Form 1023 Checklist (Revised December 2017) . Application for Recognition of Exemption under Section 501(c)(3) of the Internal Revenue Code Note: Retain a copy of the completed Form 1023 in your permanent records. Refer to the General Instructions regarding Public Inspection of approved applications. - Check each box to finish your application (Form 1023). Send this completed Checklist with your filled-in application. If you have not answered all the items below. your application may be returned to you as incomplete. Assemble the application and materials in this order. 0 Form 1023 Checklist - Form 2848. Power of Attorney and Declaration of Representative (if filing) 0 Form 8821. Tax information Authorization (if filing) - Expedite request (if requesting) - Application (Form 1023 and Schedules A through H. as required) 0 Articles of organization - Amendments to articles of organization in chronological order - Bylaws or other rules of operation and amendments 0 Documentation of nondiscriminatory policy for schools, as required by Schedule 0 Form 5768, Election/Revocation of Election by an Eligible Section 501(c)(3) Organization To Make Expenditures To influence Legislation (if ?ling) - All other attachments,_ including explanations, financial data, and printed materials or publications. Label each page with name and EIN. User fee payment placed in envelope on top of checklist. DO NOT STAPLE or otherwise attach your check or money order to your application. Instead, just place it in the envelope. Employer Identification Number Completed Parts I through XI of the application, including any requested information and any required Schedules A through H. i 0 You must provide speci?c details about your past, present. and planned activities. 0 Generalizations or, failure to answer questions in the Form 1023 application will prevent us from recognizing you as tax exempt. 0 Describe your purposes and proposed activities in specific easily understood terms. 0 Financial information should correspond with proposed activities. Schedules. Submit?oniy those schedules that apply to you and check either "Yes" or "No" below. ScheduleA Yes No: Schedule Yes No_l_ Schedule Yes Schedule Yes Schedule Yes Schedule Yes Schedule Yes No I Schedule Yes An exact copy of your complete articles of organization (creating document). AbsenCe of the proper purpose and dissolution clauses is the number one reason for delays in the issuance of determination letters. 0 Location of Purpose Clause from Part line 1 (Page. Article and Paragraph Number) Pg. 1. Art. 5, Section 0 Location of Dissolution Clause from Part line 2b or 2c (Page, Article and Paragraph Number) or by operation of state law Pg. 2. Art. 6 Signature of an officer, director, trustee, or other official who is authorized to sign the application. 0 Signature at Part XI of Form 1023. Your name on the application must be the same as your legal name as it appears in your articles of organization. Send completed Form 1023. user fee payment, and all other required information, to: Internal Revenue Service Attention: E0 Determination Letters Stop 31 PO. Box 12192 Covington, KY 41012-0192 If you are using express mail or a delivery service. send Form 1023, user fee payment. and attachments to: internal Revenue Service Attention: EO Determination Letters Stop 31 201 West Rivercenter Boulevard Covington, KY 41011 OMB No. 1545-0150 Form Power Of Attorney I For 1R5 Use Only (new. January 201a> and Declaration of Representative Received by: Department of the Treasury Internal Revenue Service Go to for instructions and the latest information. Name Power of Attorney Telephone Caution: A separate Form 2848 must be completed for each taxpayer. Form 2848 will not be honored Function for any purpose other than representation before the IRS. Dare 1 Taxpayer information. Taxpayer must sign and date this form on page 2, line 7. Taxpayer name and address States Newsroom 1340 Environ Way. 3rd Floor Chapel Hill. NC 27517 hereby appoints the following representativets) as 2 Representativeis) must sign and date this form on page 2. Part II. Taxpayer identification number(s) Daytime telephone va a tpplicable) (919) 986-1807 I Name and address CAF No Ezra W. Reese PTIN P01521393 700 13th Street NW. Suite 600 Telephone ND- .- Washington. DC 20005 Fax No. Check if to be sent copies of notices and communications Check if new: Address Telephone No. Fax No. Name and address CAF N0. "$333312? Katherine T. LaBeau P01955199 100 13th Street NW. Suite 500 Telephone No Washington. or: 20005 Fax No. 202-624-9515__ Check if to be sent copies of notices and communications Check if new: Address [3 Telephone No. Fax No. Name and address CAF NO- PTIN Telephone No. Fax No. (Note: IRS sends notices and communications to only two repreSentatives.) Check if new: Address Telephone No. Fax No. Name and address CAP NO- . .