Form 1023 Draft
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- 1 Notes
- 2 TODO List:
- 3 Sections
- 3.1 Part I - Identification of Applicant
- 3.2 Part II - Organizational Structure
- 3.3 Part III - Required Provisions in Your Organizing Document
- 3.4 Part IV - Narrative Description of Your Activities
- 3.5 Part V - Compensation and Other Financial Arrangements With Your Officers, Directors, Trustees, Employees, and Independent Contractors
- 3.6 Part VI - Your Members and Other Individuals and Organizations That Receive Benefits From You
- 3.7 Part VII - Your History
- 3.8 Part VIII - Your Specific Activites
- 3.9 Part IX - Financial Data
- 3.10 Part X - Public Charity Status
- 3.11 Part XI - User Fee Information
- HacDC is posting theirs in draft form on their wiki: http://wiki.hacdc.org/index.php?title=Form_1023_Draft
- Form 1023 (instructions)
- copy actual answers from submitted form onto this wiki page
Part I - Identification of Applicant
- Full name - Sad Bee, Inc.
- c/o name (if applicable) - no
- Mailing Address
- number and street - (jason's address since he's statutory agent?)
- City, town, state, or country and ZIP+4 - Cincinnati, OH
- EIN - (Jason & Craig have this number)(don't post the EIN here!)
- Month the annual accounting period ends - December 2009
- Primary contact
- name - (Jason)
- phone - (Jason's phone number - do not post on wiki)
- fax (optional) - (none)
- represented by an attorney or accountant? - no
- was (person from question 7) paid? - no
- website: http://www.hive13.org/
- email (optional): - email@example.com
- claiming exemption from 990? - no, we are not claiming exemption
- date incorporated - 06/18/2009
- were you under the laws of a foreign country? - no
Part II - Organizational Structure
- are you a corporation? - yes
- if yes, attach articles of incorporation - Articles of Incorporation
- are you an LLC? - no
- are you an unincorporated association? - no
- are you a trust? - no
- have you been funded? - no
- have you adopted bylaws? - yes.
- if yes, attach a copy showing date of adoption - Bylaws
Part III - Required Provisions in Your Organizing Document
- organizing document must state tax exempt purpose: - yes, Third Article in Articles of Incorporation
- upon dissolution, assets must be used for exempt purposes. is it in the organizing document> - yes
- which section? - Sixth Article in Articles of Incorporation
- does state law provide for the distribution of assets? - no
Part IV - Narrative Description of Your Activities
HIVE13 is a collaborative charitable, educational, and scientific organization. We are organized to provide a physical "makerspace" (also known as a "creative space" or "hackerspace") where people with common interests (such as science, technology, digital, mechanical, and electrical art) can meet, socialize, and collaborate. We strive to provide an open community lab/workshop/studio where people of diverse backgrounds can come together (or network) to share knowledge and resources for the purpose of learning and making things.
Since our formation as Sad Bee, Inc. on 06/18/2009, our organization, also known as "HIVE13" (pronounced "Hive-One-Three" as a take-off from the Cincinnati telephone area code "513"), has rented a 3,500 sq.ft. physical lab/studio space at 2929 Spring Grove Avenue in the Camp Washington neighborhood within Cincinnati, Ohio USA. This space is open to members 24x7 to work on individual or group projects. We hold weekly meetings, providing presentations and lectures on specific topics of group interest for the purposes of learning and sharing. We also provide social activities within this space including games and parties.
Our members are a diverse group of college undergraduate students, graduate students, college drop-outs, college graduates, small-business owners, technical employees at area technology companies, unemployed individuals between jobs, and retirees. The common thread is an interest in a broad range of technologies.
The following paragraphs provide specific samples of our past, present, and planned activates:
Sample Activity – "Five Minutes of Fame" This activity is part of our regular weekly meeting on Tuesday nights. Volunteers from the group membership or invited guests give a short speech or brief presentation on a form of "show-and-tell" on a specific technology or project. • One recent example was a demonstration of an Etch-a-Sketch modified with motors on the two control knobs and connected to a computer that would automatically draw the graphic picture displayed on the computer. • A second example was a member's talk on his home-built CNC (computer numerically controlled) milling machine. • A third example was an invited guest who talked about his small business which uses a laser engraving machine to make craft products. These presentations serve to spawn interest in forming future collaborations on related technology projects, such as described in the next activity.
