Application for Recognition of Exemption

Transcription

1 The Interative version of Form 123 is availale at StayExempt.irs.gov. It inludes prerequisite questions, auto-alulated fields, help uttons and links to relevant information. Form 123 (Rev. Deemer 213) Department of the Treasury Internal Revenue Servie Appliation for Reognition of Exemption Under Setion 51()(3) of the Internal Revenue Code (Use with the June 26 revision of the Instrutions for Form 123 and the urrent tie 1382) OMB te: If exempt status is approved, this appliation will e open for puli inspetion. Use the instrutions to omplete this appliation and for a definition of all old items. For additional help, all IRS Exempt Organizations Customer Aount Servies toll-free at Visit our wesite at for forms and puliations. If the required information and douments are not sumitted with payment of the appropriate user fee, the appliation may e returned to you. Attah additional sheets to this appliation if you need more spae to answer fully. Put your name and EIN on eah sheet and identify eah answer y Part and line numer. Complete Parts I - XI of Form 123 and sumit only those Shedules (A through H) that apply to you. () Part I Identifiation of Appliant 1 Full name of organization (exatly as it appears in your organizing doument) US Right to Know 2 /o Name (if appliale) 3 Mailing address (Numer and street) (see instrutions) Room/Suite 4 Employer Identifiation Numer (EIN) 626A Harwood Ave. City or town, state or ountry, and ZIP + 4 Oakland, CA Month the annual aounting period ends (1 12) 6 Primary ontat (offier, diretor, trustee, or authorized representative) a Name: Gary Ruskin Phone: Fax: (optional) 7 Are you represented y an authorized representative, suh as an attorney or aountant? If, provide the authorized representative s name, and the name and address of the authorized representative s firm. Inlude a ompleted Form 2848, Power of Attorney and Delaration of Representative, with your appliation if you would like us to ommuniate with your representative. 8 Was a person who is not one of your offiers, diretors, trustees, employees, or an authorized representative listed in line 7, paid, or promised payment, to help plan, manage, or advise you aout the struture or ativities of your organization, or aout your finanial or tax matters? If, provide the person s name, the name and address of the person s firm, the amounts paid or promised to e paid, and desrie that person s role. 9a Organization s wesite: Organization s (optional) 1 Certain organizations are not required to file an information return (Form 99 or Form 99-EZ). If you are granted tax-exemption, are you laiming to e exused from filing Form 99 or Form 99-EZ? If, explain. See the instrutions for a desription of organizations not required to file Form 99 or Form 99-EZ. 11 Date inorporated if a orporation, or formed, if other than a orporation. (MM/DD/YYYY) 5 / 2 / Were you formed under the laws of a foreign ountry? If, state the ountry. For Paperwork Redution At tie, see page 24 of the instrutions. Cat K Form 123 (Rev ) 6-26)

2 Form 123 (Rev ) 6-26) () US Right to Know Name: EIN: Page 2 Part II Organizational Struture You must e a orporation (inluding a limited liaility ompany), an uninorporated assoiation, or a trust to e tax exempt. (See instrutions.) DO NOT file this form unless you an hek on lines 1, 2, 3, or a Are you a orporation? If, attah a opy of your artiles of inorporation showing ertifiation of filing with the appropriate state ageny. Inlude opies of any amendments to your artiles and e sure they also show state filing ertifiation. Are you a limited liaility ompany (LLC)? If, attah a opy of your artiles of organization showing ertifiation of filing with the appropriate state ageny. Also, if you adopted an operating agreement, attah a opy. Inlude opies of any amendments to your artiles and e sure they show state filing ertifiation. Refer to the instrutions for irumstanes when an LLC should not file its own exemption appliation. Are you an uninorporated assoiation? If, attah a opy of your artiles of assoiation, onstitution, or other similar organizing doument that is dated and inludes at least two signatures. Inlude signed and dated opies of any amendments. Are you a trust? If, attah a signed and dated opy of your trust agreement. Inlude signed and dated opies of any amendments. Have you een funded? If, explain how you are formed without anything of value plaed in trust. 5 Have you adopted ylaws? If, attah a urrent opy showing date of adoption. If, explain how your offiers, diretors, or trustees are seleted. Part III Required Provisions in Your Organizing Doument The following questions are designed to ensure that when you file this appliation, your organizing doument ontains the required provisions to meet the organizational test under setion 51()(3). Unless you an hek the oxes in oth lines 1 and 2, your organizing doument does not meet the organizational test. DO NOT file this appliation until you have amended your organizing doument. Sumit your original and amended organizing douments (showing state filing ertifiation if you are a orporation or an LLC) with your appliation. 1 2a Setion 51()(3) requires that your organizing doument state your exempt purpose(s), suh as haritale, religious, eduational, and/or sientifi purposes. Chek the ox to onfirm that your organizing doument meets this requirement. Desrie speifially where your organizing doument meets this requirement, suh as a referene to a partiular artile or setion in your organizing doument. Refer to the instrutions for exempt purpose language. Loation of Purpose Clause (Page, Artile, and Paragraph): Page 1, artile 2. Setion 51()(3) requires that upon dissolution of your organization, your remaining assets must e used exlusively for exempt purposes, suh as haritale, religious, eduational, and/or sientifi purposes. Chek the ox on line 2a to onfirm that your organizing doument meets this requirement y express provision for the distriution of assets upon dissolution. If you rely on state law for your dissolution provision, do not hek the ox on line 2a and go to line 2. 2 If you heked the ox on line 2a, speify the loation of your dissolution lause (Page, Artile, and Paragraph). Do not omplete line 2 if you heked ox 2a. Page 1, artile 6. 2 See the instrutions for information aout the operation of state law in your partiular state. Chek this ox if you rely on operation of state law for your dissolution provision and indiate the state: not appliale Part IV Narrative Desription of Your Ativities Using an attahment, desrie your past, present, and planned ativities in a narrative. If you elieve that you have already provided some of this information in response to other parts of this appliation, you may summarize that information here and refer to the speifi parts of the appliation for supporting details. You may also attah representative opies of newsletters, rohures, or similar douments for supporting details to this narrative. Rememer that if this appliation is approved, it will e open for puli inspetion. Therefore, your narrative desription of ativities should e thorough and aurate. Refer to the instrutions for information that must e inluded in your desription. Part V 1a Compensation and Other Finanial Arrangements With Your Offiers, Diretors, Trustees, Employees, and Independent Contrators List the names, titles, and mailing addresses of all of your offiers, diretors, and trustees. For eah person listed, state their total annual ompensation, or proposed ompensation, for all servies to the organization, whether as an offier, employee, or other position. Use atual figures, if availale. Enter none if no ompensation is or will e paid. If additional spae is needed, attah a separate sheet. Refer to the instrutions for information on what to inlude as ompensation. Name Title Mailing address Charlie Cray Diretor, Treasurer 1827 Kilourne Pl. NW Washington, DC 21 Lisa Graves Diretor, Seretary 49 E. Main Street, 1 Madison, WI 5373 Juliet Shor Diretor, Chair 5 Stuart Rd. Newton, MA 2459 Gary Ruskin Exeutive Diretor 626A Harwod Ave. Oakland, CA Compensation amount (annual atual or estimated) none none none not yet determined Form 123 (Rev ) 6-26)

