Exemption revoked after organization failed to substantiate its operations

Plain-English summary

A private foundation did not fully respond to repeated IRS requests for its organizing documents, activity descriptions, minutes, financial records, and other examination materials. The partial response included incomplete and unsigned filings, and the organization did not provide proof that its articles had been accepted by the state. The IRS said the available books and records were insufficient to determine how funds were distributed, who received charitable distributions, or whether the assets were used exclusively for charitable purposes. It concluded that the organization failed both to meet the reporting requirements in sections 6001 and 6033 and to prove that it satisfied the organizational and operational tests under section 501(c)(3). The IRS revoked the exemption and stated that private-foundation filing duties would continue until the foundation terminated that status under section 507.

Ruling snapshot

• Question: Could an organization retain section 501(c)(3) status without producing sufficient records or proving that it had a compliant organizing document?
• Outcome: Revocation
• Key authorities: IRC §§ 501(c)(3), 6001, and 6033; Treas. Reg. §§ 1.501(c)(3)-1, 1.6001-1, and 1.6033-1; Rev. Rul. 59-95

Full text (IRS public release)

Internal Revenue Service
Tax Exempt and Government Entities

IRS Taxpayer ID number:

Form:

Department of the Treasury Date: October 26, 2021

Tax periods ended:
Release Number: 202243011

Release Date: 10/28/2022 Person to contact:

UIL Code: 501.03-00 Name:
ID number:

Telephone:
Fax:

CERTIFIED MAIL - RETURN RECEIPT REQUESTED

Why we are sending you this letter
This is a final determination that you don’t qualify for exemption from federal income tax under Internal
Revenue Code (IRC) Section 501(a) as an organization described in IRC Section 501(c)(3), effective

. Your determination letter dated , is revoked.

Our adverse determination as to your exempt status was made for the following reasons: Organizations
described in IRC Section 501(c)(3) and exempt under IRC Section 501(a) must be both organized and operated
exclusively for exempt purposes. You failed to adequately respond to repeated reasonable requests to allow the
Internal Revenue Service to examine your records regarding your receipts, expenditures, or activities as
required by IRC Sections 6001, 6033(a)(1) and the regulations thereunder. You also failed to demonstrate that
you are operating exclusively for one or more exempt purposes as required by Treasury Regulations Section

1.501(c)(3)-1(c)(1).

Organizations that are not exempt under IRC Section 501 generally are required to file federal income tax
returns and pay tax, where applicable. For further instructions, forms and information please visit www.irs.gov.

Because you were a private foundation as of the effective date of the adverse determination, you are considered
to be a taxable private foundation until you terminate your private foundation status under IRC Section 507.

In addition to your income tax return, you must also continue to file Form 990-PF, Return of Private Foundation
or Section 4947(a)(1) Trust Treated as Private Foundation, by the 15th day of the fifth month after the end of
your annual accounting period.

Contributions to your organization are no longer deductible under IRC Section 170.

What you must do if you disagree with this determination
If you want to contest our final determination, you have 90 days from the date this determination letter was

mailed to you to file a petition or complaint in one of the three federal courts listed below.

How to file your action for declaratory judgment
If you decide to contest this determination, you may file an action for declaratory judgment under the provisions

of IRC Section 7428 in one of the following three venues: 1) United States Tax Court, 2) the United States Court
of Federal Claims or 3) the United States District Court for the District of Columbia.

Letter 6337 (12-2020)
Catalog Number 74808E

Please contact the clerk of the appropriate court for rules and the appropriate forms for filing an action for
declaratory judgment by referring to the enclosed Publication 892, How to Appeal an IRS Determination on
Tax-Exempt Status. You may write to the courts at the following addresses:

United States Tax Court U.S. Court of Federal Claims U.S. District Court for the District of Columbia
400 Second Street, NW 717 Madison Place, NW 333 Constitution Ave., N.W.
Washington, DC 20217 Washington, DC 20439 Washington, DC 20001

Processing of income tax returns and assessments of any taxes due will not be delayed if you file a petition for
declaratory judgment under IRC Section 7428.

We’ll notify the appropriate state officials (as permitted by law) of our determination that you aren’t an
organization described in IRC Section 501(c)(3).

