Form AS 2645.1
Page 2 of 4
Rev. Oct 26 11
Name ___________________________________________
Part II - Information Concerning Activities and Operations
YES
NO
1.
Describe in detail your past and current activities as well as the activities planned for the future (Do not quote
from the Articles of Incorporation). Describe each activity separately in order of importance. Indicate its
purpose, when it began or will begin, who and where it will be realized. Submit shedule, if necessary.
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2.
Indicate the organization's source or sources of income.
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3.
Describe the programs of activities to collect funds, if any, and the way they will be done.
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4.
Indicate how income and surplus, if any, are used.
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5.
Does the organization provide any kind of insurance plan to its members, employees, partners or executives,
their dependents or other persons (include payments of benefits from sickness or death, pensions or annuities)?
If the answer is yes, explain the eligibility requirements and include as an example, a copy of each insurance
plan issued and of each plan.
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Is the organization under the supervision of any governmental agency such as the Department of Family Affairs
6.
or the Department of Health? .........................................................................................................................
If the answer is yes, include copy of all administrative opinions, judicial determinations, etc.
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7.
Does the organization spend or plan to spend money to influence judicial determinations subject to legislation
in its favor, or in favor of some of its employees, any member of its Board of Directors, etc.? ......................
If the answer is yes, explain how the recipients or beneficiaries are, or will be benefited.
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8.
Has the organization issued any booklets, letters, magazines, informative bulletins or any similar material? ...
If the answer is yes, include copies.
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9.
What percent (%) of the net income is distributed to the benefit of any member of the board of directors, partner
or individual at the end of the taxable year?
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Retention: Fifty (50) years.