3 Form 123 (Rev ) 6-26) () US Right to Know 46 Name: EIN: Page 3 Part V Compensation and Other Finanial Arrangements With Your Offiers, Diretors, Trustees, Employees, and Independent Contrators (Continued) List the names, titles, and mailing addresses of eah of your five highest ompensated employees who reeive or will reeive ompensation of more than $5, per year. Use the atual figure, if availale. Refer to the instrutions for information on what to inlude as ompensation. Do not inlude offiers, diretors, or trustees listed in line 1a. Name Title Mailing address Compensation amount (annual atual or estimated) Please see attahed statement List the names, names of usinesses, and mailing addresses of your five highest ompensated independent ontrators that reeive or will reeive ompensation of more than $5, per year. Use the atual figure, if availale. Refer to the instrutions for information on what to inlude as ompensation. Name Title Mailing address Compensation amount (annual atual or estimated) Please see attahed statement The following or questions relate to past, present, or planned relationships, transations, or agreements with your offiers, diretors, trustees, highest ompensated employees, and highest ompensated independent ontrators listed in lines 1a, 1, and 1. 2a Are any of your offiers, diretors, or trustees related to eah other through family or usiness relationships? If, identify the individuals and explain the relationship. 3a Do you have a usiness relationship with any of your offiers, diretors, or trustees other than through their position as an offier, diretor, or trustee? If, identify the individuals and desrie the usiness relationship with eah of your offiers, diretors, or trustees. Are any of your offiers, diretors, or trustees related to your highest ompensated employees or highest ompensated independent ontrators listed on lines 1 or 1 through family or usiness relationships? If, identify the individuals and explain the relationship. For eah of your offiers, diretors, trustees, highest ompensated employees, and highest ompensated independent ontrators listed on lines 1a, 1, or 1, attah a list showing their name, qualifiations, average hours worked, and duties. Do any of your offiers, diretors, trustees, highest ompensated employees, and highest ompensated independent ontrators listed on lines 1a, 1, or 1 reeive ompensation from any other organizations, whether tax exempt or taxale, that are related to you through ommon ontrol? If, identify the individuals, explain the relationship etween you and the other organization, and desrie the ompensation arrangement. 4 In estalishing the ompensation for your offiers, diretors, trustees, highest ompensated employees, and highest ompensated independent ontrators listed on lines 1a, 1, and 1, the following praties are reommended, although they are not required to otain exemption. Answer to all the praties you use. a Do you or will the individuals that approve ompensation arrangements follow a onflit of interest poliy? Do you or will you approve ompensation arrangements in advane of paying ompensation? Do you or will you doument in writing the date and terms of approved ompensation arrangements? Form 123 (Rev ) 6-26)

