Non Profit Organizer 1.16.18

Organizer for Exempt Organizations
Organization: _____________________ __________________________________________ ___________

EIN Name Date Incorporated
Address: ___________________________________________ ______ ___________ _______ _______
Mailing Address Suite # City State Zip Code
Contact Name: __________________________________________ Email:________________________
Contact Phones: ____________________ ___________________ _____________________

(Office) (Home) (Mobile)
_____________________________________________________ ______ ___________ _______ _______
Contact Mailing Address Suite # City State Zip Code
This Organizer is provided to help you gather and organize information relating to preparation of your
Organizational return. Where indicated, we have provided additional worksheets and other specialized
organizers where you can provide additional important information. Please provide us with a copy of the
corporation’s tax returns for the past 3 years if you are a first-time client of Pacific Northwest Tax Service.
• If you maintain your organization’s books using a bookkeeping system such as QuickBooks, Quicken or
Excel, you can provide us with a backup file of your records rather than completing the income and
expense and balance sheet sections of this organizer.
• If you would like our accounting staff to prepare organizational income and expense reports for you, we will
need you to provide us with the following documents:
o Organizational bank statements for all months of the year
o Credit card statements (for organizational-use credit cards)
o Receipts for cash purchases not shown on bank or credit card statements
o Checkbook register (please identify all checks by entering an expense category in the memo section)
Filing Information. Please answer ALL of the following questions.

What is the organization type? 501(C) ( ) (insert no.) other:_______
Is the organization's application for tax exempt status pending with the IRS?
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 return for affiliates? Yes □ No □ If “yes”, how many?________________________
What accounting method does the Organization use? Cash□ Accrual □ Other (describe) ________________
Does the organization file under a calendar year? Yes □ No □ If “no”, what is the fiscal year? _______________
Did the organization engage in any activity not previously reported to IRS? Yes□ No □ If yes, describe here.
Were any changes made in the organizing or governing documents? Yes □ No □

If yes, were changes made to the organization’s name? Yes □ No □
Did the organization have Unrelated Business Income of $1,000 or more this year? Yes □ No □
Was there a liquidation, dissolution, termination, or significant disposition of assets during the year? Yes□ No □
Is the organization related (other than by association with a statewide organization 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 □ If “yes”, $ spent___________
If organization makes lobbying expenditures, has Form 5768 been filed? Yes □ No □
Did the organization comply with IRS public inspection or returns/applications? Yes □ No □
Did the organization solicit it 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? Yes□ No □ Or, to any country outside the
U.S.? Yes□ No□ If “yes”, which states &/or countries? _________________________
Does the organization have any foreign bank accounts? Yes□ No □
Pacific Northwest Tax Service Non-Profit and Exempt Organization Organizer © 2008-2018
Page 1 of 4
Current Officers, Directors, Trustees & Key Employees
Average
Name and Address Title hours/wk Compensation
1.
2.
3.
4.
5.
6.
7.
How many officers, directors, trustees & key employees are permitted to vote at board meetings?_____________
Complete the following for all employees paid more than $100,000/year:
(attach separate sheet if you have more than 2)
Name and Address Title hours/wk Compensation
1.
2.
Complete the following for independent contractors paid more than $100,000/year:
(attach separate sheet if you have more than 2)
Name and Address Type of Service Compensation

1.
2.
Page 2 of 4
Organization Income: Organization Expenses:
Total: Total:
Contributions, gifts, grants Accounting fees
Membership dues Bank Fees
Program service revenue Employee Benefits
Government contracts Credit Card Fees
Investment (Interest) Dept. of Justice Fee (OR)
Fundraiser or special event income (list) Equipment
1. Fundraising
2. Grants paid
3. Insurance
4. Internet
5. Meetings
6. Payroll taxes
Other income (list) Postage and shipping
Printing & publications
Rent
State Corporation Fees
Supplies
Telephone
Travel
Wages
Website fees
Other (list)
Program Accomplishments
In general categories, list the organization's accomplishments for the year. Include approximate number of people
served, publications issued, etc. Also, indicate $ amount of grants provided.
1.
Grants: $ Expenses: $
2.
3.
4.
What is the organization’s primary purpose?
Page 3 of 4
Assets at beginning of year: Assets at year end:
Checking Account $ Checking Account $
Savings Account $ Savings Account $
Accounts/Pledges receivable $ Accounts/Pledges receivable $
Other current assets (describe) $ Other current assets (describe) $
$ $
$ $
$ $
Liabilities at beginning of year: Liabilities at year end:

Accounts payable $ Accounts payable $
Grants payable $ Grants payable $
Other liabilities (describe) $ Other liabilities (describe) $
$ $
$ $
$ $
$ $
Schedule of Contributors For Organizations Exempt Under Section 501(c)(3)

(don't complete if organization is a Private Foundation, Section 501(e), 501(k), 501(n) or 4947(a)(1) )
Complete the following for any contributors who gave $5,000 or more (cash & non-cash). Attach separate
additional pages if needed.
Contribution
Name and Address (year total) If non-cash, provide description
1.
2.
3.
4.
5.
6.
Page 4 of 4

Non Profit Organizer 1.16.18

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Organizer for Exempt Organizations

Organization: _ ____________ _

Contact Name: __________________ Email:

Contact Phones: __________ _ _____________

Filing Information. Please answer ALL of the following questions.

Were any changes made in the organizing or governing documents? Yes □ No □

Name and Address Type of Service Compensation

Liabilities at beginning of year: Liabilities at year end:

Schedule of Contributors For Organizations Exempt Under Section 501(c)(3)

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