Information about the IRS Taxpayer Advocate Service

The IRS office whose phone number appears at the top of the notice can best address and access your tax
information and help get you answers. However, you may be eligible for free help from the Taxpayer Advocate
Service (TAS) if you can't resolve your tax problem with the IRS, or you believe an IRS procedure just isn't
working as it should. TAS is an independent organization within the IRS that helps taxpayers and protects
taxpayer rights. Contact your local Taxpayer Advocate Office at:

Or call TAS at 877-777-4778. For more information about TAS and your rights under the Taxpayer Bill of Rights,
go to taxpayeradvocate.irs.gov. Do not send your federal court pleading to the TAS address listed above. Use
the applicable federal court address provided earlier in the letter. Contacting TAS does not extend the time to
file an action for declaratory judgment.

Where you can find more information
Enclosed are Publication 1, Your Rights as a Taxpayer, and Publication 594, The IRS Collection Process, for
more comprehensive information.

Find tax forms or publications by visiting www.irs.gov/forms or calling 800-TAX-FORM (800-829-3676).
If you have questions, you can call the person shown at the top of this letter.

If you prefer to write, use the address shown at the top of this letter. Include your telephone number, the best
time to call, and a copy of this letter.

Keep the original letter for your records.

Sincerely,
S PNP 24
Sean E. O'Reilly (7
Director, Exempt Organizations Examinations

Enclosures:
Publication 1
Publication 594
Publication 892

Letter 6337 (12-2020)
Catalog Number 74808E

Department of the Treasury Date:

Internal Revenue Service 10/01/2020
I Tax Exempt and Government Entities Taxpayer ID number:

Form:
Tax periods ended:

Person to contact:
Name:
ID number:
Telephone
Fax:
Hours:
Manager's contact information:
Name:
ID number:

CERTIFIED MAIL — Return Receipt Requested Telephone

Response due date:
November 1, 2020

Why you’re receiving this letter
We enclosed a copy of our audit report, Form 886-A, Explanation of Items, explaining that we propose to revoke
your tax-exempt status as an organization described in Internal Revenue Code (IRC) Section 501(c)(3).

If you agree

If you haven’t already, please sign the enclosed Form 6018, Consent to Proposed Action, and return it to the
contact person shown at the top of this letter. We'll issue a final adverse letter determining that you aren't an
organization described in IRC Section 501(c)(3) for the periods above.

After we issue the final adverse determination letter, we’ll announce that your organization is no longer eligible
to receive tax deductible contributions under IRC Section 170.

If you disagree

1. Request a meeting or telephone conference with the manager shown at the top of this letter.

2. Send any information you want us to consider.

3. File a protest with the IRS Appeals Office. If you request a meeting with the manager or send additional
   information as stated in 1 and 2, above, you’ll still be able to file a protest with IRS Appeals Office after
   the meeting or after we consider the information.

The IRS Appeals Office is independent of the Exempt Organizations division and resolves most disputes
informally. If you file a protest, the auditing agent may ask you to sign a consent to extend the period of
limitations for assessing tax. This is to allow the IRS Appeals Office enough time to consider your case.
For your protest to be valid, it must contain certain specific information, including a statement of the
facts, applicable law, and arguments in support of your position. For specific information needed for a
valid protest, refer to Publication 892, How to Appeal an IRS Determination on Tax-Exempt Status.

Fast Track Mediation (FTM) referred to in Publication 3498, The Examination Process, generally doesn’t
apply now that we’ve issued this letter.

Letter 3618 (Rev. 8-2019)
Catalog Number 34809F

4. Request technical advice from the Office of Associate Chief Counsel (Tax Exempt Government Entities)
   if you feel the issue hasn’t been addressed in published precedent or has been treated inconsistently by the
   IRS.

If you’re considering requesting technical advice, contact the person shown at the top of this letter. If you
disagree with the technical advice decision, you will be able to appeal to the IRS Appeals Office, as
explained above. A decision made in a technical advice memorandum, however, generally is final and
binding on Appeals.

If we don't hear from you
If you don't respond to this proposal within 30 calendar days from the date of this letter, we’ll issue a final
adverse determination letter.

Contacting the Taxpayer Advocate Office is a taxpayer right
The Taxpayer Advocate Service (TAS) is an independent organization within the IRS that can help protect your

taxpayer rights. TAS can offer you help if your tax problem is causing a hardship, or you've tried but haven't
been able to resolve your problem with the IRS. If you qualify for TAS assistance, which is always free, TAS
will do everything possible to help you. Visit www.taxpayeradvocate.irs.gov or call 877-777-4778.