4 Form 123 (Rev ) 6-26) () US Right to Know 46 Name: EIN: Page 4 Part V Compensation and Other Finanial Arrangements With Your Offiers, Diretors, Trustees, Employees, and Independent Contrators (Continued) d e f g 5a Do you or will you reord in writing the deision made y eah individual who deided or voted on ompensation arrangements? Do you or will you approve ompensation arrangements ased on information aout ompensation paid y similarly situated taxale or tax-exempt organizations for similar servies, urrent ompensation surveys ompiled y independent firms, or atual written offers from similarly situated organizations? Refer to the instrutions for Part V, lines 1a, 1, and 1, for information on what to inlude as ompensation. Do you or will you reord in writing oth the information on whih you relied to ase your deision and its soure? If you answered to any item on lines 4a through 4f, desrie how you set ompensation that is reasonale for your offiers, diretors, trustees, highest ompensated employees, and highest ompensated independent ontrators listed in Part V, lines 1a, 1, and 1. Have you adopted a onflit of interest poliy onsistent with the sample onflit of interest poliy in Appendix A to the instrutions? If, provide a opy of the poliy and explain how the poliy has een adopted, suh as y resolution of your governing oard. If, answer lines 5 and 5. What proedures will you follow to assure that persons who have a onflit of interest will not have influene over you for setting their own ompensation? What proedures will you follow to assure that persons who have a onflit of interest will not have influene over you regarding usiness deals with themselves? te: A onflit of interest poliy is reommended though it is not required to otain exemption. Hospitals, see Shedule C, Setion I, line 14. 6a Do you or will you ompensate any of your offiers, diretors, trustees, highest ompensated employees, and highest ompensated independent ontrators listed in lines 1a, 1, or 1 through non-fixed payments, suh as disretionary onuses or revenue-ased payments? If, desrie all non-fixed ompensation arrangements, inluding how the amounts are determined, who is eligile for suh arrangements, whether you plae a limitation on total ompensation, and how you determine or will determine that you pay no more than reasonale ompensation for servies. Refer to the instrutions for Part V, lines 1a, 1, and 1, for information on what to inlude as ompensation. Do you or will you ompensate any of your employees, other than your offiers, diretors, trustees, or your five highest ompensated employees who reeive or will reeive ompensation of more than $5, per year, through non-fixed payments, suh as disretionary onuses or revenue-ased payments? If, desrie all non-fixed ompensation arrangements, inluding how the amounts are or will e determined, who is or will e eligile for suh arrangements, whether you plae or will plae a limitation on total ompensation, and how you determine or will determine that you pay no more than reasonale ompensation for servies. Refer to the instrutions for Part V, lines 1a, 1, and 1, for information on what to inlude as ompensation. 7a Do you or will you purhase any goods, servies, or assets from any of your offiers, diretors, trustees, highest ompensated employees, or highest ompensated independent ontrators listed in lines 1a, 1, or 1? If, desrie any suh purhase that you made or intend to make, from whom you make or will make suh purhases, how the terms are or will e negotiated at arm s length, and explain how you determine or will determine that you pay no more than fair market value. Attah opies of any written ontrats or other agreements relating to suh purhases. Do you or will you sell any goods, servies, or assets to any of your offiers, diretors, trustees, highest ompensated employees, or highest ompensated independent ontrators listed in lines 1a, 1, or 1? If, desrie any suh sales that you made or intend to make, to whom you make or will make suh sales, how the terms are or will e negotiated at arm s length, and explain how you determine or will determine you are or will e paid at least fair market value. Attah opies of any written ontrats or other agreements relating to suh sales. 8a Do you or will you have any leases, ontrats, loans, or other agreements with your offiers, diretors, trustees, highest ompensated employees, or highest ompensated independent ontrators listed in lines 1a, 1, or 1? If, provide the information requested in lines 8 through 8f. d e f Desrie any written or oral arrangements that you made or intend to make. Identify with whom you have or will have suh arrangements. Explain how the terms are or will e negotiated at arm s length. Explain how you determine you pay no more than fair market value or you are paid at least fair market value. Attah opies of any signed leases, ontrats, loans, or other agreements relating to suh arrangements. 9a Do you or will you have any leases, ontrats, loans, or other agreements with any organization in whih any of your offiers, diretors, or trustees are also offiers, diretors, or trustees, or in whih any individual offier, diretor, or trustee owns more than a 35% interest? If, provide the information requested in lines 9 through 9f. 123 Form 123 (Rev ) 6-26)

5 Form 123 (Rev ) 6-26) () Name: US Right to Know EIN: Page 5 Part V Compensation and Other Finanial Arrangements With Your Offiers, Diretors, Trustees, Employees, and Independent Contrators (Continued) d e f Desrie any written or oral arrangements you made or intend to make. Identify with whom you have or will have suh arrangements. Explain how the terms are or will e negotiated at arm s length. Explain how you determine or will determine you pay no more than fair market value or that you are paid at least fair market value. Attah a opy of any signed leases, ontrats, loans, or other agreements relating to suh arrangements. Part VI Your Memers and Other Individuals and Organizations That Reeive Benefits From You The following or questions relate to goods, servies, and funds you provide to individuals and organizations as part of your ativities. Your answers should pertain to past, present, and planned ativities. (See instrutions.) 1a 2 In arrying out your exempt purposes, do you provide goods, servies, or funds to individuals? If, desrie eah program that provides goods, servies, or funds to individuals. In arrying out your exempt purposes, do you provide goods, servies, or funds to organizations? If, desrie eah program that provides goods, servies, or funds to organizations. Do any of your programs limit the provision of goods, servies, or funds to a speifi individual or group of speifi individuals? For example, answer, if goods, servies, or funds are provided only for a partiular individual, your memers, individuals who work for a partiular employer, or graduates of a partiular shool. If, explain the limitation and how reipients are seleted for eah program. 3 Do any individuals who reeive goods, servies, or funds through your programs have a family or usiness relationship with any offier, diretor, trustee, or with any of your highest ompensated employees or highest ompensated independent ontrators listed in Part V, lines 1a, 1, and 1? If, explain how these related individuals are eligile for goods, servies, or funds. Part VII Your History The following or questions relate to your history. (See instrutions.) 1 Are you a suessor to another organization? Answer, if you have taken or will take over the ativities of another organization; you took over 25% or more of the fair market value of the net assets of another organization; or you were estalished upon the onversion of an organization from for-profit to non-profit status. If, omplete Shedule G. 2 Are you sumitting this appliation more than 27 months after the end of the month in whih you were legally formed? If, omplete Shedule E. Part VIII Your Speifi Ativities The following or questions relate to speifi ativities that you may ondut. Chek the appropriate ox. Your answers should pertain to past, present, and planned ativities. (See instrutions.) 1 Do you support or oppose andidates in politial ampaigns in any way? If, explain. 2a Do you attempt to influene legislation? If, explain how you attempt to influene legislation and omplete line 2. If, go to line 3a. Have you made or are you making an eletion to have your legislative ativities measured y expenditures y filing Form 5768? If, attah a opy of the Form 5768 that was already filed or attah a ompleted Form 5768 that you are filing with this appliation. If, desrie whether your attempts to influene legislation are a sustantial part of your ativities. Inlude the time and money spent on your attempts to influene legislation as ompared to your total ativities. 3a Do you or will you operate ingo or gaming ativities? If, desrie who onduts them, and list all revenue reeived or expeted to e reeived and expenses paid or expeted to e paid in operating these ativities. Revenue and expenses should e provided for the time periods speified in Part IX, Finanial Data. Do you or will you enter into ontrats or other agreements with individuals or organizations to ondut ingo or gaming for you? If, desrie any written or oral arrangements that you made or intend to make, identify with whom you have or will have suh arrangements, explain how the terms are or will e negotiated at arm s length, and explain how you determine or will determine you pay no more than fair market value or you will e paid at least fair market value. Attah opies or any written ontrats or other agreements relating to suh arrangements. List the states and loal jurisditions, inluding Indian Reservations, in whih you ondut or will ondut gaming or ingo. 123 Form 123 (Rev ) 6-26)

