Form 1024-A (January 2018)Department of the Treasury Internal Revenue Service Application for Recognition of Exemption Under Section 501(c)(4) of the Internal Revenue Code Go to www.irs.gov/Form1024A for instructions and the latest information. OMB No.1545-0057 Note: If exempt status is approved, this application will be open for public inspection. Complete Parts I226IX and submit Form 8718 (with payment of the appropriate user fee). Attach additional sheets if you need more space to answer fully. Use the instructions to complete this application and for definitions of terms used in this form. For additional help, call IRS Exempt Organizations Customer Account Services toll-free at 877-829-5500, or visit our website at www.irs.gov. If you don222t submit the required information, we may return the application to you. A request for a determination under section 501(c)(4) is optional. See instructions for additional information. Don't include social security numbers on this form as it may be made public. Part I Identification of Applicant 1 Full name of organization (exactly as it appears in your organizing document) 2 c/o Name (if applicable) 3 Mailing address (Number and street) (see instructions) City or town, state or country, and ZIP + 4 4 Employer Identification Number (EIN) 5 Month the annual accounting period ends 6 Primary contact (officer, director, trustee, or authorized representative) a Name: b Phone: c Fax: (optional) 7 Organization222s website: Part II Organizational Structure You must be a corporation (including a limited liability company), an unincorporated association, or a trust to be tax exempt. See instructions. Don't file this form unless you can check 223Yes224 on lines 1, 2, 3, or 4. 1 Are you a corporation? If 223Yes,224 attach a copy of your articles of incorporation showing certification of filing with the appropriate state agency. Include copies of any amendments to your articles and be sure they also show state filing certification. Yes No 2 Are you a limited liability company (LLC)? If 223Yes,224 attach a copy of your articles of organizationshowing certification of filing with the appropriate state agency. Include copies of any amendments to your articles and be sure they show state filing certification. Also, if you adopted an operating agreement, attach a copy, along with any amendments. Yes No 3 Are you an unincorporated association? If 223Yes,224 attach a copy of your articles of association, constitution, or other similar organizing document that is dated and includes at least two signatures. Include signed and dated copies of any amendments. Yes No 4 Are you a trust? If 223Yes,224 attach a signed and dated copy of your trust agreement. Include signed and dated copies of any amendments. If you are a trust, enter the date the trust was funded. (MM/DD/YYYY) Yes No 5 Have you adopted bylaws? If 223Yes,224 attach a current copy showing date of adoption. If 223No,224 explain inan attachment how your officers, directors, or trustees are selected. Yes No / / Part III Narrative Description of Your Activities Use an attachment to describe all of your past, present, and planned activities in a narrative (including the percentage of time and funds spent on these activities). You may attach representative copies of newsletters, brochures, or similar documents for supporting details to this narrative. Refer to the instructions for information that must be included in your description. Check this box to confirm that you submitted a narrative attachment describing your activities. For Paperwork Reduction Act Notice, see instructions. Cat. No. 69155Y Form 1024-A (1-2018) American LegalNet, Inc. www.FormsWorkFlow.com Form 1024-A (1-2018) Name: EIN: Page 2 Part IV Officers, Directors, Trustees, Employees, and Independent Contractors1 List the names, titles, and mailing addresses for all of your officers, directors, and trustees. If additional space is needed, attach a separate sheet. Name Title Mailing address The following 223Yes224 or 223No224 questions relate to all past, present, or planned relationships, transactions, or agreements with your officers, directors, trustees, employees, members, and independent contractors.2 Do you have a family or business relationship or agreement with any of your officers, directors, trustees, employees, members, or independent contractors, or any entity they own or control, other than throughtheir position as your officer, director, trustee, employee, member, or independent contractor? If 223Yes,224identify in an attachment the individual and describe the relationship or agreement. Yes No 3 a Do or will you pay any compensation to your officers, directors, trustees, employees, members, or independent contractors? If 223Yes,224 answer lines 3b and 3c. Yes Nob Do or will the individuals that approve compensation arrangements follow a conflict of interest policy?If 223No,224 describe in an attachment how you set compensation that is reasonable. Yes Noc Do or will you compensate any of your officers, directors, trustees, employees, members, or independent contractors through nonfixed payments, such as discretionary bonuses or revenue-based payments?If 223Yes,224 describe in an attachment all nonfixed compensation agreements. Yes No Part V Your Specific Activities The following 223Yes224 or 223No224 questions relate to all past, present, and planned activities you may conduct. See instructions.1 Has the organization spent, or does it plan to spend, any money attempting to influence the selection, nomination, election, or appointment of any person to any federal, state, or local public office or to an office in a political organization? If 223Yes,224 explain in detail and list the amounts spent or to be spent in each case in an attachment. Yes No 2 Have you previously received a ruling or determination letter recognizing you (or any predecessor organization) as exempt under section 501(c)(3) and later revoked that recognition of exemption on thebasis that you (or your predecessor) were carrying on propaganda or otherwise attempting to influence legislation or on the basis that it engaged in political activity? If 223Yes,224 explain in an attachment. Yes No 3 Are you a successor to another organization? Answer 223Yes224 if you have taken or will take over theactivities of another organization, you took over 25% or more of the fair market value of the net assets ofanother organization, or you were established upon the conversion of an organization from for-profit to nonprofit status. If 223Yes,224 explain in an attachment. Yes No 4 Are you connected in any way with any other organization (for example, financial support on a continuing basis; shared facilities or employees; same officers, directors, or trustees)? If 223Yes,224 explain in an attachment. Yes No 5 Do you have members? If 223Yes,224 state in an attachment the qualifications necessary for membership, the classes of membership and number of members in each class, and the voting rights or privileges received. Yes No 6 Have you made, or do you plan on making, any distribution of property or surplus funds to shareholders or members? If "Yes," explain in an attachment. Yes No 7 Do you receive payments for services performed? If 223Yes,224 explain in an attachment the services performed, income realized and expenses incurred, and the nature of benefits to the general public fromthese activities. Yes No 8 Do you lease property? If 223Yes,224 explain in an attachment. Include a description of the property, anyrelationship between the applicant and the other party, and a copy of the lease agreement. Yes No 9 Are you a homeowner222s association? If 223Yes,224 explain in an attachment whether access to any property or facility you own or maintain is restricted in any way. Yes No 10 Are you a local association of employees? If 223Yes,224 state in an attachment the name and address of eachemployer whose employees are eligible for membership in the organization. Yes No 11 Do you or will you make foreign grants or conduct activities in any foreign country or countries? If 223Yes,224describe those grants or activities in an attachment. Yes No Fo