- PTIN Telephone No. Fax No. (Note: IRS sends notices and communications to only two representatives.) Check it new: Address El Telephone No. C) Fax No. to represent the taxpayer before the Internal Revenue Service and perform the following acts: 3 Acts authorized (you are required to complete this line With the exception of the acts described in line so. I authorize my representative(s) to receive and inspect my con?dential tax information and to perform acts that I can perform with respect to the tax matters described below. For example. my representative(s) shall have the authority to sign any agreements, consents. or similar documents {see instructions for line 5a for authorizing a representative to sign a return). Description of Matter (Income. Employment, Payroll. Excise, Estate. Gift. Whistleblower. Practitioner Disciptine. PLFI, FOIA, Civil Penalty, Sec. 5000A Shared Responsibility Payment. Sec. 49801-1 Shared Responsibility Payment. etc.) (see instructions) Tax Form Number (1 040. 941. 720. etc.) (if applicable) Year(s) or Period(s) (if applicable) (see instructions) Application for Recognition of Exemption Under Section 501(c)(3) 1023 Return of Orqanization Exempt from Income Tax 990 2019 to 2022 4 Specific use not recorded on Centralized Authorization Fiie (CAF). If the power of attorney is for a specific use not recorded on CAF, check this b0x. See the instructions for Line 4. Speci?c Use Not Recorded on CAF . 5a Additional acts authorized. In addition to the acts listed on line 3 above. I authorize my representative{s) to perform the following acts (see instructions for line 53 for more information): Access my IRS records via an Intermediate Service Provider; El Authorize disclosure to third parties: Substitute or add representativels); Sign a return; Other acts authorized: For Privacy Act and Paperwork Reduction Act Notice. 899 the Instructions. Cat. NO. 11980.] Form 2848 (Rem -zoio) Form 2848 (Rev. 1-2015) Page 2 Specific acts not authorized. My representative(s) is (are) not authorized to endorse or otherwise negotiate any check (including directing or accepting payment by any means, electronic or otherwise. into an account owned or controlled by the representative(s) or any ?rm or other entity with whom the representative(s) is (are) associated) issued by the government in respect of a federat tax liability. List any other speci?c deletions to the acts othenrvise authorized in this power of attorney (see instructions for line 5b): 6 Retention/revocation of prior power(s) of attorney. The filing of this power of attorney automatically revokes all earlier power(s) of attorney on tile with the internal Revenue Service for the same matters and years or periods covered by this document. If you do not want . . . . . . . . . . . . . . . . . . . . . . . . . . YOU MUST ATTACH A COPY OF ANY POWER OF ATTORNEY YOU WANT TO REMAIN IN EFFECT. 7 Signature of taxpayer. If a tax matter concerns a year in which a ioint rett'Jrn was filed. each spouse must ?le a separate power of attorney even if they are appointing the same representative(s). lf signed by a corporate officer. partner. guardian, tax matters partner. partnership representative, executor, receiver, administrator. or trustee on behalf of the taxpayer. I certify that have the legal authority to execute this form on behalf of the taxpayer. IF NOT COMPLETED, SIGNED, AND DATED, THE IRS WILL RETURN THIS POWER OF ATTORNEY TO THE TAXPAYER. Title (if applicable) Chris itzsimon States Newsroom Print name of tape-payer rr??m tine 1 if Declaration of Representative Under penalties of perjury. by my signature below I declare that: - I am not currently suspended or disbarred from practice. or ineligible for practice. before the Internal Revenue Service: 0 I am subject to regulations contained in Circular 230 (31 CFR. Subtitle A, Part 10). as amended, governing practice before the internal Revenue Service; 0 I am authorized to represent the taxpayer identi?ed in Part I for the matter(s) speci?ed therethe following: a Attorney?a member in good standing of the bar of the highest court of the jurisdiction shown below. Certi?ed Public Accountant?a holder of an active license to practice as a certified public accountant in the jurisdiction shown below. Enrolled Agent?enrolled as an agent by the Internal Revenue Service per the requirements of Circular 230. Of?cer?a bona fide of?cer of the taxpayer organization. Full-Time Employee?a full-time employee of the taxpayer. 