6 Form 123 (Rev ) 6-26) () Name: US Right to Know EIN: Page 6 Part VIII Your Speifi Ativities (Continued) 4a Do you or will you undertake fundraising? If, hek all the fundraising programs you do or will ondut. (See instrutions.) mail soliitations soliitations personal soliitations vehile, oat, plane, or similar donations foundation grant soliitations Attah a desription of eah fundraising program. phone soliitations aept donations on your wesite reeive donations from another organization s wesite government grant soliitations Other Do you or will you have written or oral ontrats with any individuals or organizations to raise funds for you? If, desrie these ativities. Inlude all revenue and expenses from these ativities and state who onduts them. Revenue and expenses should e provided for the time periods speified in Part IX, Finanial Data. Also, attah a opy of any ontrats or agreements. Do you or will you engage in fundraising ativities for other organizations? If, desrie these arrangements. Inlude a desription of the organizations for whih you raise funds and attah opies of all ontrats or agreements. d List all states and loal jurisditions in whih you ondut fundraising. For eah state or loal jurisdition listed, speify whether you fundraise for your own organization, you fundraise for another organization, or another organization fundraises for you. e Do you or will you maintain separate aounts for any ontriutor under whih the ontriutor has the right to advise on the use or distriution of funds? Answer if the donor may provide advie on the types of investments, distriutions from the types of investments, or the distriution from the donor s ontriution aount. If, desrie this program, inluding the type of advie that may e provided and sumit opies of any written materials provided to donors. 5 6a 7a Are you affiliated with a governmental unit? If, explain. Do you or will you engage in eonomi development? If, desrie your program. Desrie in full who enefits from your eonomi development ativities and how the ativities promote exempt purposes. Do or will persons other than your employees or volunteers develop your failities? If, desrie eah faility, the role of the developer, and any usiness or family relationship(s) etween the developer and your offiers, diretors, or trustees. Do or will persons other than your employees or volunteers manage your ativities or failities? If, desrie eah ativity and faility, the role of the manager, and any usiness or family relationship(s) etween the manager and your offiers, diretors, or trustees. If there is a usiness or family relationship etween any manager or developer and your offiers, diretors, or trustees, identify the individuals, explain the relationship, desrie how ontrats are negotiated at arm s length so that you pay no more than fair market value, and sumit a opy of any ontrats or other agreements. 8 Do you or will you enter into joint ventures, inluding partnerships or limited liaility ompanies treated as partnerships, in whih you share profits and losses with partners other than setion 51()(3) organizations? If, desrie the ativities of these joint ventures in whih you partiipate. 1 9a Are you applying for exemption as a hildare organization under setion 51(k)? If, answer lines 9 through 9d. If, go to line 1. Do you provide hild are so that parents or aretakers of hildren you are for an e gainfully employed (see instrutions)? If, explain how you qualify as a hildare organization desried in setion 51(k). Of the hildren for whom you provide hild are, are 85% or more of them ared for y you to enale their parents or aretakers to e gainfully employed (see instrutions)? If, explain how you qualify as a hildare organization desried in setion 51(k). d Are your servies availale to the general puli? If, desrie the speifi group of people for whom your ativities are availale. Also, see the instrutions and explain how you qualify as a hildare organization desried in setion 51(k). Do you or will you pulish, own, or have rights in musi, literature, tapes, artworks, horeography, sientifi disoveries, or other intelletual property? If, explain. Desrie who owns or will own any opyrights, patents, or trademarks, whether fees are or will e harged, how the fees are determined, and how any items are or will e produed, distriuted, and marketed. 123 Form 123 (Rev ) 6-26)

7 Form 123 (Rev ) 6-26) () Name: US Right to Know EIN: Part VIII 11 Your Speifi Ativities (Continued) Do you or will you aept ontriutions of: real property; onservation easements; losely held seurities; intelletual property suh as patents, trademarks, and opyrights; works of musi or art; lienses; royalties; automoiles, oats, planes, or other vehiles; or olletiles of any type? If, desrie eah type of ontriution, any onditions imposed y the donor on the ontriution, and any agreements with the donor regarding the ontriution Page 7 12a Do you or will you operate in a foreign ountry or ountries? If, answer lines 12 through 12d. If, go to line 13a. Text Name the foreign ountries and regions within the ountries in whih you operate. Desrie your operations in eah ountry and region in whih you operate. d Desrie how your operations in eah ountry and region further your exempt purposes. 13a Do you or will you make grants, loans, or other distriutions to organization(s)? If, answer lines 13 through 13g. If, go to line 14a. Desrie how your grants, loans, or other distriutions to organizations further your exempt purposes. Do you have written ontrats with eah of these organizations? If, attah a opy of eah ontrat. d Identify eah reipient organization and any relationship etween you and the reipient organization. e Desrie the reords you keep with respet to the grants, loans, or other distriutions you make. f Desrie your seletion proess, inluding whether you do any of the following: (i) Do you require an appliation form? If, attah a opy of the form. (ii) Do you require a grant proposal? If, desrie whether the grant proposal speifies your responsiilities and those of the grantee, oligates the grantee to use the grant funds only for the purposes for whih the grant was made, provides for periodi written reports onerning the use of grant funds, requires a final written report and an aounting of how grant funds were used, and aknowledges your authority to withhold and/or reover grant funds in ase suh funds are, or appear to e, misused. g Desrie your proedures for oversight of distriutions that assure you the resoures are used to further your exempt purposes, inluding whether you require periodi and final reports on the use of resoures. 14a Do you or will you make grants, loans, or other distriutions to foreign organizations? If, answer lines 14 through 14f. If, go to line 15. Provide the name of eah foreign organization, the ountry and regions within a ountry in whih eah foreign organization operates, and desrie any relationship you have with eah foreign organization. d Does any foreign organization listed in line 14 aept ontriutions earmarked for a speifi ountry or speifi organization? If, list all earmarked organizations or ountries. Do your ontriutors know that you have ultimate authority to use ontriutions made to you at your disretion for purposes onsistent with your exempt purposes? If, desrie how you relay this information to ontriutors. e Do you or will you make pre-grant inquiries aout the reipient organization? If, desrie these inquiries, inluding whether you inquire aout the reipient s finanial status, its tax-exempt status under the Internal Revenue Code, its aility to aomplish the purpose for whih the resoures are provided, and other relevant information. f Do you or will you use any additional proedures to ensure that your distriutions to foreign organizations are used in furtherane of your exempt purposes? If, desrie these proedures, inluding site visits y your employees or ompliane heks y impartial experts, to verify that grant funds are eing used appropriately. 123 Form 123 (Rev ) 6-26)

