion of the purpose for which the grant was awarded, (2) investigate
diversions of funds from their intended purposes, and (3) take all reasonable and
appropriate steps to recover diverted funds, ensure other grant funds held by a grantee
are used for their intended purposes, and withhold further payments to grantees until you
obtain grantees’ assurances that future diversions will not occur and that grantees will
take extraordinary precautions to prevent future diversions from occurring? 3 - Do you represent that you will maintain all records relating to individual grants, including
information obtained to evaluate grantees, identify whether a grantee is a disqualified
person, establish the amount and purpose of each grant, and establish that you
undertook the supervision and investigation of grants described in line 2? 4a - Do you or will you award scholarships, fellowships, and educational loans to attend an
educational institution based on the status of an individual being an employee of a
particular employer? If “Yes,” complete lines 4b through 4f. b - Will you comply with the seven conditions and either the percentage tests or facts and
circumstances test for scholarships, fellowships, and educational loans to attend an
educational institution as set forth in Revenue Procedures 76-47, 1976-2 C.B. 670, and
80-39, 1980-2 C.B. 772, which apply to inducement, selection committee, eligibility
requirements, objective basis of selection, employment, course of study, and other
objectives? (See lines 4c, 4d, and 4e, regarding the percentage tests.) c - Do you or will you provide scholarships, fellowships, or educational loans to attend an
educational institution to employees of a particular employer?
If “Yes,” will you award grants to 10% or fewer of the eligible applicants who were
actually considered by the selection committee in selecting recipients of grants in that
year as provided by Revenue Procedures 76-47 and 80-39?
d - Do you provide scholarships, fellowships, or educational loans to attend an educational
institution to children of employees of a particular employer?
If “Yes,” will you award grants to 25% or fewer of the eligible applicants who were
actually considered by the selection committee in selecting recipients of grants in that
year as provided by Revenue Procedures 76-47 and 80-39? If “No,” go to line 4e.
e - If you provide scholarships, fellowships, or educational loans to attend an educational
institution to children of employees of a particular employer, will you award grants to 10%
or fewer of the number of employees’ children who can be shown to be eligible for grants
(whether or not they submitted an application) in that year, as provided by Revenue
Procedures 76-47 and 80-39?
If “Yes,” describe how you will determine who can be shown to be eligible for grants
without submitting an application, such as by obtaining written statements or other
information about the expectations of employees’ children to attend an educational
institution. If “No,” go to line 4f.
Note. Statistical or sampling techniques are not acceptable. See Revenue Procedure
85-51, 1985-2 C.B. 717, for additional information. f - If you provide scholarships, fellowships, or educational loans to attend an educational
institution to children of employees of a particular employer without regard to either the
25% limitation described in line 4d, or the 10% limitation described in line 4e, will you
award grants based on facts and circumstances that demonstrate that the grants will not
be considered compensation for past, present, or future services or otherwise provide a
significant benefit to the particular employer? If “Yes,” describe the facts and
circumstances that you believe will demonstrate that the grants are neither compensatory
nor a significant benefit to the particular employer. In your explanation, describe why you
cannot satisfy either the 25% test described in line 4d or the 10% test described in line 4e.
Form 1023 Checklist
(Revised December 2013) Application for Recognition of Exemption under Section 501(c)(3) of the
Internal Revenue Code
Note. Retain a copy of the completed Form 1023 in your permanent records. Refer to the General Instructions
regarding Public Inspection of approved applications.
Check each box to finish your application (Form 1023). Send this completed Checklist with your filled-in
application. If you have not answered all the items below, your application may be returned to you as
Assemble the application and materials in this order:
● Form 1023 Checklist
● Form 2848, Power of Attorney and Declaration of Representative (if filing)
● Form 8821, Tax Information Authorization (if filing)
● Expedite request (if requesting)
● Application (Form 1023 and Schedules A through H, as required)
● Articles of organization
● Amendments to articles of organization in chronological order
● Bylaws or other rules of operation and amendments
● Documentation of nondiscriminatory policy for schools, as required by Schedule B
● Form 5768, Election/Revocation of Election by an Eligible Section 501(c)(3) Organization To Make
Expenditures To Influence Legislation (if filing)
● All other attachments, including explanations, financial data, and printed materials or publications. Label
each page with name and EIN. User fee payment placed in envelope on top of checklist. DO NOT STAPLE or otherwise attach your check or
money order to your application. Instead, just place it in the envelope. Employer Identification Number (EIN)
Completed Parts I through XI of the application, including any requested information and any required
Schedules A through H.
● You must provide specific details about your past, present, and planned activities.
● Generalizations or failure to answer questions in the Form 1023 application will prevent us from recognizing
you as tax exempt.
● Describe your purposes and proposed activities in specific easily understood terms. ● Financial information should correspond with proposed activities. Schedules. Submit only those schedules that apply to you and check either “Yes” or “No” below. Schedule A Schedule B Schedule C Schedule D Schedule E Schedule F Schedule G Schedule H
An exact copy of your complete articles of organization (creating document). Absence of the proper purpose
and dissolution clauses is the number one reason for delays in the issuance of determination letters.
● Location of Purpose Clause from Part III, line 1 (Page, Article and Paragraph Number)
● Location of Dissolution Clause from Part III, line 2b or 2c (Page, Article and Paragraph Number) or by
operation of state law
Signature of an officer, director, trustee, or other official who is authorized to sign the application.
● Signature at Part XI of Form 1023.
Your name on the application must be the same as your legal name as it appears in your articles of
Send completed Form 1023, user fee payment, and all other required information, to:
Internal Revenue Service
P.O. Box 192
Covington, KY 41012-0192
If you are using express mail or a delivery service, send Form 1023, user fee payment, and attachments to:
Internal Revenue Service
201 West Rivercenter Blvd.
Attn: Extracting Stop 312
Covington, KY 41011