Line 1a—Organization's Name.
Enter the organization's name as it appears in its organizing
documents, including amendments. If the organization will be operated
under another name, show that name in parentheses.
Line 1b—Employer Identification Number (EIN).
If the organization does not have an EIN, it should apply for one
using
Form SS-4, Application for Employer Identification
Number. Form SS-4 can be obtained at Social Security Administration
(SSA) offices, or by calling 1-800-TAX-FORM. Form SS-4 has information
on how to apply for an EIN by mail or by telephone. If the
organization has previously applied for a number, enter “
applied for”
on line 1b, and attach a statement giving the date of the application
and office where it was filed.
Do not apply more than once
for an EIN.
Part II—Type of Entity and Organizational
Documents
One of the basic requirements for exemption is that the
organization be “organized” for one or more exempt purposes. If
the organization does not have an organizing instrument, it will not
qualify for exempt status.
None of the documents submitted in support of this application,
including organizational documents, will be returned.
Instead of the originals, submit “conformed” copies of these
documents. A “conformed” copy is one that agrees with the
original document and all of its amendments. If the copies are not
signed, they must be accompanied by a declaration signed by an officer
authorized to sign for the organization, certifying that they are
complete and accurate copies of the original documents.
Chemically or photographically reproduced copies of articles of
incorporation showing the certification of an appropriate government
official need not be accompanied by a declaration.
Part III—Activities and Operational
Information
Lines 17 through 19.
The information requested on lines 17 through 19 must be completed
for the current year and each of the 3 immediately preceding years (or
for the time the organization has existed if less than 4 years). The
requested information for the current year must cover the period
beginning on the first day of your organization's established annual
accounting period and ending on any day which is within 60 days of the
date of the application. If the date of the application is less than
60 days after the first day of the current accounting period, no
information is required for the current year. Requested information is
required for the 3 preceding years regardless of the current year
requirement. Please note that if no information is required for the
current year, the preceding year's information period can end on any
day which is within 60 days of the date of the application.
Definitions.
The term “
producer” means an individual or corporation engaged
in farming as a business receiving income based on farm production
rather than fixed compensation. For example, a corporation leases its
land to a tenant farmer who agrees to pay a rental fee based on a
percentage of the farm crops produced. Both the landowner and the
tenant farmer qualify as producers.
“
Current and active” producers are patrons of a cooperative
who market more than 50% of their products or purchase more than 50%
of their supplies and equipment through the cooperative during the
cooperative's tax year.
The statement of receipts and expenditures and the balance sheets
must be completed for the current year and each of the 3 immediately
preceding years (or for the time the organization has existed if less
than 4 years). We may request financial data for more than 4 years if
circumstances warrant. All financial information for the current year
must cover the period beginning on the first day of your
organization's established annual accounting period and ending on any
day which is within 60 days of the date of the application. If the
date of the application is less than 60 days after the first day of
the current accounting period, no financial information is required
for the current year. Financial information is required for the 3
preceding years regardless of the current year requirements. Please
note that if no financial information is required for the current
year, the preceding year's financial information can end on any day
which is within 60 days of the date of the application.
You may reproduce page 4 of the form and complete the financial
data for each required year. Attach the financial data for all
required years to the application.
The statements should be consistent with the method of accounting
the organization uses in maintaining its books and records.
Line 3b—Cost of Goods Sold.
Include per-unit retain allocations paid to patrons in money,
qualified written notices of allocation, or other property (except
nonqualified per-unit retain certificates) and the amount paid to
patrons in money or other property (except per-unit retain
certificates) to redeem nonqualified per-unit retain certificates.
(See sections 1382 and 1388.)
Line 15—Other Expenditures.
In the attached schedule for other expenditures, include a
breakdown for nonpatronage distributions paid as dividends on capital
stock and nonpatronage distributions made on a patronage basis. This
breakdown should include only distributions of earnings derived from
business done for the United States Government or any of its agencies
or income from sources other than patronage, but only to the extent
such amounts are paid in the same manner provided for patronage
dividends below. The term “
income from sources other than patronage”
means incidental income derived from sources not directly related to
the marketing, purchasing, or service activities of the cooperative
association. For example, income derived from the lease of premises,
from investment in securities, or from the sale or exchange of capital
assets constitutes income from sources other than patronage.
Also include in the schedule the total amount of per-unit retain
allocations other than those reflected in cost of sales on line 3b and
the total amount of written notices of allocation other than those
reflected on line 16. (See sections 1382 and 1388.)
Line 16—Patronage Dividends.
In the attached schedule, show the amount of patronage dividends
paid to patrons in money, qualified written notices of allocation, or
other property (except non-qualified written notices of allocation)
and the amount paid to patrons in money or other property (except
written notices of allocation) to redeem nonqualified written notices
of allocation. (See sections 1382 and 1388 and the related
regulations.)