Additional information
You can get any of the forms and publications mentioned in this letter by visiting our website at

www.irs.gov/forms-pubs or by calling 800-TAX-FORM (800-829-3676).
If you have questions, you can contact the person shown at the top of this letter.

Sincerely.

Director, Exempt Organizations Examinations
Enclosures:

Form 886-A

Form 6018
Form 4621-A

Publication 892
Publication 3498

Letter 3618 (Rev. 8-2019)
Catalog Number 34809F

886 Department of the Treasury — Internal Revenue Service Schedule number
Form 886-A or exhibit
Explanations of Items Exhibit
Name of taxpayer Tax Identification Number (last 4 digits) | Year/Period ended
Date of Notice:
Issues:
Whether (the organization), which qualified for exemption from Federal

Income Tax under Section 501(c)(3) of the Internal Revenue Code, should be revoked due to its
failure to respond and produce records to substantiate that the organization meets the operational
test?

Whether (the organization), which qualified for exemption from Federal
Income Tax under Section 501(c)(3) of the Internal Revenue Code, should be revoked due to its
failure to respond and produce records to substantiate that the organization meets the
organizational test?

Facts:
The organization applied for tax-exempt status by filing the Form , Streamlined
Application for Recognition of Exemption Under Section 501(c)(3) of the Internal Revenue Code,
on and was granted tax-exempt status as a 501(c)(3) on with an

effective date of

An organization exempt under 501(c)(3) needs to be organized and operated exclusively for

religious, charitable, scientific, testing for public safety, literary or educational purposes and to
and

The organization was selected for examination to ensure that the activities and operations align
with their approved exempt status.

The organization failed to fully respond to the Internal Revenue Service attempts to obtain all

the necessary information to perform an examination of Form for the tax year ending
The Form application lists the phone number of for the Executive
Director, of

The organization attested on Form , Part III, that the organization would be organized

and operated exclusively to further charitable, religious and educational purposes.

The organization checked the boxes on Form , Part II, ensuring that when the
application was filed that the organization’s organizing document contains the required
provisions to meet the organizational test.

Catalog Number 20810W Page 1 www.irs.gov Form 886-A (Rev. 5-2017)

Department of the Treasury — Internal Revenue Service Schedule number
Form 886-A

. or exhibit
Explanations of Items Exhibit
Name of taxpayer Tax Identification Number (last 4 digits) | Year/Period ended

Correspondence for the examination was as follows:

Letter 3611, EO Initial Appointment - No Prior Contact, (Rev. 8-2019) with attachments, was
mailed to the organization on with a response date of The letter
requested the organization's organizing document and any amendments including proof of filing
with the applicable state entity, a copy of their By-Laws, a properly completed Form to
be processed in place of the previously filed Form , a detailed description of each of
their activities, minutes and financials.

On TCO attempted phone contact at the number provided for

(Executive Director) to confirm receipt of correspondence. TCO left a voice message requesting
a call back. TCO provided full name, identification number, direct phone number and hours of
availability.

On TCO spoke with a at the number provided for (Executive
Director). The refused to confirm if was TCO advised that just needed
to confirm receipt of correspondence sent on , at that time terminated
the call.

Letter 3844-A, Correspondence Audit Follow Up, was mailed with a due date of
to (Executive Director), (Administrator),
(Program manager), and the organization.

TCO received a call from (disclosure verified). confirmed he
had received the correspondence, Information Document Request (IDR) and Publication 1.
TCO confirmed that caller understood rights as provided in the Publication 1. TCO
confirmed that caller understood that due to their current status a Form needs to be
submitted and that the submitted Form was not valid. Caller stated that had
submitted a Form 4790 requesting termination of the Private Foundation. TCO advised that until
he receives confirmation of any actions —__ needs to continue to file a Form

A response was received from the organization via email on . The response included
a Form 8940, not dated and with no indication of user fee submitted. The Form 8940 is requesting
termination of private foundation status. The response included a copy of By-Laws signed by the
President, . The signature lines for the Secretary, , and Treasurer,