Sample Activity – "Makerbot Mondays" A member owns a tabletop 3-D printing machine known as a "Makerbot". He keeps this machine in the shared studio. The machine extrudes molten plastic under computer control onto a moving build stage to fabricate a variety of small (6" x 6" x 6") plastic parts as complete 3-D shapes. This group of members and enthusiasts meet on Monday nights, typically for 3 to 5 hours per week, to operate the machine to make parts and learn 3-D printing technology. This group interacts with other similar "Makerbot" groups around the country.
Sample Activity - "Python Class" In this case, "Python" is a new programming language. Several members of the group have assorted experience working with this programming language, and other members of the group have an interest to learn more about the specifics of this language. The knowledgeable members volunteered to conduct several informal (unpaid) classes, lasting 1 to 2 hours, which were attended by the group of interested members. A similar informal series of classes was conducted on a different software program called "Blender" with a different group.
Sample Activity - "Arcade Night" One member operates a small business to restore vintage arcade video games such as "Pac-Man", "Asteroid", and "Frogger", often replacing the original electronics with new computer hardware. He has donated to maintain several of these game consoles in the studio space. On arcade nights, approximately every other month, the members who are video gaming enthusiasts meet to socialize, play these games, and discuss various collaborations on future gaming projects.
Sample Activity - "Soldering Class" A member, who is an electrical engineer, has volunteered to teach a class in soldering skills. A small project was identified to make "Minty-boosts". These are small USB-device battery pack extenders for cell phones, i-pods, etc. There is a nominal charge to each registered student ($40.00) to make a group purchase of component materials; circuit board, resistors, capacitors, batteries, etc. Each student then learns to solder by building their own individual minty-boost during the 2-hour class.
Sample Activity - "Assorted Projects" Different informal groups of members band together on assorted project efforts. Two members have assembled autonomous vehicles using remote control model cars. A group is building a Do-It-Yourself (DIY) CNC machine. This project has branched into an effort to design and build the electronic circuit boards that drive the stepping motors on this and similar machines. Another member is leading an effort to construct an aluminum foundry. Another member leads an effort to remove the gasoline engine from a motorcycle and replace it with a battery powered electric motor and drive train. Additional projects include an ATX power kit, a bioreactor, an HHO generator, and glass block LED matrix. Members typically spend 2 to 8 hours per week on different projects.
Sample Activity - "Field Trips" The group has scheduled several volunteer field trips. One trip was a Saturday visit to a large electronic store in nearby Dayton, Ohio. Another trip was to see a model show at a large indoor model railroad called EnterTRAINment Junction. There are several national conventions within the "maker" community and the group plans to attend and participate in future events such as the MakerFaire in Detroit, in August 2010.
Since inception back in June 2009, the group has been stable and has grown. We are starting to get some publicity within Cincinnati and are attracting new members. We are slightly ahead each month from a financial stand point. That is, the income from membership dues and limited fundraising (door prize raffle at a recent party, proceeds from the on-site vending machine, etc.) are covering the expenses of the building rent and insurance costs. Going forward, with increasing membership, we anticipate expanding this positive cash flow to enable voting to fund acquiring the Makerbot and various pieces of shop equipment and to have proceeds to apply to larger scale group projects.
Part V - Compensation and Other Financial Arrangements With Your Officers, Directors, Trustees, Employees, and Independent Contractors
- (1a) "List the names, titles, and mailing addresses of all your officers, directors, and trustees. For each person listed, state their total annual compensation, or proposed compensation, for all services to the organization, whther as an officer, employee, or other position. Use actual figures if available. Enter "none" if no compensation is or will be paid."
|Name||Title||Mailing Address||Compensation amount (annual actual or estimated)|
|Chris Anderson||Director, Cheif Technology Officer||(don't post addres on wiki)||none|
|Jason Bailey||President, Statutory Agent||(don't post addres on wiki)||none|
|Dave Menninger||Secretary, Director||(don't post addres on wiki)||none|
|Craig Smith||Tresurer, Director||(don't post addres on wiki)||none|
|Paul Vincent||Chief Operations Officer||(don't post addres on wiki)||none|
- (1b) "List the names, titles, and mailing addresses of each of your five highest compensated employees who receive or will receive compensation of more than $50,000 per year. Use the actual figure, if available. Refer to the instructions for information on what to include as compensation. Do not include officers, directors, or trustees listed in line 1a." none
- (1c) "List the names, titles and mailing addresses of your five highest compensated independent contractors that receive or will receive compensation of more than $50,000 per year. Use the actual figure, if available. Refer to the instructions for information on what to include as compensation." none
- (2a) "Are any of your officers, directors, or trustees related to each other through family or business relationships? If yes identify the individuals and explain the relationship." No
- (2b) "Do you have a business relationship with any of your officers, directors, or trustees other than through their position as an officer, director, or trustee? If yes, identify the individuals and describe the business relationship with each of your officers, directors, or trustees." No
- (2c) "Are any of your officers, directors, or trustees related to your highest compensated employees or highest compensated independent contractors listed on lines 1b or 1c through family or business relationships? If yes, identify the individuals and explain the relationship." No
- (3a) "For each of your officers, directors, trustees, highest compensated employees, and highest compensated independent contractors listed on line 1a, 1b, or 1c, attach a list showing their name, qualifications, average hours worked, and duties."