8 Form 123 (Rev ) 6-26) () Name: US Right to Know EIN: Page 8 Part VIII Your Speifi Ativities (Continued) 15 Do you have a lose onnetion with any organizations? If, explain Are you applying for exemption as a ooperative hospital servie organization under setion 51(e)? If, explain. Are you applying for exemption as a ooperative servie organization of operating eduational organizations under setion 51(f)? If, explain. Are you applying for exemption as a haritale risk pool under setion 51(n)? If, explain. Do you or will you operate a shool? If, omplete Shedule B. Answer, whether you operate a shool as your main funtion or as a seondary ativity. Is your main funtion to provide hospital or medial are? If, omplete Shedule C. Do you or will you provide low-inome housing or housing for the elderly or handiapped? If, omplete Shedule F. 22 Do you or will you provide sholarships, fellowships, eduational loans, or other eduational grants to individuals, inluding grants for travel, study, or other similar purposes? If, omplete Shedule H. te: Private foundations may use Shedule H to request advane approval of individual grant proedures. 123 Form 123 (Rev ) 6-26)

9 Form 123 (Rev ) 6-26) () US Right to Know 46 Name: EIN: Page 9 Part IX Finanial Data For purposes of this shedule, years in existene refer to ompleted tax years. If in existene 4 or more years, omplete the shedule for the most reent 4 tax years. If in existene more than 1 year ut less than 4 years, omplete the statements for eah year in existene and provide projetions of your likely revenues and expenses ased on a reasonale and good faith estimate of your future finanes for a total of 3 years of finanial information. If in existene less than 1 year, provide projetions of your likely revenues and expenses for the urrent year and the 2 following years, ased on a reasonale and good faith estimate of your future finanes for a total of 3 years of finanial information. (See instrutions.) Revenues Expenses A. Statement of Revenues and Expenses Type of revenue or expense Current tax year 3 prior tax years or 2 sueeding tax years (a) From 1/1/14 () From 1/1/15 () From 1/1/16 (d) From 12/31/14 12/31/15 12/31/16 To To To To Gifts, grants, and ontriutions reeived (do not inlude unusual grants) Memership fees reeived Gross investment inome Net unrelated usiness inome Taxes levied for your enefit Value of servies or failities furnished y a governmental unit without harge (not inluding the value of servies generally furnished to the puli without harge) Any revenue not otherwise listed aove or in lines 9 12 elow (attah an itemized list) Total of lines 1 through 7 Gross reeipts from admissions, merhandise sold or servies performed, or furnishing of failities in any ativity that is related to your exempt purposes (attah itemized list) Total of lines 8 and 9 Net gain or loss on sale of apital assets (attah shedule and see instrutions) Unusual grants Total Revenue Add lines 1 through 12 Fundraising expenses Contriutions, gifts, grants, and similar amounts paid out (attah an itemized list) Disursements to or for the enefit of memers (attah an itemized list) Compensation of offiers, diretors, and trustees Other salaries and wages Interest expense Oupany (rent, utilities, et.) Depreiation and depletion Professional fees Any expense not otherwise lassified, suh as program servies (attah itemized list) Total Expenses Add lines 14 through 23 (e) Provide Total for (a) through (d) Form 123 (Rev ) 6-26)

10 () US Right to Know Page 1 Finanial Data (Continued) B. Balane Sheet (for your most reently ompleted tax year) Year End: 214 Form 123 (Rev ) 6-26) Name: EIN: Part IX Assets Cash Aounts reeivale, net Inventories Bonds and notes reeivale (attah an itemized list) Corporate stoks (attah an itemized list) Loans reeivale (attah an itemized list) Other investments (attah an itemized list) Depreiale and depletale assets (attah an itemized list) Land Other assets (attah an itemized list) Total Assets (add lines 1 through 1) Liailities Aounts payale Contriutions, gifts, grants, et. payale Mortgages and notes payale (attah an itemized list) Other liailities (attah an itemized list) Total Liailities (add lines 12 through 15) Fund Balanes or Net Assets Total fund alanes or net assets Total Liailities and Fund Balanes or Net Assets (add lines 16 and 17) Have there een any sustantial hanges in your assets or liailities sine the end of the period shown aove? If, explain. Part X Puli Charity Status (Whole dollars) Part X is designed to lassify you as an organization that is either a private foundation or a puli harity. Puli harity status is a more favorale tax status than private foundation status. If you are a private foundation, Part X is designed to further determine whether you are a private operating foundation. (See instrutions.) 1a 2 Are you a private foundation? If, go to line 1. If, go to line 5 and proeed as instruted. If you are unsure, see the instrutions. As a private foundation, setion 58(e) requires speial provisions in your organizing doument in addition to those that apply to all organizations desried in setion 51()(3). Chek the ox to onfirm that your organizing doument meets this requirement, whether y express provision or y reliane on operation of state law. Attah a statement that desries speifially where your organizing doument meets this requirement, suh as a referene to a partiular artile or setion in your organizing doument or y operation of state law. See the instrutions, inluding Appendix B, for information aout the speial provisions that need to e ontained in your organizing doument. Go to line 2. Are you a private operating foundation? To e a private operating foundation you must engage diretly in the ative ondut of haritale, religious, eduational, and similar ativities, as opposed to indiretly arrying out these ativities y providing grants to individuals or other organizations. If, go to line 3. If, go to the signature setion of Part XI. 3 Have you existed for one or more years? If, attah finanial information showing that you are a private operating foundation; go to the signature setion of Part XI. If, ontinue to line 4. 4 Have you attahed either (1) an affidavit or opinion of ounsel, (inluding a written affidavit or opinion from a ertified puli aountant or aounting firm with expertise regarding this tax law matter), that sets forth fats onerning your operations and support to demonstrate that you are likely to satisfy the requirements to e lassified as a private operating foundation; or (2) a statement desriing your proposed operations as a private operating foundation? 5 a d If you answered to line 1a, indiate the type of puli harity status you are requesting y heking one of the hoies elow. You may hek only one ox. The organization is not a private foundation eause it is: 59(a)(1) and 17()(1)(A)(i) a hurh or a onvention or assoiation of hurhes. Complete and attah Shedule A. 59(a)(1) and 17()(1)(A)(ii) a shool. Complete and attah Shedule B. 59(a)(1) and 17()(1)(A)(iii) a hospital, a ooperative hospital servie organization, or a medial researh organization operated in onjuntion with a hospital. Complete and attah Shedule C. 59(a)(3) an organization supporting either one or more organizations desried in line 5a through, f, g, or h or a pulily supported setion 51()(4), (5), or (6) organization. Complete and attah Shedule D. Form 123 (Rev ) 6-26)