, were blank. The By-Laws stated they were adopted on .A
Corporation abstract print-out dated was included in the response. This print-out
shows that “ ” initially filed with the .
The report shows a reinstatement and then again . A certificate
with a stamp from the was included showing reinstatement of the Corporation
with an effective date of . A Form was included in the response. The
return was not signed or dated and appears to be filled out incompletely. The response included a
copy of the Articles of Incorporation (AOI) dated . While the AOI passes the

Catalog Number 20810W Page 2 www.irs.gov Form 886-A (Rev. 5-2017)

Department of the Treasury — Internal Revenue Service Schedule number
Form 886-A

. or exhibit
Explanations of Items Exhibit
Name of taxpayer Tax Identification Number (last 4 digits) | Year/Period ended

organizational test by having adequate language pertaining to its charitable activities they do not
include proof of filing and being accepted by the state.

The TCO replied to the organization via email on requesting the items missing
from the organization’s response: detailed description of activities, minutes, financials and proof
of filing of submitted AOI. Included were questions regarding the submitted Form as
follows:

Form

There is no income showing. The Income of $ needs to be reported either on line 1 or
line depending on form of income and a schedule pertaining to said income needs to be
attached. (Please refer to the Instructions for Form on website irs.gov.)

Please report the proper cash at the end of the year on Part II line . (Generally amount in bank
statements and/or the general ledger). Correct the amount reported on Part II line if necessary.
This line is for outstanding accounts receivable.

Provide expense amounts for activities reported in Part IX-A if there were expenses incurred.
Please sign and date the Form on page __. Include the title of the signatory ie: President,
Secretary.

The organization responded via email on . The response stated that the
organization lost its “incorporation status” in the in . At that time the
“governing rules, along with the minutes and testimonies was erased”. The organization was
reinstated in the in , the organization has yet to “form another Board of
Directors, thus there are no minutes of committee meetings or board of Director activity to
report. They state that “there is no investments, assets, revenues or liabilities to report outside
the .” The submitted Form is not dated and still appears to be incomplete.

TCO left a voice mail for (Executive Director) requesting a call back
due to questions regarding the submitted email of .

On TCO left a voice mail for (Executive Director) requesting a call
back. TCO advised that a second IDR and correspondence would be issued if a
call back was not received. TCO advised that it appears as though the organization may have

separate entities set up as there is a website for ( )
and one for ( ). TCO advised that it appears as though the
tax return filed only relates to the ( ).

Letter 3844-B, Correspondence Audit Request for Additional Information, was mailed on
with a due date of

Letter 5077-B, TE/GE IDR Delinquency Notice, was mailed on with a due date of
to (Administrator), (Executive director), and

Catalog Number 20810W Page 3 www.irs.gov Form 886-A (Rev. 5-2017)

Department of the Treasury — Internal Revenue Service Schedule number
Form 886-A

gs or exhibit
Explanations of Items Exhibit
Name of taxpayer Tax Identification Number (last 4 digits) | Year/Period ended

(Program manager). Included with the letter was an IDR, a copy of the Form

filed, a copy of the Form and a copy of the Determination Letter 1076.
TCO retrieved a voice mail on which was left by on at
pm(_ ). The voice mail requested that no further correspondence be sent to
as was no longer affiliated with the organization. stated that has
provided all the information that has. stated that if anything more was needed the TCO
will need to contact the . stated that “if this is not acceptable then I will

see you in court.”
Law:

Internal Revenue Code (IRC) §501(c)(3) of the Code provides that an organization organized
and operated exclusively for charitable or educational purposes is exempt from Federal income
tax, provided no part of its net earnings inures to the benefit of any private shareholder or
individual.

IRC §511 of the Internal Revenue Code imposes a tax at corporate rates under section 11 on the
unrelated business taxable income of certain tax-exempt organizations.

IRC §6001 of the Code provides that every person liable for any tax imposed by this title, or for the
collection thereof, shall keep such records, render such statements, make such returns, and
comply with such rules and regulations as the Secretary may from time to time prescribe.
Whenever in the judgment of the Secretary it is necessary, he may require any person, by notice
served upon such person or by regulations, to make such returns, render such statements, or
keep such records, as the Secretary deems sufficient to show whether or not such person is liable
for tax under this title.

IRC §6033(a)(1) of the Code provides, except as provided in section 6033(a)(2), every
organization exempt from tax under section 501(a) shall file an annual return, stating specifically
the items of gross income, receipts and disbursements, and such other information for the
purposes of carrying out the internal revenue laws as the Secretary may by forms or regulations
prescribe, and keep such records, render under oath such statements, make such other returns,
and comply with such rules and regulations as the Secretary may from time to time prescribe.