Jason Bailey Qualifications: - Full member in good standing - Nominated and duly elected per bylaw provisions - President, Director Average hours worked: less than 2 hrs/wk Duties: (per bylaws and reproduced here) 1. The President serves as a representative of the Corporation to the public and in all functions where a President may be called for by law or any other outside requirements, and is responsible for public-facing communication. 2. The President is responsible for making sure that the corporation files its annual report and any other papers required to maintain legal nonprofit status by the law of Ohio or Federal law. 3. The President shall organize and preside over all meetings of the membership and of the board of directors. 4. The President is responsible for enforcing the rules of meeting procedure as detailed in these documents. Chris Anderson Qualifications: - Full member in good standing - Nominated and duly elected per bylaw provisions - Chief Technical Officer, Director Average hours worked: less than 2 hrs/wk Duties: (per bylaws and reproduced here) 1. The Chief Technical Officer is responsible for ensuring the maintenance and consistency of the technological infrastructure as needed by the organization. This includes, but is not limited to, the website and internal network of the physical space. Paul Vincent Qualifications: - Full member in good standing - Nominated and duly elected per bylaw provisions - Chief Operating Officer, Director Average hours worked: less than 2 hrs/wk Duties: (per bylaws and reproduced here) 1. The Chief Operations Officer is responsible for managing the safety, security and tidiness of the physical space. 2. The Chief Operations Officer is responsible for planning and logistics of official events such as classes, workshops and parties. Craig Smith Qualifications: - Full member in good standing - Nominated and duly elected per bylaw provisions Average hours worked: less than 2 hrs/wk Duties: (per bylaws and reproduced here) 1. The Treasurer is responsible for monitoring all financial assets of the Corporation. This includes but is not restricted to: 1. keeping record of the organization’s budget, 2. the collection of membership dues from members, 3. the payment of rent and utilities for any space leased by the Corporation, 4. filing taxes, 5. the disbursement and reimbursement of funds authorized to be spent under the procedures detailed in these bylaws, and 6. preparing financial reports to the board. Dave Menninger Qualifications: - Full member in good standing - Nominated and duly elected per bylaw provisions - Secretary, Director Average hours worked: less than 2 hrs/wk Duties: (per bylaws and reproduced here) 1. The Secretary shall supervise the keeping of a full and complete record of the proceedings of the Board of Directors and its committees. 2. The Secretary shall supervise the giving of such notices as may be proper or necessary. 3. The Secretary shall supervise the keeping of the minute books of this corporation. 4. The Secretary shall be responsible for recording all minutes of all official meetings of the membership and the board of directors in the corporation's permanent records. 5. The Secretary shall be responsible for collecting a list of the issues on the agenda for each membership meeting, and circulating that list to the members for them to vote on at the upcoming meeting as provided in the section of these bylaws entitled Notice of Meetings.
- (3b) "Do any of your ... receive compensation from any other organizations ... that are related to you through commons control. If yes explain ..." (yes/no) No
The following are recommended, but not required. All are yes/no.