9 Famiiy Member?a member of the taxpayer's immediate family (spouse. parent. child. grandparent. grandchild, step-parent. step-child. brother, 0r sister). Enrolled Actuary?enrolled as an actuary by the Joint Board for the Enrollment of Actuaries under 29 U.S.C. 1242 (the authority to practice before the Internal Revenue Service is limited by section 10.3(d) of Circular 230). Unenrolled Return Preparer?Authority to practice before the IRS is limited. An unenrolled return preparer may represent. provided the preparer (1) prepared and signed the return or ciaim for refund (or prepared if there is no signature space on the form); (2) was eligible to sign the return or claim for refund; (3) has a valid and (4) possesses the required Annual Filing Season Program Record of Completion(s). See Special Rules and Requirements for Unenrolled Return Preparers in the instructions for additional information. It Qualifying Student?receives permission to represent taxpayers before the by virtue of his/her status as a law. business. or accounting student working in an LITC or STOP. See instructions for Part ii for additional information and requirements. Enrolled Retirement Plan Agent?enrolled as a retirement plan agent under the requirements of Circular 230 (the authority to practice before the Internal Revenue Service is limited by section IF THIS DECLARATION OF REPRESENTATIVE IS NOT SIGNED, AND DATED, THE IRS WILL RETURN THE POWER OF ATTORNEY. REPRESENTATIVES MUST SIGN IN THE ORDER LISTED IN PART I, LINE 2. Note: For designations d-f, enter your title. position. or relationship to the taxpayer in the "Licensing jurisdiction? column. Designation? beensmg Jur'Sd'cnon Bar, license. certification, Insert above registration. or enrollment Signature Date letter (if applicab'e). number 0f applicable). n? A cc 431750 6/2 a DC 1023852 [17?20 7? Form 2848 (Rev. 1-2018) THE FOUNDATION June 20, 2019 Chris Fitzsimon States Newsroom 1340 Environ Way, Fl. Chapel Hill, NC 27517 Dear Mr. Fitzsimon: The Foundation is interested in providing a contribution of $1,000,000 (one million. dollars) to the States Newsroom. Prior to making this contribution, please provide us with proof of Section 501. federal tax exempt-status for the organization. If the States Newsroom is unable to present an exemption letter from the Internal Revenue Service by July 31, 2019, the Foundation will divert these contribution dollars to another organization. Thank you for your prompt attention to this matter. Molly McUsic, President Foundation 1759 Street Washington, DC 20009 1759 STREET. - WASHINGTON, DC I 2noo9 - 203452-44? - FAX 202-232?4419 a Q.) mesa?para PeRKINscoie I June 19, 2019 VIA DELIVERY SERVICE Internal Revenue Service 550 Main Street Room 4024 Cincinnati, OH 45202 Washington, DC. 20005-3960 Re: States Newsroo Privacv Redaction To Whom It May Concern; 0 0.202.654?6200 6 PerkinsCoierom 700 13th Street. NW Suite 600 Ezra W. Reese Ereese@perkinscoie.com D. +1.202.434.l6!6 F. +1.202.654.9109 The purpose of this letter is to request expedited processing of the Form 1023 Application for Recognition of Exemption for States Newsroom, BIN 84-2113822. States Newsroom has been offered a $1,000,000 contribution from The Foundation, which represents a considerable portion of States NeWsroom?s planned program activity for 2019. The donor requires that the Internal Revenue Service approve States Newsroom?s application for tax- exempt status by July 31,- 2019, or these funds Will be forfeited. Without these funds, States Newsroom will be unable to conduct signi?cant portions of its program activities planned for summer and fall 2019. Please contact me if you have any questions or require more information. Sincerely, Ezra W. Reese Counsel to States Newsroom Enclosure: Form 2848 ?erkms Cote LLP 1 Application for Recognition Of Exemption OMB No. 1545-0056 Fm? Under Section 501(c)(3) of the Internal Revenue Code Note statusis Do not enter social security numbers on this form as it may be made public. imam} be open intemai Revenue Service Go to for instructions and the latest information. for public inspection. Use the instructions to complete this application and for a de?nition of all bold items. For additions! help. call IRS Exempt Organizations Customer Account Services toll-free at 1-877-829-5500. Visit our website at for forms and publications. If the required information and documents are not submitted with payment of the appropriate user fee. the application may be returned to you. Attach additional sheets to this application if you need more space to answer fuily. Put your name and EN on each sheet and identify each answer by Part and line number. Complete Parts I XI of Form 1023 and submit only those Schedules (A through H) that apply to you. Identification of Applicant 1 Full name of organization (exactly as it appears in your organizing document) 2 0/0 Name (if applicable) States Newsroom 3 Mailing address (Number and street) (see instructions) Room/Suite 4 Employer Identification Number (EIN) rlva 1340 Environ Way 3rd Floor City or town. state or country. and ZIP 4 5 Montht . 