11 () US Right to Know Page 11 Puli Charity Status (Continued) Form 123 (Rev ) 6-26) Name: EIN: Part X 6 e f g h i a 59(a)(4) an organization organized and operated exlusively for testing for puli safety. 59(a)(1) and 17()(1)(A)(iv) an organization operated for the enefit of a ollege or university that is owned or operated y a governmental unit. 59(a)(1) and 17()(1)(A)(vi) an organization that reeives a sustantial part of its finanial support in the form of ontriutions from pulily supported organizations, from a governmental unit, or from the general puli. 59(a)(2) an organization that normally reeives not more than one-third of its finanial support from gross investment inome and reeives more than one-third of its finanial support from ontriutions, memership fees, and gross reeipts from ativities related to its exempt funtions (sujet to ertain exeptions). A pulily supported organization, ut unsure if it is desried in 5g or 5h. The organization would like the IRS to deide the orret status. If you heked ox g, h, or i in question 5 aove, you must request either an advane or a definitive ruling y seleting one of the oxes elow. Refer to the instrutions to determine whih type of ruling you are eligile to reeive. Request for Advane Ruling: By heking this ox and signing the onsent, pursuant to setion 651()(4) of the Code you request an advane ruling and agree to extend the statute of limitations on the assessment of exise tax under setion 494 of the Code. The tax will apply only if you do not estalish puli support status at the end of the 5-year advane ruling period. The assessment period will e extended for the 5 advane ruling years to 8 years, 4 months, and 15 days eyond the end of the first year. You have the right to refuse or limit the extension to a mutually agreed-upon period of time or issue(s). Puliation 135, Extending the Tax Assessment Period, provides a more detailed explanation of your rights and the onsequenes of the hoies you make. You may otain Puliation 135 free of harge from the IRS we site at or y alling toll-free Signing this onsent will not deprive you of any appeal rights to whih you would otherwise e entitled. If you deide not to extend the statute of limitations, you are not eligile for an advane ruling. Consent Fixing Period of Limitations Upon Assessment of Tax Under Setion 494 of the Internal Revenue Code For Organization (Signature of Offier, Diretor, Trustee, or other authorized offiial) (Type or print name of signer) (Type or print title or authority of signer) (Date) For IRS Use Only IRS Diretor, Exempt Organizations (Date) Request for Definitive Ruling: Chek this ox if you have ompleted one tax year of at least 8 full months and you are requesting a definitive ruling. To onfirm your puli support status, answer line 6(i) if you heked ox g in line 5 aove. Answer line 6(ii) if you heked ox h in line 5 aove. If you heked ox i in line 5 aove, answer oth lines 6(i) and (ii). (i) (a) Enter 2% of line 8, olumn (e) on Part IX-A. Statement of Revenues and Expenses. () Attah a list showing the name and amount ontriuted y eah person, ompany, or organization whose gifts totaled more than the 2% amount. If the answer is ne, hek this ox. (ii) (a) For eah year amounts are inluded on lines 1, 2, and 9 of Part IX-A. Statement of Revenues and Expenses, attah a list showing the name of and amount reeived from eah disqualified person. If the answer is ne, hek this ox. () For eah year amounts are inluded on line 9 of Part IX-A. Statement of Revenues and Expenses, attah a list showing the name of and amount reeived from eah payer, other than a disqualified person, whose payments were more than the larger of (1) 1% of line 1, Part IX-A. Statement of Revenues and Expenses, or (2) $5,. If the answer is ne, hek this ox. 7 Did you reeive any unusual grants during any of the years shown on Part IX-A. Statement of Revenues and Expenses? If, attah a list inluding the name of the ontriutor, the date and amount of the grant, a rief desription of the grant, and explain why it is unusual. 123 Form 123 (Rev ) 6-26)

12

13 USRighttoKnow EIN: USRighttoKnow IRSform123 Responsestospeifiquestions PartIV:NarrativeDesriptionofYourAtivities USRighttoKnowisaneworganization.Atthistimewehavenopastorpresentativities. Weareplanningthefollowingativities. WeplantopromotethehealthofallAmeriansyworkingforahealthier,saferfood system,andforinreasingthetransparenyofourfoodsystem. Weplantofousmuhofourresearhandinvestigativeeffortsattentiononsituationsin whihourfoodsystemisinadequatelytransparent;forexample,wherefoodlaeling, restaurantlaelingotherfood3relateddislosureisinadequateornonexistent. Weplantoeduatethepuliaoutfoodandhealthissues,tohelpAmerianshoosefoods thataresaferandhealthier,andtoenourageaninreasedsupplyandavailailityoffoods thataresaferandhealthier. Weplantoresearhandinvestigatethesafetyofertainfoodandotherproduts.Weplan towarnthepuliinaseswheretherearepotentiallydangerous,toxi,unsafeor unwholesomeprodutsinourfoodsupplyorinotherprodutsthatonsumersmayuse. Weplantoeduatethepuliaouthowfederal,stateandloalgovernmentdeisionsare maderegardingissuesoffoodandhealth. Weplantodistriuteourinvestigativeandresearhfindingsforfreetoitizensand onsumersviaourwesite,inartiles,updates,logposts,andthroughsoialmediasuh astwitterandfaeook.wewillalsodistriutethesefindingstothenewsmedia.we mayalsowriteartilesforpuliationinnewspapers,magazinesandothermediaoutlets. Weplantoeginthisworkwithinthenextmonth,andtoontinueitforaslongasthereis inadequatetransparenyinourfoodsystem. OurworkwilleondutedyUSRighttoKnowstaff,onsultants,volunteersand memersofthegeneralpuli. Wewillfundourworkthroughontriutionsfromindividualdonorsandharitale foundations.wehopeandexpetthattherearemanypeopleandsomeharitale foundationsthatareaoutfoodandhealththatwillsupportourause.wewilllikely aeptontriutionsfromthepuliviaourwesiteaswell. 1

