AMIBA Group Exemption Application

AMIBA Group Exemption Application Affiliates applying for inclusion in AMIBA s 501c6 tax-exempt group for the first time must complete and submit this application with a $75 one-time processing fee to AMIBA. Eligible affiliate organizations must: 1) have a Federal Employer Identification Number (FEIN) 2) be based in the United States 3) be incorporated as a non-profit organization or association with their respective State within 15 months of this application. 4) be organized and operate in accordance with AMIBA s recommended protocol in the areas of: Public education about the greater overall value local businesses often can provide as well as the vital economic, social and cultural role they play in the community. Cooperative promotion, advertising, purchasing and other activities to help local businesses gain economies of scale and compete more effectively. Creating a strong voice and advocacy group for local independent businesses in their local government and media while engaging citizens in guiding the future of their community. 5) have adopted a fiscal year of January 1 December 31 (change will require bylaws amendment) 6) be current, paid AMIBA affiliate 1. Name of Affiliate Group 2. Federal Employer Identification Number 3. Date of Incorporation or Association (find on your approved Articles of Incorporation) 4. Affiliate Mailing Address

Affiliate Actual Address (if different) Type of organization (please circle one): corporation association Organization s average gross annual income (please circle one): under $50,000 over $50,000 5. Has the Affiliate ever applied for recognition of tax-exempt status to the IRS? (Please circle one) No Yes A. If yes, what is the status of the application? (Please circle one) Pending Denied Granted Withdrawn Attach copies, any letter granting or denying exemption, and any other correspondence with the IRS regarding the application or exemption. B. If an application is pending, when and where was the application filed? 6. Has Affiliate ever been recognized as a private foundation under Section 509(a) of the Internal Revenue Code? (Please circle one) No Yes 7. Has Affiliate ever filed Form 990 or 990EZ tax return with the IRS? (Please circle one) No Yes (If yes, list years: ) If filed, enclose copies of Form 990 for the previous two years. 8. Has Affiliate ever filed Form 990-T tax return (for unrelated business income) with the IRS? No Yes (If yes, list years: ) If filed, enclose copies of Form 990-T for the previous two years.

9. Does Affiliate have employees and file a form 941 (payroll liabilities) to the IRS? No Yes 10. Submit to AMIBA: one conformed copy each of your organization s Articles of Incorporation and Bylaws. A conformed copy includes the original provisions and any amendments. A copy of approved Articles of Incorporation is sufficient. a list and description of the primary activities of your organization, how the activities are financed and who conducts the activities. Activities may include publishing a directory, administration, membership recruitment and retention, public education, public events, member events, specific programs (please identify and treat as separate), newsletter, etc. Please do not copy and type the provisions of your organization s bylaws. See the last page of this document for an example from an IBA. Organization s Profit & Loss statements (i.e. income and expenditures) for last fiscal year and this fiscal year to date Signed Authorization and Verification form (attached) Signed Certification of Intent to Amend Bylaws (only if fiscal year is not already Jan 1 Dec 31) (attached) Completed board members list (attached) Completed Subordinate Policy Statement (attached) Completed Facilities Declaration (attached) Completed IRS Form 990 Schedule C (available at http://bit.do/schedulec) * See AMIBA s helpful instructions for completion in Member Resources at amiba.net/members/amiba-programs/501c6/schedule-c. one copy of printed materials your organization uses, such as brochures, handouts, flyers, directories, etc. Check or Money Order for $75 payable to AMIBA Submit to: AMIBA 222 S. Black Ave. Bozeman, MT 59715

Authorization and Verification Of Fiscal Year (Organization name) requests exemption from federal income taxation under the current revision of Section 501(c)(6) of the Internal Revenue Code and wishes to be included in the American Independent Business Alliance s Group Exemption. Our board of directors attests and affirms: our organization s fiscal year is January 1 December 31, approved by vote and incorporated into our attached bylaws. -OR- our board of directors attests to and affirms it will vote to amend our procedures and bylaws to change our fiscal year to January 1 December 31 at its next meeting; I have attached the signed Certification of Intent to Amend Bylaws. The undersigned authorized organizational representative also attests to and affirms the accuracy of the description of our organizational activities, financial information and the authenticity of the attached governing documents and shall not hold the American Independent Business Alliance accountable for their veracity or accuracy. Signature and title of authorized officer Date