12) Chapel Hill, NC 21511 December 6 Primary contact (officer. director. trustee, or authorized representative) 3 Name: Phone: (919) 986-1807 Chris Fitzsimon Fax: (opt'ona') 7 Are you represented by an authorized representative, such as an attorney or accountant? If ?Yes.? Yes No provide the authorized representative's name. and the name and address of the authorized representative?sfirm. Include a completed Form 2848. Power of Attorney and Declaration of Representative, with your application if you would like us to communicate with your representative. 8 Was a person who is not one of your officers, directors. trustees. employees. or an authorized Yes No representative listed in line 7. paid. or promised payment. to help plan. manage. or advise you about the structure or activities of your organization. or about your financial or tax matters? if "Yes," provide the person?s name. the name and address of the person?s firm. the amounts paid or promised to be paid. and describe that person's role. 9a Organization?s website: Organization's email: (optional) 10 Certain organizations are not required to file an information return (Form 990 or Form 990-EZ). It you Yes No are granted tax-exemption. are you claiming to be excused from filing Form 990 or Form 990-52? If ?Yes,? explain. See the instructions for a description of organizations not required to file Form 990 or Form SQU-EZ. 11 Date incorporated it a corporation. or formed. if other than a corporation. 05 17 2019 12 Were you formed under the laws of a foreign country? CI Yes No If "Yes." state the country. For Papemork Reduction Act Notice, see instructions. Cat. No. 17133K Form 1023 (Rev. 12-2017) Ire Form 1023 (Rev. 12-2017) Name? States Newsroom riva cv Re a Ct i 0 Part il Organizational Structure You must be a corporation (including a limited liability company}. an unincorporated association, or a trust to be tax exempt. See instructions. DO NOT file this form unless you can check "Yes" on lines corporation? If ?Yes,? attach a copy of your articles of incorporation showing certification of Yes No filing with the appropriate state agency. lnctude copies of any amendments to your articles and be sure they also show state filing certification. 2 Are you a limited liability company If "Yes," attach a copy of your articles of organization showing Yes No certification of filing with the appropriate state agency. Also, if you adopted an operating agreement, attach a copy. Include copies of any amendments to your articles and be sure they show state filing certification. Refer to the instructions for circumstances when an LLC should not file its own exemption application. 3 Are you an unincorporated association? If ?Yes,? attach a copy of your articles of association. DYes No constitution, or other similar organizing document that is dated and includes at least two signatures. include signed and dated copies of any amendments. 4a Are you a trust? it ?Yes,? attach a signed and dated copy of your trust agreement. Include signed and Yes No dated copies of any amendments. Have you been funded? If explain how you are formed without anything of value placed in trust. a Yes [3 No 5 Have you adopted bylaws? If "Yes." attach a current copy showing date of adoption. If explain Yes No how your officers, directors, or trustees are selected. Required Provisions in Your Organizing Document The fotlowing questions are designed to ensure that when you file this application, your organizing document contains the required provisions to meet the organizational test under section 501(c)(3). Unless you can check the boxes in both lines 1 and 2, your organizing document does not meet the organizational test. DO NOT file this application until you have amended your organizing document. Submit your original and amended organizing documents (showing state filing certification if you are a corporation or an LLC) with your application. 1 Section 501(c)(3) requires that your organizing document state your exempt purpose(s), such as charitable. reiigious, educational, and/or scientific purposes. Check the box to confirm that your organizing document meets this requirement. Describe specifically where your organizing document meets this requirement, such as a reference to a particular article or section in your organizing document. Refer to the instructions for exempt purpose language. Location of Purpose Clause (Page. Article, and Paragraph): P3991, AnicIe 5, Section (3) 2a Section 501(c)(3) requires that upon dissolution of your organization. your remaining assets must be used exclusively for exempt purposes, such as charitable, religious, educational, and/or scientific purposes. Check the box on line 2a to confirm that your organizing document meets this requirement by express provision for the distribution of assets upon dissolution. if you rely on state law for your dissolution provision, do not check the box on line 2a and go to line 20. if you checked the box on line 2a, specify the location of your dissoiution clause (Page, Article, and Paragraph). Do not complete