- (4a) have a conflict of interest policy? yes, there is a conflict of interest policy in the Bylaws section 13
- (4b) approve compensation agreements in advance of paying compensation? no
- (4c) document in writing date and terms of compensation arrangements? no
- (4d) record in writing decision made by each individual who decided or voted on compensation arrangements? no
- (4e) approve compensation arrangements based on similar organizations for similar services? no
- (4f) record in writing information on which you relied to make decisions and its source? no
- (4g) if you answered "no" to any of (a) through (f), explain how you set compensation that is reasonable. Hive13 does not provide compensation
- (5a) Have you adopted a conflict of interest policy consistent with the sample conflict of interest policy in Appendix A to the instructions? If “Yes,” provide a copy of the policy and explain how the policy has been adopted, such as by resolution of your governing board. If “No,” answer lines 5b and 5c. yes
- (5b) What procedures will you follow to assure that persons who have a conflict of interest will not have influence over you for setting their own compensation? Hive13 does not provide compensation
- (5c) What procedures will you follow to assure that persons who have a conflict of interest will not have influence over you regarding business deals with themselves? See section 13 of Bylaws'
- (5-Note) Note: A conflict of interest policy is recommended though it is not required to obtain exemption. Hospitals, see Schedule C, Section I, line 14
- (6a) Do you or will you compensate any of your officers, directors, trustees, highest compensated employees, and highest compensated independent contractors listed in lines 1a, 1b, or 1c through non-fixed payments, such as discretionary bonuses or revenue-based payments? If “Yes,” describe all non-fixed compensation arrangements, including how the amounts are determined, who is eligible for such arrangements, whether you place a limitation on total compensation, and how you determine or will determine that you pay no more than reasonable compensation for services. Refer to the instructions for Part V, lines 1a, 1b, and 1c, for information on what to include as compensation. No
- (6b) Do you or will you compensate any of your employees, other than your officers, directors, trustees, or your five highest compensated employees who receive or will receive compensation of more than $50,000 per year, through non-fixed payments, such as discretionary bonuses or revenue-based payments? If “Yes,” describe all non-fixed compensation arrangements, including how the amounts are or will be determined, who is or will be eligible for such arrangements, whether you place or will place a limitation on total compensation, and how you determine or will determine that you pay no more than reasonable compensation for services. Refer to the instructions for Part V, lines 1a, 1b, and 1c, for information on what to include as compensation. No
- (7a) Do you or will you purchase any goods, services, or assets from any of your officers, directors, trustees, highest compensated employees, or highest compensated independent contractors listed in lines 1a, 1b, or 1c? If “Yes,” describe any such purchase that you made or intend to make, from whom you make or will make such purchases, how the terms are or will be negotiated at arm’s length, and explain how you determine or will determine that you pay no more than fair market value. Attach copies of any written contracts or other agreements relating to such purchases. No
- (7b) Do you or will you sell any goods, services, or assets to any of your officers, directors, trustees, highest compensated employees, or highest compensated independent contractors listed in lines 1a, 1b, or 1c? If “Yes,” describe any such sales that you made or intend to make, to whom you make or will make such sales, how the terms are or will be negotiated at arm’s length, and explain how you determine or will determine you are or will be paid at least fair market value. Attach copies of any written contracts or other agreements relating to such sales. No
- (8a) "Do you or will you have any leases, contracts, loans, or other agreements with your officers, directors, trustees, highest compensated employees, or highest compensated independent contractors listed in lines 1a, 1b, or 1c? If “Yes,” provide the information requested in lines 8b through 8f. Yes
- (8b) Describe any written or oral arrangements that you made or intend to make.
Sad Bee, Inc. (HIVE13) made an oral agreement with Jason Bailey. Jason Bailey paid the $1150 security deposit for the HIVE13 studio location at 2929 Spring Grove Ave. Cincinnati, OH. The agreement is that if/when the organization accumulates funds greater than three-months rent plus $1150, or if this lease agreement ends, Jason Bailey will be repaid the balance of the original $1150 amount put forward for the security deposit, without interest.
- (8c) Identify with whom you have or will have such arrangements.
- (8d) Explain how the terms are or will be negotiated at arm’s length.
These terms were negotiated at arm’s length to be favorable to Sad Bee, Inc. (HIVE13) as a voluntary charitable contribution of Jason Bailey
- (8e) Explain how you determine you pay no more than fair market value or you are paid at least fair market value.
Security deposit amount repaid is not more than the amount put forward.
- (8f) Attach copies of any signed leases, contracts, loans, or other agreements relating to such arrangements.
See attached copies of signed leases
- (This section will be all "no"'s.)
Part VI - Your Members and Other Individuals and Organizations That Receive Benefits From You
1a. In carrying out your exempt purposes, do you provide goods, services, or funds to individuals? (We need to edit this to be customized to what we actually do:) -
Yes, HIVE13 provides benefits to members: Our core purpose is to provide a cooperative space for the exploration of technology. Members use the space and incidental services provided. Our growing educational program provides more formalized classes and introductory knowledge in electronics, open source software, and other technical pursuits. By participating in collaborative projects our members expose each other to new skills and capabilities, a valued benefit of membership. As we grow, we expect to acquire shop equipment which members will have access to use.