14 USRighttoKnow EIN: PartV:Compensation Question1a Theoardofdiretorsofournewlyformednonprofitorporationhasnotyetdeidedthe ompensationforitsexeutivediretor,garyruskin.whenitdoes,anysuhontratwill provideforpaymentinommeriallyreasonaleamountsinreturnforserviesrelatedto theexemptfuntionsofthisnonprofit. Question1 Ournewlyformednonprofitorporationdoesnotatthistimepayanyonemorethan $5,peryear.Ifandwhenitdoes,anysuhontratswillprovideforpaymentin ommeriallyreasonaleamountsinreturnforserviesrelatedtotheexemptfuntionsof thisnonprofit. Question1 Thisnewlyformednonprofitorporationdoesnotatthistimepayanyonemorethan $5,peryear.Ifandwhenitdoes,anysuhontratswillprovideforpaymentin ommeriallyreasonaleamountsinreturnforserviesrelatedtotheexemptfuntionsof thisnonprofit Question3a FollowingareiographialskethesoftheoardofdiretorsandoffiersofUSRightto Know.Allthreediretorswilllikelyworkanaverageoflessthanonehourperweek,and theywillreeivenoompensation.theirdutiesaretodiretandoverseetheoperationsof USRighttoKnow. Attheoutset,theexeutivediretorofUSRighttoKnowisexpetedtoworkapproximately 3hoursperweek.HisdutiesaretoexeutetheoperationsofUSRighttoKnow,to superviseotherstaff,toondutallneessaryfinanialandprogramplanning,andto ondutfundraisingneededtoarryouttheoperationsofusrighttoknow. BioofLisaGraves,DiretorandSeretary LisaGravesisexeutivediretoroftheCenterforMediaandDemoray.Shehasservedas asenioradvisorinallthreeranhesofthefederalgovernmentandotherposts.shehas alsoworkedasaleadingstrategistonivilliertiesadvoayintheareaofnational seurityandasanadjuntlawprofessoratoneofthetoplawshoolsintheountry.her formerleadershippositionsinlude: DeputyAssistantAttorneyGeneralintheOffieofLegalPoliy/PoliyDevelopment attheu.s.departmentofjustie(handlinganarrayofivilandriminalpoliy issuesaswellasleadingtheworkinggrouponjudiialnominations33workedunder othattorneysgeneraljanetrenoandjohnashroft) 2

15 USRighttoKnow EIN: ChiefCounselforminationsfortheU.S.SenateJudiiaryCommitteeforthe Chairman/RankingMemer SeniorLegislativeStrategistfortheAmerianCivilLiertiesUnion(onnational seurityandsurveillanepoliies) DeputyDiretoroftheCenterforNationalSeurityStudies DeputyChiefoftheArtileIIIJudgesDivisionoftheU.S.Courts(inludingoversight ofthefinanialdislosureoffieforjudiialethis) Graveshastestifiedasanexpertwitnessonnationalseurity/homelandseurityand transparenyissueseforeoththeu.s.senateandthehouseofrepresentatives.shehas alsoappearedasanexpertoncnn,abc,nbc,cbs,msnbc,cnbc,bbc,c3span,andother newsprogramsandonnumerousradioshows,inludingnationalpuliradio,demoray w!,airameria,andpaifiaradio.heranalysishaseenquotedinthe$new$york$ Times,The$Washington$Post,The$Los$Angeles$Times,The$Chiago$Triune,The$Boston$ Gloe,The$Assoiated$Press,Reuters,USA$Today,The$Nation,The$Progressive,$In$These$Times,$ Mother$Jones,Vanity$Fair,Congressional$Quarterly,Roll$Call,National$Journal,Legal$ Times,Newsday,andWired,amongothers,aswellasonlineinTheHuffingtonPost,Talking PointsMemo,andotherlogs.Shehasalsohelpedwithlegalriefsandheranalysisof nationalseurityissueshaseenpulishedythetexas$law$reviewandother puliations.shewasalsothemanagingeditorfortheclintonadministration'snational IntegratedFirearmsVioleneRedutionStrategy. BioofJulietShor,DiretorandChair JulietShorisProfessorofSoiologyatBostonCollege.BeforejoiningBostonCollege,she taughtatharvarduniversityfor17years,inthedepartmentofeonomisandthe CommitteeonDegreesinWomen sstudies.agraduateofwesleyanuniversity,shor reeivedherph.d.ineonomisattheuniversityofmassahusetts. HermostreentookisPlenitude:$The$New$Eonomis$of$True$Wealth(ThePenguinPress 21).Sheisalsoauthorofthenationalest3seller,The$Overworked$Amerian:$The$ Unexpeted$Deline$of$Leisure(BasiBooks,1992)andThe$Overspent$Amerian:$Why$We$ Want$What$We$Don t$need(basibooks,1998).the$overworked$amerianappearedonthe est3sellerlistsofthe$new$york$times,pulisher s$weekly,the$chiago$triune,the$village$ Voie,The$Boston$GloeaswellastheannualestookslistforThe$New$York$Times, Business$Weekandotherpuliations.Theookiswidelyreditedforinflueningthe nationaldeateonworkandfamily.the$overspent$amerianwasalsomadeintoavideoof thesamename,ythemediaeduationfoundation(septemer23). ShoralsowroteBorn$to$Buy:$TheCommerializedChildandtheNewConsumerCulture (Sriner24).SheistheauthorofDo$Amerians$Shop$Too$Muh?(BeaonPress2), o3editorofconsumer$soiety:$a$reader(thenewpress2)ando3editorofsustainale$ Planet:$Solutions$for$the$TwentySfirst$Century(BeaonPress22).Anessayolletion, Consumerism$and$Its$DisontentsisforthomingfromOxfordUniversityPressin211.She hasalsoo3editedanumerofaademiolletions. 3