line 2c if you checked box 2a. Page 2, Article 6 6 See the instructions for information about the operation of state iaw in your particular state. Check this box if you rely on operation of state law for your dissolution provision and indicate the state: Part lV Narrative Description of Your Activities Using an attachment, describe your past, present, and planned activities in a narrative. if you believe that you have already provided some of this information in response to other parts of this application, you may summarize that information here and refer to the speci?c parts of the application for supporting details. You may also attach representative copies of newsletters, brochures, or similar documents for supporting details to this narrative. Remember that if this application is approved, it will be open for public inspection. Therefore, your narrative description of activities should be thorough and accurate. Refer to the instructions for information that must be included in your description. Compensation and Other Financiat Arrangements With Your Officers, Directors, Trustees, Employees, and independent Contractors 1a List the names, titles, and mailing addresses of all of your officers. directors, and trustees. For each person listed, state their total" annual compensation, or proposed compensation, for all services to the organization, whether as an officer, employee, or other position. Use actual figures, if available. Enter ?none? if no compensation is or will be paid. If additional space is needed, attach a separate sheet. Refer to the instructions for information on what to include as compensation. Compensation amount Name Title Mailing address (annual actual or estimated) 33ft!) Environ Way, 3rd Floor . Chris itzsimon Director. President Publisher Chapel Hill, NC 27511 $180,000 191:5. man sees -. Courtney Cuff Director 8. Treasurer Boulder, CO 80302 St) 105 Mill Run Drive Adam Searing Director Chapel Hill, NC 27514-3135 $0 Form 1023 (Rev.12-2017) Form 1023 (Rev. 12-2017) Name: States Newsroom EIN: rlvacv Ke Page 3 Compensation and Other Financial Arrangements With Your Officers, Directors, Trustees, Employees, and Independent Contractors (Continued) List the names, titles, and mailing addresses of each of your five highest compensated employees who receive or will receive compensation of more than $50,000 per year. Use the actual figure, it available. Refer to the instructions for information on what to include as compensation. Do not include officers, directors, or trustees listed in line 1a. Compensation amount Name Title Mailing address (annual actual or estimated) 5330 Environ Way. 3rd Fioor Andrea Verykoukis Deputy Director Chapel Hill, NC 27511 $95,000 John Micek Editor in Chief Harrisburg, PA 17102 $100,000 1340 Environ-Way, 3rd Floor Robin Bravender Washington Bureau Chief Chapel Hill, NC 21517 $110,000 Julie Hauserman Florida Editor in Chief . Tallahassee. FL 32301 $87,500 .1. liter-blasted -5919. 3.3..2 Susan Demas Michigan Editor in Chief Lansing, MI 48933 $90,000 List the names, names of businesses, and mailing addresses of your five highest compensated independent contractors that receive or will receive compensation of more than $50,000 per year. Use the actual figure, if available. Refer to the instructions for information on what to include as compensation. Compensation amount Name Title address actuai or The following "Yes" or "No" questions relate to past, present, or planned relationships, transactions, or agreements with your officers. directors, trustees, highest compensated employees, and highest compensated independent contractors listed in lines 1ayour officers, directors, or trustees related to each other through family or business Yes No relationships? If "Yes," identify the individuals and explain the relationship. in Do you have a business relationship with any of your officers, directors, or trustees other than through Yes No their position as an officer, director, or trustee? If "Yes," identify the individuals and describe the business relationship with each of your officers, directors, or trustees. Are any of your officers, directors, or trustees related to your highest compensated employees or highest Cl Yes No compensated independent contractors listed on lines 1 or to through family or business relationships? lf "Yes," identify the individuals and explain the relationship. 3a For each of your officers, directors, trustees, highest compensated empioyees, and highest compensated independent contractors-listed on lines 1a, lb, or to, attach a list showing their name, qualifications, average hours worked, and duties. Do any of your of?cers. directors, trustees, highest compensated employees, and highest compensated Ci Yes . No independent contractors listed on lines la, to, or 10 receive compensation from any other organizations, whether tax exempt or taxable, that are related to you through common controi? If ?Yes,? identify the individuals, explain the relationship between you and the other organization, and describe the compensation arrangement. 