1b. In carrying out your exempt purposes, do you provide goods, services, or funds to organizations?
Yes, HIVE13 provides benefits to organizations, primarily as a focal point and as a place to contact and network to our members: • In September and October of 2009, HIVE13 members volunteered provided benefits to the Edgecliff Theater Company in Cincinnati. This local theater group needed electronics to light the eyes in horse head props for a new production. Members worked as volunteers over several days as a charitable contribution to this local cultural institution. Material costs were paid by the theater company. • In November 2009, HIVE13 was contacted and members assisted a local teacher who was constructing the web-site for Cheviot Elementary School. Several members have this expertise and volunteered several hours of technical assistance. • In February 2010, HIVE13 was again contacted and again members provided similar web site hosting volunteer assistance to the Cincinnati Sports Boxing Association.
2. Do any of your programs limit the provision of goods, services, or funds to a specific individual or group of specific individuals?
Yes Per our bylaws, page 3, section 2.2.1, Sad Bee, Inc, (HIVE13) has two classes of membership; full members and contributing members. By vote, the organization may elect to allocate group owned goods, services, or funds to specific members or project teams (made up of members) to be applied for a particular purpose or project.
3. Do any individuals who receive goods, services, or funds through your programs have a family or business relationship with any officer, director, trustee, or with any of your highest compensated employees or highest compensated independent contractors listed in Part V, lines 1a, 1b, and 1c? No
Part VII - Your History
1. Are you a successor to another organization? No
2. Are you submitting this application more than 27 months after the end of the month in which you were legally formed? No
Part VIII - Your Specific Activites
1. Do you support or oppose candidates in political campaigns in any way? No
2a. Do you attempt to influence legislation? No
3a. Do you or will you operate bingo or gaming activities? No
4a. Do you or will you undertake fundraising?
No mail solicitations Yes email solicitations Yes personal solicitations No vehicle, boat, plane, or similar donations Yes foundation grant solicitations No phone solicitations Yes accept donations on your website Yes receive donations from another organization’s website Yes government grant solicitations No Other
Attach a description of each fundraising program:
• General Fundraising: We have pursued limited fundraising to support the efforts of HIVE13. Such fundraising has taken place through our website, at events in our space, via external events we participate in, and through various channels by our members' individual initiative. • Equipment Donations: Most of HIVE13's present equipment (basic powered woodworking equipment ex: table saw, radial arm saw, drill press, etc.) has been consigned into the shared space by current members. We plan on pursuing other similar equipment donations from members or outside sources to increase the capabilities of the shared space. • Specific Fundraising: Members have expressed interest and plan on targeting fundraising efforts towards the acquisition of larger pieces of equipment or capital intensive projects (machine shop equipment ex; milling machine, metal lathe, aluminum foundry, welding equipment, CNC equipment, etc.) for the shared space or for certain projects of general agreement to the group. Members are also interested to provide periodic technical training classes and hands-on lab work as a benefit to other members and as service to the community. We would consider donations and grants from outside sources that may enable or facilitate such offerings, but have not received any such yet.
4b. Do you or will you have written or oral contracts with any individuals or organizations to raise funds for you? No
4c. Do you or will you engage in fundraising activities for other organizations? No
4d. List all states and local jurisdictions in which you conduct fundraising.
Cincinnati, Ohio jurisdictions for our own organization only
4e. Do you or will you maintain separate accounts for any contributor under which the contributor has the right to advise on the use or distribution of funds? No
5. Are you affiliated with a governmental unit? No
6. Do you or will you engage in economic development? No
7a. Do or will persons other than your employees or volunteers develop your facilities? No
7b. Do or will persons other than your employees or volunteers manage your activities or facilities? No
7c. We should not have any relationships which need to be documented in this section
8. Do you or will you enter into joint ventures, including partnerships or limited liability companies treated as partnerships, in which you share profits and losses with partners other than section 501(c)(3) organizations? No
9a. Are you applying for exemption as a childcare organization under section 501(k)? No
10. Do you or will you publish, own, or have rights in music, literature, tapes, artworks, choreography, scientific discoveries, or other intellectual property? No
11. Do you or will you accept contributions of: real property; conservation easements; closely held securities; intellectual property such as patents, trademarks, and copyrights; works of music or art; licenses; royalties; automobiles, boats, planes, or other vehicles; or collectibles of any type?
