Non-Profit Organizer - GO Green Tax

Taxpayer Name

First Last

Organization Name*

Organization EIN #*

Date Incorporated*

Non-profit Organization Address

Street Address City State / Province / Region ZIP / Postal Code Country

Contact Name

First Last

Contact Email

Contact Address*

Street Address City State / Province / Region ZIP / Postal Code Country

Organization's primary purpose

What is the organization type?

501(C)

Is the organization's application for tax exempt status pending with the IRS?*

Yes
No

Is this a new address?*

Yes
No

Is this an initial return?*

Yes
No

Is this a final return?*

Yes
No

Is this a group of affiliates?*

Yes
No

How many?*

What accounting methods does the organization use?*

Cash
Accrual

Does the organization file under a calendar year?*

Yes
No

What is the fiscal year?

Did the organization make changes to its activities or methods of conducting activities?*

Yes
No

Were there any changes made in the organizing or governing documents?*

Yes
No

Were they reported to IRS?*

Yes
No

Did the organization have Unrelated Business Income of $1000 or more this year?*

Yes
No

Is the organization related (other than by association with a statewide or nationwide organization) to any other exempt or non-exempt organization?*

Yes
No

Did the organization make any direct or indirect political expenditures?*

Yes
No

Did the organization lobby/attempt to influence any legislation?*

Yes
No

$ spent

Has form 5768 been filed?*

Yes
No

Did the organization comply with IRS public inspection or returns/application?*

Yes
No

Did the organization solicit any contributions that were not tax deductible?*

Yes
No

Did the organization make grants for scholarships or student loans?*

Yes
No

Did the organization conduct activities in any state other than Oregon or country outside the U.S.?*

Yes
No

Which states &/or countries?

Does the organization have any foreign bank accounts?*

Yes
No

Current Officers, Directors, Trustees, and Key Employees

Name	Address	Title	Average Hours/Week	Compensation

How many officers, directors, trustees, and key employees are permitted to vote at board meetings?

List all employees paid more than $50,000/year

Name	Address	Title	Average Hours/Week	Compensation

List all independent contractors paid more than $50,000/year

Name	Address	Type of Service	Compensation

Have your books been prepared?*

Yes
No

If you don't have a set of books completed, we will need the additional information below completed. The information will help us successfully complete your return.

Organization Income

Contributions, gifts	Membership dues	Program income	Other income	Other income	Special event income	Special event income	Special event income

Organization Expenses

Accounting fees	Bank fees	Employee benefits	Credit card fees	Department of Justice fee (OR)	Equipment	Fundraising	Grants paid	Insurance	Internet	Meetings

Organization Expenses

Payroll taxes	Postage	Printing and publications	Rent	State corporation fees	Supplies	Telephone	Travel	Wages	Website fees	Other	Other

Program Accomplishments

Grant	$ amount received

List the organization's general accomplishments for the year. Include approximate number of people served, publications issued, etc.

Assets at beginning of year

Checking account	Savings Account	Accounts/pledges receivable	Other current assets (describe)	Other current assets (describe)	Other current assets (describe)

Assets at year end

Checking account	Savings Account	Accounts/pledges receivable	Other current assets (describe)	Other current assets (describe)	Other current assets (describe)

Liabilities at beginning of year

Accounts payable	Grants payable	Other liabilities (describe)	Other liabilities (describe)	Other liabilities (describe)

Liabilities at year end

Accounts payable	Grants payable	Other liabilities (describe)	Other liabilities (describe)	Other liabilities (describe)

Organization type

Private Foundation
Section 501(e)
Section 501(k)
Section 501(n)
4947(a)(1)

Schedule of Contributors for Organizations Exempt under Section 501(c)(3)

Complete the following for any contributors who gave $5,000 or more (cash & non-cash).

Name	Address	Contribution (year total)	If non-cash, provide description

Non-Profits

Organization Expenses