501c3 Questionnaire

Nonprofit 501c3 Questionnaire

Please complete the form below. Once you submit your questionnaire, a Biz Specialist will contact you to set up your assessment call! If you have any questions about the questionnaire, please contact us at 323-744-8571 or email info@coffeyandbiz.com
Full Name *

First Name Middle Name Last Name
Name of Organization *

What will be the official mailing address for the nonprofit? (Must be a physical address) *

Street Address
Street Address Line 2
City	State / Province
Postal / Zip Code	Country

Employer Identification Number (EIN)? *
Contact Telephone Number *

Area Code Phone Number
E-mail (This is where your confirmation will be sent to) *
Organization Email Address
example@example.com
Organizations Website (If one is available)
Have you ever applied for your 501c3 with the IRS?

Yes No
Has your nonprofit been formed in your state? (Meaning: Have you filed the Articles of Incorporation with the Secretary of State?) *

Yes No
What date was your nonprofit incorporated? (If you do not have this information, please leave this question blank. The date must be accurate.)
What state was your organization formed in?
Please upload a copy of your Articles of Incorporation
**If you do not have a copy, please proceed to the next question.
As an organization, what general purposes do you promote? (Choose all that apply)

Religious Literary Educational Testing for public safety Prevention of cruelty to children or animals Charitable Scientific To foster national or international amateur sports competition
What is the purpose of your organization? (If we have a copy of your articles already on file, or you attached them in the previous section above, please type "N/A") *
Example: List the purpose, services you provide, your target audience, OR a list of activities. This is used to simply see what your organization does, so that we can code it properly with the IRS. IT DOES NOT HAVE TO BE IN FULL DETAIL, SO DON'T THINK TOO HARD ON THIS QUESTION.
What is the end of your fiscal year? *
December 31st is what most people choose.
PLEASE NOTE:

It is very important that you understand, as a nonprofit, 501c3 organization, you are NOT permitted to participate in the following activities: Support or oppose candidates in political campaigns in any way, conduct a trade or business that is not related to the exempt purposes of the organization, influence legislation, divide net earnings to shareholders or individuals of the organization.
Please list the names, addresses and phone numbers of your three Board of Directors (President, Secretary, and Treasurer) and any additional Board Members that you may have.

Two or more offices may be held by the same individual, except for president and secretary. It is best to have three separate people for each office.
President Name *

First Name Last Name
President Phone Number *

Area Code Phone Number

President Mailing Address *

Street Address
Street Address Line 2
City	State / Province
Postal / Zip Code	Country

Secretary Name *

First Name Last Name
Secretary Phone Number *

Area Code Phone Number

Secretary Mailing Address *

Street Address
Street Address Line 2
City	State / Province
Postal / Zip Code	Country

Treasurer Name *

First Name Last Name
Treasurer Phone Number *

Area Code Phone Number

Treasurer Mailing Address *

Street Address
Street Address Line 2
City	State / Province
Postal / Zip Code	Country

Board Member #1 Name

First Name Last Name
Board Member #1 Phone Number

Area Code Phone Number

Board Member #1 Address

Street Address
Street Address Line 2
City	State / Province
Postal / Zip Code	Country

Title of Board member #1
You can choose "Board Member" if this additional person does not have a specific title.
Board Member #2 Name

First Name Last Name
Board Member #2 Phone Number

Area Code Phone Number

Board Member #2 Address

Street Address
Street Address Line 2
City	State / Province
Postal / Zip Code	Country

Title of Board member #2
You can choose "Board Member" if this additional person does not have a specific title.
Should be Empty:

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Nonprofit 501c3 Questionnaire

PLEASE NOTE:

Please list the names, addresses and phone numbers of your three Board of Directors (President, Secretary, and Treasurer) and any additional Board Members that you may have.