Yes Sad Bee, Inc. (HIVE13) has and will accept contributions of real property. • Prior donations have included a used stove and refrigerator for the kitchen area of the studio space. There were no conditions imposed by the donor and no agreement made with the donor, other than, "It is yours if you haul it away." • Prior donations of used technical equipment including obsolete or surplus computers, printers, monitors, and such. There were no conditions imposed by the donor and no agreement made with the donor, other than, "Use it if you can, or throw it out." • We will consider accepting similar donations of shop equipment and materials for technology projects into the future.
12. Do you or will you operate in a foreign country or countries? No
13a. Do you or will you make grants, loans, or other distributions to organization(s)? No
14a. Do you or will you make grants, loans, or other distributions to foreign organizations? No
15. Do you have a close connection with any organizations? No
16. Are you applying for exemption as a cooperative hospital service organization under section? No
17. Are you applying for exemption as a cooperative service organization of operating educational organizations under section 501(f)? No
18. Are you applying for exemption as a charitable risk pool under section 501(n)? No
19. Do you or will you operate a school? No
20. Is your main function to provide hospital or medical care? If “Yes,” complete Schedule C. No
21. Do you or will you provide low-income housing or housing for the elderly or handicapped? No
22. Do you or will you provide scholarships, fellowships, educational loans, or other educational grants to individuals, including grants for travel, study, or other similar purposes? No
Part IX - Financial Data
"If in existence less than 1 year, provide projections of your likely revenues and expenses for the current year and the 2 following years, based on a reasonable and good faith estimate of your future finances for a total of 3 years of financial information. (See instructions.)"
- 1a = ??? (Donations from speedspan)
- 2a = Before 2010. 58 Full Payments, 37 Student Payments ($7,095)
- 3a, 4a, 5a, 6a, 7a = 0
- 8 = $7,095
- 9 = 0 (Unless pledgie goes here?)
- 10 = $7,095
- 11, 12 = 0
- 13 = $7,095
- 14 = $300 ($100 for kegs, $200 for raffle cabinet)
- 15 = 0
- 16 = $50 (parts for Know theater costumes, although no receipts :/)
- 17, 18, 19 = 0
- 20 = $1,150 Rent/Utilities, $94.50 phone/inet, $300 insurance/yr, $30/mo food/drinks ($1,299.5/mo) ytd ~$7,647
- 21, 22, 23 = 0
- 24 = ~$7,997
Part X - Public Charity Status
1. Are you a private foundation? No
2 - 4: all No.
5. If you answered “No” to line 1a, indicate the type of public charity status you are requesting by checking one of the choices below. You may check only one box. Box 5h most closely applies to Hive13
5h. 509(a)(2)—an organization that normally receives not more than one-third of its financial support from gross investment income and receives more than one-third of its financial support from contributions, membership fees, and gross receipts from activities related to its exempt functions (subject to certain exceptions).
6. If you checked box g, h, or i in question 5 above, you must request either an advance or a definitive ruling by selecting one of the boxes below. Refer to the instructions to determine which type of ruling you are eligible to receive. Choose Advance Ruling
7. Did you receive any unusual grants during any of the years shown on Part IX-A. Statement of Revenues and Expenses? If “Yes,” attach a list including the name of the contributor, the date and amount of the grant, a brief description of the grant, and explain why it is unusual. No
Part XI - User Fee Information
You must include a user fee payment with this application. It will not be processed without your paid user fee. If your average annual gross receipts have exceeded or will exceed $10,000 annually over a 4-year period, you must submit payment of $750. If your gross receipts have not exceeded or will not exceed $10,000 annually over a 4-year period, the required user fee payment is $300. See instructions for Part XI, for a definition of gross receipts over a 4-year period. Your check or money order must be made payable to the United States Treasury. User fees are subject to change. Check our website at www.irs.gov and type “User Fee” in the keyword box, or call Customer Account Services at 1-877-829-5500 for current information.
- Have your annual gross receipts averaged or are they expected to average not more than $10,000? No
- If “Yes,” check the box on line 2 and enclose a user fee payment of $300 (Subject to change—see above).
- If “No,” check the box on line 3 and enclose a user fee payment of $750 (Subject to change—see above).
- Check the box if you have enclosed the reduced user fee payment of $300 (Subject to change).
- Check the box if you have enclosed the user fee payment of $750 (Subject to change).