Certification of Intent to Amend Bylaws for Participation in AMIBA s 501c6 Group Exemption To be completed by organizations whose fiscal year is not Jan 1 Dec 31 Under penalty of perjury, I hereby certify the board of (ORGANIZATION NAME) will adopt the following language to include in the bylaws at its next meeting, taking place on (DATE). I also certify we will provide AMIBA with an amended conforming copy of the bylaws following adoption. Add under Name and Purpose: The (ORGANIZATION NAME) is incorporated in compliance with section 501(c)(6) of the Internal Revenue Code and its revisions. Add to existing operation section or create new section to include: Maintenance of Federal Tax-Exempt Status (ORGANIZATION NAME) enjoys federal tax-exempt status under section 501(c)(6) of the Internal Revenue Code through AMIBA s group exemption. Participation in the group exemption requires all board members and staff to be familiar with section 501c6 of the Internal Revenue Code and the content of any statements and agreements required under AMIBA s group exemption program signed by any staff or officer of (ORGANIZATION NAME) and apply this knowledge to the duties of their position. To maintain participation in the group exemption, (ORGANIZATION NAME) must provide financial and activity reports to AMIBA from time to time, as prescribed by AMIBA, and comply with any other reporting and activity requirements AMIBA has identified in their group exemption guidelines, IBA Handbook, and any other source. The (ORGANIZATION NAME) director or a designated board officer shall be designated to interact with AMIBA regarding (ORGANIZATION NAME S) tax-exempt purpose, activities, income and expenditures and any other questions regarding compliance for inclusion in the 501(c)(6) group exemption. Name: Title: Date:

POLICY STATEMENT FOR SUBORDINATES TO BE INCLUDED IN GROUP EXEMPTION (Subordinate Name) American Independent Business Alliance (Central Organization Name) We agree that we wish to be included in our central organization s group ruling. We also agree that we must adhere to all of the following as a part of being a subordinate. Abide by the policies and principles of our central organization. We agree to follow any Bylaws, Policies, and Handbooks they have. We agree to adhere to their purpose. Provide an annual activities and financial report to demonstrate our operation within section 501c6 of the IRC. We are under the general control and supervision of our central organization. We agree that we are prohibited from any activities involving: Organizations that intend to provide housing through a partnership, joint venture, or similar arrangement with any entity that is not described in IRC 501(c)(3) or 501(c)(4); Title-holding organizations described in IRC 501(c)(2) or 501(c)(25); Organizations participating in gaming as their primary activity, such as bingo, pull-tabs, casino nights, and similar activities to members; Credit counseling organizations; Donor advised funds; Charter schools; Organizations that primarily benefit professional fundraisers; Organizations involved in down-payment assistance; Organizations that are private foundations; Organizations that are organized and operated in a foreign country. If we wish to engage in any of these activities, we will need to withdraw from the group ruling and pursue our own individual exemption. We agree that if we already have an individual 501(c)(6) exemption, we are willing to give it up in order to be part of this group ruling. We also understand that if we are already a subordinate of another group ruling, we are willing to give up being a part of that group ruling in order to be part of this group ruling. We understand that if we ever leave the group ruling or it ceases to exist, we will need to apply for individual exemption and pay the applicable user fee should we wish to be exempt. We acknowledge acceptance of this policy on behalf of the above-named subordinate. Signature of Officer Type of Print Name and Title Date Signature of Officer Type of Print Name and Title Date Date Resolution Adopted I understand that this resolution, as it is submitted as an integral part of a central organization s application for exemption, is signed under penalties of perjury and to the best of my knowledge is true, correct and complete.

***This document must be signed by at least 2 officers*** Board Members List Name of Organization: FEIN: Name Title Mailing address City, State Zip Salary

Facilities Declaration Organization name: Our organization does not have facilities/office space Our organization has facilities/office space Facilities are owned by Facilities are donated to our organization Our organization leases facilities. Payment is $ per month If improvements are made, who is responsible to pay for them? owner organization Under IRC Section 501(c)(6), no individual can gain private benefit from the organization. If your organization is responsible for payment, what are your arrangements for compensation by the owner for improvements? Who pays for appliances, furniture, etc.? owner organization If the organization pays, does the organization keep the items upon vacating the facility? If the owner pays, do the items remain in the facility or are they donated to the organization? Owner is a related / unrelated party (please circle one) If an unrelated party, please indicate the details of your lease agreement (attach a page if needed): If owner is a related party, please provide: 1) information to demonstrate lease rate is reasonable in relation to fair market value. Examples of acceptable proof: a previously conducted appraisal, value stated by insurance, classified ads for the area. 2) A copy of your lease agreement between your organization and the facility owner. The lease must show the exact lease amount, duration of the lease, who is responsible for all utility payments, property taxes, and capital leasehold improvements to the facility as well as who will retain title of any capital leasehold improvements to the facilities.