Treasury Regulations (Regulation) 1.501(c)(3)-1 In order to be exempt under §501(c)(3) the
organization must be both organized and operated exclusively for one or more of the purposes
specified in the section. (religious, charitable, scientific, testing for public safety, literary or
educational).

Regulation §1.501(c)(3)-1(a)(1) of the regulations states that in order to be exempt as an
organization described in section 501(c)(3), an organization must be both organized and operated

Catalog Number 20810W Page 4 www.irs.gov Form 886-A (Rev. 5-2017)

Department of the Treasury — Internal Revenue Service Schedule number
Form 886-A

° or exhibit
Explanations of Items Exhibit
Name of taxpayer Tax Identification Number (last 4 digits) | Year/Period ended

exclusively for one or more of the purposes specified in such section. If an organization fails to
meet either the organizational test or the operational test, it is not exempt.

Regulation §1.501(c)(3)-1(b)(1)(i) An organization is organized exclusively for one or more
exempt purposes only if its articles of organization (a) Limit the purposes of such organization to
one or more exempt purposes; and (b) Do not expressly empower the organization to engage,
otherwise than as an insubstantial part of its activities, in activities which in themselves are not in
furtherance of one or more exempt purposes.

Regulation 1.501(c)(3)-1(b)(4) An organization is not organized exclusively for one or more
exempt purposes unless its assets are dedicated to an exempt purpose. An organization's assets
will be considered dedicated to an exempt purpose, for example, if, upon dissolution, such assets
would, by reason of a provision in the organization's articles or by operation of law, be distributed
for one or more exempt purposes, or to the Federal Government, or to a State or local
government, for a public purpose, or would be distributed by a court to another organization to be
used in such manner as in the judgment of the court will best accomplish the general purposes for
which the dissolved organization was organized. However, an organization does not meet the
organizational test if its articles or the law of the State in which it was created provide that its
assets would, upon dissolution, be distributed to its members or shareholders.

Regulation 1.501(c)(3)-1(c)(1) of the regulations provides that an organization will not be
regarded as "operated exclusively" for one or more exempt purposes described in section
501(c)(3) of the Code if more than an insubstantial part of its activities is not in furtherance of a
501(c)(3) purpose. Accordingly, the organization does not qualify for exemption under section
501(c)(3) of the Code.

Regulation §1.6001-1(c) of the Code provides that such permanent books and records as are
required by paragraph (a) of this section with respect to the tax imposed by section 511 on
unrelated business income of certain exempt organizations, every organization exempt from tax
under section 501(a) shall keep such permanent books of account or records, including
inventories, as are sufficient to show specifically the items of gross income, receipts and
disbursements. Such organizations shall also keep such books and records as are required to
substantiate the information required by section 6033. See section 6033 and §§ 1.6033-1 through
1.6033-3.

Regulation §1.6001-1(e) of the Code provides that the books or records required by this section
shall be kept at all time available for inspection by authorized internal revenue officers or
employees, and shall be retained as long as the contents thereof may be material in the
administration of any internal revenue law.

Regulation §1.6033-1(h)(2) of the regulations provides that every organization which has
established its right to exemption from tax, whether or not it is required to file an annual return of
information, shall submit such additional information as may be required by the district director for

Catalog Number 20810W Page 5 www.irs.gov Form 886-A (Rev. 5-2017)

Department of the Treasury — Internal Revenue Service Schedule number
Form 886-A

. or exhibit
Explanations of Items Exhibit
Name of taxpayer Tax Identification Number (last 4 digits) | Year/Period ended

the purpose of enabling to inquire further into its exempt status and to administer the
provisions of subchapter F (section 501 and the following), chapter 1 of the Code and section
6033.

Regulation §1.6033-2(a)(1) of the Regulations provides, in part, that, except for certain
exceptions not here applicable, every organization exempt from taxation under section 501(a)
shall file an annual information return specifically setting forth its items of gross income, gross
receipts and disbursements, and such other information as may be prescribed in the instructions
issued with respect to the return.