4 ln establishing the compensation for your officers, directors, trustees, highest compensated employees, and highest compensated independent contractors listed on lines 1a, 1b, and 1c, the following practices are recommended, although they are not required to obtain exemption. Answer "Yes" to all the practices you use. a Do you or will the individuals that approve compensation arrangements follow a con?ict of interest policy? Yes No Do you or will you approve compensation arrangements in advance of paying compensation? Yes No Do you or will you document in writing the date and terms of approved compensation arrangements? Yes No Form 1023 (Rev.12-2017) Form 1023(Rev. 12-2017) Name: States Newsroom Eli Privacv Redactio lg? Compensation and Other Financial Arrangements With Your Officers, Directors, Trustees, Employees, and Independent Contractors (Continued) . Do you or will you record in writing the decision made by each individual who decided or voted on Yes No compensation arrangements? Do you or wilt you approve compensation arrangements based on information about compensation paid by Yes No similarly situated taxable or tax-exempt organizations for similar services, current compensation surveys compiled by independent firms, or actual written offers from similarly situated organizations? Refer to the instructions for Part V, lines 1a, 1b, and 1c, for information on what to include as compensation. Do you or will you record in writing both the information on which you relied to base your decision and its Yes No source? If you answered "No" to any item on lines 4a through 4f. describe how you set compensation that is reasonable for your officers, directors, trustees, highest compensated employees. and highest compensated independent contractors listed in Part V, lines 1a, 1b, and 1c. 5a Have you adopted a conflict of interest policy consistent with the sample conflict of interest policy in Yes E1 No Appendix A to the instructions? If ?Yes,? provide a copy of the policy and explain how the policy has been adopted, such as by resolution of?your governing board. it answer lines 5b and 5c. What procedures will you follow to assure that persons who have a conflict of interest will not have influence over you for setting their own compensation? What procedures will you follow to assure that persons who have a conflict of interest will not have influence over you regarding business deals with themselves? Note: A conflict of interest policy is recommended though it is not required to obtain exemption. Hospitals, see Schedule C, Section I, line 14. Ba 00 you or will you compensate any of your of?cers. directors, tmstees, highest compensated employees, and highest El Yes No compensated independent contractors listed in lines ta, lb. or to through non-fixed payments, such as discretionary bonuses or revenue-based payments? If "Yes," describe all non-fixed compensation arrangements, including how the - amounts are determined. who is eligible for such arrangements, whether you place a limitation on total compensation. and how you determine or will determine that you pay no more than reasonable compensation for services. Refer to the instructions for Part V, lines 1a, 1b, and 1c, for information on what to include as compensation. 00 you or will you compensate any of your employees. other than your officers, directors. trustees, or your Yes No ?ve highest compensated employees who receive or will receive compensation of more than $50,000 per year, through non?fixed payments, such as diScretionary bonuses or revenue?based payments? If ?Yes,? describe all non-fixed compensation arrangements, including how the amounts are or will be determined, who is or will be eligible for such arrangements, whether you place or will place a limitation on total compensation, and how you determine or will determine that you pay no more than reasonable compensation for services. Refer to the instructions for Part V, lines 1a, 1b, and 1c, for information on what to include as compensation. 7a 00 you or will you purchase any goods. services. or assets from any of your of?cers, directors, trustees, highest Yes No compensated employees, or highest compensated independent contractors listed in lines 1a, 1b, or to? If "Yes," describe any such purchase that you made or intend to make, from whom you make or will make such purchases, how the terms are or will be negotiated at arm's length, and explain how you determine or will determine that you pay no more than fair market value. Attach copies of any written contracts or other agreements relating to such purchases. I) Do you or will you seil any goods, services, or assets to any of your officers, directors, trustees, highest Yes No compensated employees, or highest compensated independent contractors listed in lines 1a, lb, or to? if "Yes," describe any such sales that you made or intend to make, to whom you make or will make such sales, how the terms are or will be negotiated at arm?s length, and explain how you determine or will determine you are or will be paid at least fair market vaiue. Attach copies of any written contracts or other agreements relating to such sales. 