Non-Profit Intake Form

1

Entity Name* This field is required.

2

Address* This field is required.For Non-Profit

Street Address

Street Address Line 2

City

State / Province

Postal / Zip Code

Country

3

Entity Federal Identification Number* This field is required.

4

Point of Contact* This field is required.

First Name

Last Name

5

Phone Number* This field is required.For Point of Contact

Please enter a valid phone number.

6

Email* This field is required.For Point of Contact

example@example.com

7

Full Name/Title/Hours Per Week* This field is required.Board Member 1

Board Member 1 Name

Board Member 1 Title

Board Member 1 Hours Per Week Spent on Non-Profit

8

Full Name/Title/Hours Per WeekBoard Member 2 (if applicable)

Board Member 2 Name

Board Member 2 Title

Board Member 2 Hours Per Week Spent on Non-Profit

9

Full Name/Title/Hours Per WeekBoard Member 3 (if applicable)

Board Member 3 Name

Board Member 3 Title

Board Member 3 Hours Per Week Spent on Non-Profit

10

Full Name/Title/Hours Per WeekBoard Member 4 (if applicable)

Board Member 4 Name

Board Member 4 Title

Board Member 4 Hours Per Week Spent on Non-Profit

11

Full Name/Title/Hours Per WeekBoard Member 5 (if applicable)

Board Member 5 Name

Board Member 5 Title

Board Member 5 Hours Per Week Spent on Non-Profit

12

Full Name/Title/Hours Per WeekBoard Member 6 (if applicable)

Board Member 6 Name

Board Member 6 Title

Board Member 6 Hours Per Week Spent on Non-Profit

13

Did any officer/board members receive compensation?If yes, please make sure we have access to payroll reporting

YESNO

14

Did any officer, director, or key employee have a family or business relationship with any of the other officers?

YESNO

15

Did the board members perform the management duties of the organization?

YESNO

16

Were there any changes made in the Organization or Governing documents?

YESNO

17

Did the Organization document the meetings held by the board?

YESNO

18

Does the organization have a written conflict of interest policy?

YESNO

19

Were there any conflicts of interest disclosed this year?

YESNO

20

Did the organization monitor and enforce compliance of the conflict of interest policy?

YESNO

21

Does the organization have a written whistleblower policy?

YESNO

22

Does the organization have a written document retention and destruction policy?

YESNO

23

Does the organization have a process to determine the compensation of top management?

YESNO

24

Was there a change of address?

YESNO

25

Estimated total number of volunteers

26

How many W-2's were issued at the end of the current tax year?

27

How many 1099's were issued at the end of the current tax year?

28

Did the organization engage in any NEW activity not previously reported to the IRS?

YESNO

29

If yes to New Activity, please describe below

30

Did the organization have UNRELATED business income of $1,000 or more this year?

YESNO

31

Did the organization solicit any contributions that were not tax deductible?

YESNO

32

Did the organization receive more than $25,000 in non-cash contributions?

YESNO

33

Did the organization receive contributions totaling $5,000 or more (in money or property) from any one contributor?If yes, please provide a schedule of contributors that donated $5,000 or more. Please provide Name, Address, Total Contribution, and Description if necessary)

YESNO

34

Did the organization make any direct or indirect political expenditures?

YESNO

35

Did the organization acquire, sell, or dispose of any assets?(If yes, please provide details and/or update fixed asset list. Contact us if you would like a current fixed asset schedule to review and update)

YESNO

36

Did the organization maintain an office, employees, or agents outside the US or have any dealings with foreign organizations?

YESNO

37

Did the organization hold any financial accounts in a foreign country?

YESNO

38

How does the organization share its 990 for inspection?

Website

Upon Request

Other

39

Notes for your preparer