EXAMPLE: IBA Activities Description The focus of a 501c6 organization (i.e. business league ) is to change or enhance conditions for a sector of business (for this purpose, independent business) in aggregate, not any individual business. We realize IBAs must talk about improving conditions for individual businesses as part of membership recruitment. However, for this description, your description must reflect your overarching change/enhance purpose. So, for example, refrain from mentions of advertising or promoting members. This kind of activity may be reframed as providing a means for citizens to learn which businesses in their community are local and independent toward forwarding your organization s mission and helping citizens make better informed decisions. The following example does a nice job of including specificity, but with a more global approach. Primary Activities of the Metro Independent Business Alliance 1. Public Education Purpose: MetroIBA is a non-profit organization working to support and preserve locally owned, independent businesses in the Twin Cities region. MetroIBA's mission is to help the Twin Cities maintain its unique community character, provide continuing opportunities for entrepreneurs, build economic strength, and create an environment where locally owned, independent businesses grow and flourish. To raise community awareness of these issues, MetroIBA conducts community education activities through its website, other online communications, hosting an educational table at public events, and conducting events featuring speakers on these and related topics, as well as through the public media (newspapers, radio). Financing: Dues paid by business and citizen members of MetroIBA fund MetroIBA s educational outreach activities. Approximately 20% of organizational time is given to public education. Who: A volunteer website developer manages the content of our website. Website material is composed by the executive director and volunteers (board members and others). The Speakers Bureau is made up of volunteers (MetroIBA members) and the Executive Director. 2. Publish an online directory of Independent Businesses Purpose: To elevate the profile of independent business in the community and state, provide a community resource, provide a benefit to member businesses, educate the public, and strengthen the local economy by keeping more money circulating locally, MetroIBA publishes a web-based directory of independent businesses, which is available at http://www.metroiba.org/memberdirectory. The directory currently contains 160 local independent businesses. MetroIBA also maintains BuyLocalMN.com, which is a web portal for identifying and locating local independent businesses in the state of Minnesota. This is a free, public service to any local independent business meeting criteria to be listed. Funding: Membership dues support the operation of the websites. Maintenance is donated by a member business. Who: About 20% of organizational time is dedicated to developing and maintaining the online directories. 3. Membership and Marketing Functions: Membership recruitment and retention by creating an organization that has value to its members.

Funding: These activities are funded primarily by membership dues. Who: The Executive Director conducts the majority of membership recruitment with volunteer assistance from board members comprising a membership committee of the board. About 20% of organizational time is devoted to these efforts. 4. Member Events and Programs Functions: Provide membership benefits, including free educational seminars, free networking events, and programs with guest speakers to educate our members. Funding: These events are funded primarily through the donations of members and sponsors and member dues. Who: The events are largely designed and coordinated by the Executive Director with volunteer assistance from the board of directors. About 15% of organizational time goes to these events and programs. 5. Website, Newsletter, Social Media Functions: The website provides a searchable online directory of locally owned businesses for the public to use, member resources, member spotlights, sponsorship recognition and MetroIBA contact information. It also serves to educate the public about the overall benefit independent businesses provide the Twin Cities Metro Area. The newsletter is electronic and is distributed monthly. It includes notices about upcoming events, member news, community announcements, plus news and tips members can use (on everything from obtaining capital to improving their website). Members are free to submit content. MetroIBA also maintains a member forum through LinkedIn and provides brief announcements about member businesses and news bulletins of interest to members and other followers through Twitter. Funding: Member dues cover the cost of hosting the website. LinkedIn and Twitter are free services. Who: A member business volunteered development and maintenance of the website. Hosting is provided by another member business for a cost. The Executive Director and a volunteer create and issue the e-newsletter (with input from members, Board members and the Executive Director). These efforts take about 10% of organizational time. 6. Advocacy Activities: MetroIBA serves as the voice for independent businesses in the Twin Cities Metro Area by issuing news releases on our perspective about issues facing local independent businesses in the media, participating in economic development forums, speaking with local and state decision makers about issues that impact small businesses, and testifying before the Minnesota State Legislature and municipal city governments. Funding: Membership dues cover this cost, and members are aware their dues covering this portion of our work are not deductible expenses. Who: The Executive Director and volunteer board members conduct this work. MetroIBA member businesses and citizens are kept appraised of this activity and may, at times, be asked to assist in providing testimony or for stories/quotes/perspectives for news releases. Approximately 2% of organizational time goes to this activity. 7. Administration Function: To manage the day-to-day operation of the organization, paperwork, written communication, database management, invoicing and payment of obligations. Funding: Member dues cover the cost of this activity. Who: The administrative work is conducted primarily by the Executive Director, with assistance from a volunteer intern and board members. About 13% of the organization s time goes to this activity.