Regulation §1.6033-2(i)(2) of the Regulations provides, in part, that every organization which is
exempt from tax, whether or not it is required to file an annual information return, shall submit such
additional information as may be required by the Internal Revenue Service for the purpose of
inquiring into its exempt status and administering the provisions of subchapter F, chapter 1 of
subtitle A of the Code, section 6033, and chapter 42 of subtitle D of the Code.

Regulation §1.61-1 of the regulations provides that Gross income means all income from
whatever source derived, unless excluded by law. Gross income includes income realized in any
form, whether in money, property, or services. Income may be realized, therefore, in the form of
services, meals, accommodations, stock, or other property, as well as in cash.

Rev. Rul. 59-95, 1959-1 C.B. 627, concerns an exempt organization that was requested to
produce a financial statement and statement of its operations for a certain year. However, its
records were so incomplete that the organization was unable to furnish such statements. The
Service held that the failure or inability to file the required information return or otherwise to
comply with the provisions of section 6033 of the Code and the regulations which implement it,
may result in the termination of the exempt status of an organization previously held exempt, on
the grounds that the organization has not established that it is observing the conditions required
for the continuation of exempt status.

Rev. Proc. 2020-5, Sec 11.02 (3) Inaccurate information on request. A determination letter
issued to an organization that submitted a request in accordance with this revenue procedure may
not be relied upon by the organization submitting the request if it was based on any inaccurate
material information submitted by the organization. Inaccurate material information includes an
incorrect representation or attestation as to the organization's organizational documents, the
organization’s exempt purpose, the organization’s conduct of prohibited and restricted activities, or
the organization’s eligibility to file Form 1023-EZ.

Organization’s Position:

Taxpayer's position is unknown at this time.

Catalog Number 20810W Page 6 www.irs.gov Form 886-A (Rev. 5-2017)

Department of the Treasury — Internal Revenue Service Schedule number
Form 886-A

. or exhibit
Explanations of Items Exhibit
Name of taxpayer Tax Identification Number (/ast 4 digits) | Year/Period ended

Government's Position:

During the examination, the organization did not respond fully to verify that they are organized
and operated exclusively for one or more of the purposes specified in IRC Section 501(c)(3). If
an organization fails to meet either the organizational test or the operational test, it is not
exempt.

The books and records are not adequate to permit the Internal Revenue Service to verify that
the funds and activities were used for an exempt purpose. The organization did not maintain
original source documents to support your transactions. Specifically, we cannot determine how
and under what circumstances funds were distributed. Also, we cannot confirm the recipients of
the charitable distributions, and whether they were charitable organizations or of a charitable
class. Consequently, we cannot ascertain whether the organization’s assets were dedicated
exclusively for charitable purposes in order to justify continued recognition of tax-exempt status
under IRC 501(c)(3) of the Code.

In accordance with the above-cited provisions of the Code and regulations under sections 6001
and 6033, organizations recognized as exempt from federal income tax must meet certain
reporting requirements. These requirements relate to the filing of a complete and accurate
annual information (and other required federal tax forms) and the retention of records sufficient
to determine whether such entity is operated for the purposes for which it was granted tax-
exempt status and to determine its liability for any unrelated business income tax.

The organization fails the organizational test because it did not establish that it had an organizing
document that complied with section 501(c)(3) at the time of applying for tax exemption.

Section 1.6033-1(h)(2) of the regulations specifically state that exempt organizations shall
submit additional information for the purpose on enabling the Internal Revenue Service to
inquire further into its exempt status.

Using the rationale that was developed in Revenue Ruling 59-95, the organization’s failure to
provide requested information should result in the termination of exempt status.

Conclusion:

It is the IRS's position that the organization failed to establish that it meets the reporting
requirements under IRC §§ 6001 and 6033 to be recognized as exempt from federal income tax
under IRC § 501(c)(3). Furthermore, the organization has not established that it is observing
the conditions required for the continuation of its exempt status or that it is organized and
operated exclusively for an exempt purpose. Accordingly, the organization's exempt status is
revoked effective .

Catalog Number 20810W Page 7 Www.irs.gov Form 886-A (Rev. 5-2017)

Department of the Treasury — Internal Revenue Service Schedule number
or exhibit

Explanations of Items Exhibit

Tax Identification Number (last 4 digits) | Year/Period ended

Form 886-A

Name of taxpayer

Form , U.S. Corporation Income Tax Return, should be filed for the tax periods after

Catalog Number 20810W Page 8 www.irs.gov Form 886-A (Rev. 5-2017)