8a Do you or will you have any leases, contracts, loans, or other agreements with your officers, directors, Yes No - trustees, highest compensated employees, or highest compensated independent contractors listed in lines 1a, lb, or 1c? If "Yes," provide the information requested in lines 8b through at. Describe any written or oral arrangements that you made or intend to make. identify with whom you have or will have such arrangements. Explain how the terms are or will be 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. Attach copies of any signed leases, contracts, loans, or other agreements relating to such arrangements. 9a Do you or wiil you have any leases, contracts, loans, or other agreements with any organization in which Yes No any of your officers, directors, or trustees are also officers, directors, or trustees, or in which any individual officer, director, or trustee owns more than'a 35% interest? if ?Yes,? provide the information requested in lines 9b through St. Form 1023 (Rev. 12-2017) Form 1023 (Rev. 12-2017) Name: states Newsroom 5' rivacv Redactio 5 Compensation and Other Financial Arrangements With Your Officers, . Employees, and Independent Contractors (Continued) Describe any written or oral arrangements you made or intend to make. Identify with whom you have or will have such arrangements. Explain how the terms are or will be 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: Attach a copy of any signed leases. contracts. loans. or other agreements relating to such arrangements. 00.06 Part VI Your Members and Other Individuals and Organizations That Receive Benefits From You The following ?Yes? or ?No? questions relate to goods. services, and funds you provide to individuals and organizations as part of your activities. Your answers should pertain to past, present, and planned activities. See instructions. 1a In carrying out your exempt purposes, do you provide goods. services. or funds to individuals? If "Yes." Yes No describe each program that provides goods, services. or funds to individuals. In carrying out your exempt purposes, do you provide goods. services, or funds to organizations? if Yes [3 No ?Yes,? describe each program that provides goods. services, or funds to organizations. 2 Do any of your programs limit the provision of goods. services. or funds to a specific individual or group Yes No of specific individuals? For example, answer ?Yes.? if goods. services. or funds are provided only for a particular individual. your members. individuais who work for a particular employer. or graduates of a particular school. If ?Yes,? explain the limitation and how recipients are selected for each program. 3 Do any individuals who receive goods. services. or funds through your programs have a family or Yes No business relationship with any officer, director. trustee. or with any of your highest compensated employees or highest compensated independent contractors listed in Part V. lines 1a, 1b, and to? If "Yes." explain how these reiated individuals are eligible for goods. services, or funds. Your History The following ?Yes? or "No" questions relate to your history. See instructions. 1 Are you a successor to another organization? Answer ?Yes,? if you have taken or will take over the Yes No activities of another organization; you took over 25% or more of the fair market value of the net assets of another organization; or you were established upon the conversion of an organization from for-profit to nonprofit status. If ?Yes.? complete Schedule G. 2 Are you submitting this application more than 27 months after the end of the month in which you were Yes No legally formed? If ?Yes,? complete Schedule E. Part Your Specific Activities The following ?Yes? or "No" questions relate to specific activities that you may conduct. Check the appropriate box. Your answers should pertain to past. present, and planned activities. See instructions. 1 Do you support or oppose candidates in political campaigns in any way? If ?Yes.? explain. Yes No 2a Do you attempt to influence legislation? If "Yes," explain how you attempt to influence legislation and Yes No complete line 2b. If go to line 3a. Have you made or are you making an election to have your legislative activities measured by Yes No expenditures by filing Form 5768? If "Yes." attach a copy of the Form 5768 that was already filed or attach a completed Form 5768 that you are filing with this application. If describe whether your attempts to influence legislation are a substantial part of your activities. Include the time and money spent on your attempts to in?uence legislation as compared to your total activities. 