16 USRighttoKnow EIN: Sheisao3founderando3hairoftheBoardoftheCenterforaNewAmerianDream,a nationalsustainailityorganization. ShewasafellowattheJohnSimonGuggenheimMemorialFoundationin fora projetentitled NewAnalysesofConsumerSoiety. In26shereeivedtheLeontief PrizefromtheGloalDevelopmentandEonomisInstituteatTuftsUniversityfor expandingthefrontiersofeonomithought.in1998shorreeivedthegeorgeorwell AwardforDistinguishedContriutionstoHonestyandClarityinPuliLanguagefromthe NationalCounilofTeahersofEnglish.Shor ssholarlyartileshaveappearedinthe EonomiJournal,TheReviewofEonomisandStatistis,WorldDevelopment,Industrial Relations,TheJournalofEonomiPsyhology,EologialEonomis,TheJournalof IndustrialEology,SoialProlemsandotherjournals.Shorhasservedasaonsultantto theunitednations,attheworldinstitutefordevelopmenteonomisresearh,andtothe UnitedNationsDevelopmentProgram. Inadditiontotheforegoing,Shorisao3founderoftheSouthEndPressandtheCenterfor PopularEonomis.SheisaformerTrusteeofWesleyanUniversity,anoasionalfaulty memeratshumahercollege,andaformerfellowofthebrookingsinstitution.shorhas leturedwidelythroughouttheunitedstates,europeandjapantoavarietyofivi, usiness,laorandaademigroups.sheappearsfrequentlyonnationalandinternational media,andprofilesonherandherworkhaveappearedinsoresofmagazinesand newspapers,inludingthe$new$york$times,wall$street$journal,newsweek,andpeople$ magazine.shehasappearedon6minutes,thetodayshow,goodmorningameria,the EarlyShowonCBS,numerousstoriesonnetworknews,aswellasmanyothernationaland loaltelevisionnewsprograms. BioofCharlieCray,DiretorandTreasurer CharliehaseenamemerofGreenpeaeUSA sresearhdepartmentsine21. Between1989and1999,healsoworkedwithGreenpeaeasamemeroftheGreenpeae ToxisCampaign,organizingampaignstoshutdowntoxiwasteinineratorsandphase outpvcplastis. Between1999and24,CharliehelpededitMultinational$Monitormagazineanddireted thecampaignforcorporatereformatcitizenworks,whihwaso3foundedyralph NaderafteraseriesoforporaterimewaveeginningwithEnron. Heistheo3authorof$The$People s$business:$controlling$corporations$and$restoring$ Demoray(Berrett3Koehler,23),aswellasnumerousenvironmentalandorporate aountailityartiles,reports,andlogs. 4

17 USRighttoKnow EIN: Between24and21,CharliediretedtheCenterforCorporatePoliy (orporatepoliy.org),researhingandpulishingnumerousartilesandreportsaouta varietyoftopisrelatedtoorporatepowerandaountaility,inludingorporatetax dodging,exeutiveompensation,ontratoraountailityandorporaterime.during thattimeheo3foundedandmaintainedthewathdogwesite,halliurtonwath.org, usingittopressforgovernmentontratoraountailityandreform. CharlieisagraduateofAmherstCollege. BioofGaryRuskin,ExeutiveDiretor Duringthe212eletionyle,GaryRuskinwasampaignmanagerforProposition37,a statewideallotinitiativeforlaelingofgenetiallyengineeredfoodincalifornia.for fourteenyears,hediretedthecongressionalaountailityprojet,whihopposed orruptionintheu.s.congress.fornineyears,hewasexeutivediretorando3founder ofcommerialalert,whihopposedtheommerializationofeverynookandrannyof ourlivesandulture.hehasofteneenquotedinmajornewspapersarosstheountry andhasappearedsoresoftimesonnationaltvnewsprograms. HereeivedhisundergraduatedegreeinreligionfromCarletonCollege,andamaster s degreeinpulipoliyfromharvarduniversity sjohnf.kennedyshoolofgovernment. Question4a USRighttoKnowhasadoptedaonflitofinterestpoliythatontrolstheapprovalof salariestodiretors,offiersandother disqualifiedpersons asdefinedinsetion4958of theinternalrevenuecode.seeartile9,aswellasartile3,setion6,andartile4, Setion9,oftheylawsattahedtothisappliation.Also,Artile9,Setion5,oftheylaws appliesadditionalonflitofinterestrequirementsontheoardandompensation ommitteewhenapprovingompensationarrangements. Question4 Artile9,Setion3,ofUSRighttoKnow sylawsrequirestheapprovalofompensationof diretors,offiers,andany disqualifiedperson asdefinedinsetion4958oftheinternal RevenueCodeinadvaneafterfulldislosureofthesurroundingfatsandapprovaly disinterestedmemersofthegoverningoardorommitteeandpriortoenteringintothe ompensationagreementorarrangement.further,artile9,setion5(a)ofusrightto Know sylawsrequiresspeifiapprovalofompensationarrangementspriortothefirst paymentofompensationundersuharrangements. Question4 Artile9,Setion4,ofUSRighttoKnow sylaws,whihareattahedtothisappliation, requirethetakingofwrittenminutesofmeetingsatwhihompensationpaidtoany diretor,offier,orother disqualifiedperson asdefinedinsetion4958oftheinternal 5