3a Do you or will you operate bingo or gaming activities? If "Yes." describe who conducts them. and list ali Yes No revenue received or expected to be received and expenses paid or expected to be paid in operating these activities. Revenue and expenses should be provided for the time periods specified in Part IX. Financial Data. Do you or will you enter into contracts or other agreements with individuals or organizations to conduct Yes No bingo or gaming for you? If ?Yes.? describe any written or oral arrangements that you made or intend to make. identify with whom you have or will have such arrangements. expiain how the terms are or will be negotiated at arm?s length. and explain how you determine or will determine you pay no more than fair market value or you will be paid at least fair market value. Attach copies or any written contracts or other agreements relating to such arrangements. List the states and local jurisdictions. including Indian Reservations, in which you conduct or will conduct gaming or bingo. Form 1023 (Rev.12-2017) Form 1023 (Rev. 12-2017) Name: States Newsroom Page 6 Part Your Specific Activities (Continued) Rndantinn 4a Do you or will you undertake fundraising? it "Yes," check all the fundraising programs you do or will Yes No conduct. See instructions. mail solicitations phone solicitations email solicitations accept donations on your website personal solicitations receive donations from another organization's website vehicle, boat, plane, or similar donations government grant solicitations foundation grant solicitations Other Attach a description of each fundraising program. Do you or will you have written or oral contracts with any individuals or organizations to raise funds for Yes No you? if ?Yes,? describe these activities. include all revenue and expenses from these activities and state who conducts them. Revenue and expenses should be provided for the time periods specified in Part IX. Financial Data. Also, attach a copy of any contracts or agreements. Do you or will you engage in fundraising activities for other organizations? If "Yes," describe these [1 Yes No arrangements. Include a description of the organizations for which you raise funds and attach copies of all contracts or agreements. List all states and local jurisdictions in which you conduct fundraising. For each state or local jurisdiction listed, specify whether you fundraise for your own organization, you fundraise for another organization, or another organization fundraises for you. 9 Do you or will you maintain separate accounts for any contributor under which the contributor has the [Wes No right to advise on the use or distribution of funds? Answer "Yes" if the donor may provide advice on the types of investments, distributions from the types of investments, or the distribution from the donor?s contribution account. if "Yes," describe this program, including the type of advice that may be provided and submit copies of any written materials provided to donors. No No 5 Are you affiliated with a governmental unit? If ?Yes,? explain. Yes 6a Do you or will you engage in economic development? if ?Yes,? describe your program. Cl Yes Describe in full who benefits from your economic development activities and how the activities promote exempt purposes. 7a Do or will persons other than your employees or volunteers develop your facilities? If "Yes," describe Yes No each facility, the role of the developer, and any business or family between the developer and your officers. directors, or trustees. Do or will persons other than your employees or volunteers manage your activities or facilities? lf "Yes," Yes No describe each activity and facility, the role of the manager, and any business or family reiationship(s) between the manager and your officers, directors. or trustees. HE If there is a business or family relationship between any manager or developer and your officers, directors, or trustees, identify the individuals, explain the relationship, describe how contracts are negotiated at arm?s length so that you pay no more than fair market value, and submit a copy of any contracts or other agreements. 8 Do you or wiil you enter into joint ventures, including partnerships or limited liability companies Yes No treated as partnerships, in which you share profits and losses with partners other than section 501(c)(3) organizations? If ?Yes,? 'describe the activities of these joint ventures in which you participate. 93 Are you applying for exemption as a childcare organization under section 501(k)? If "Yes," answer lines Yes No 9b through 9d. If go to line 10. Do you provide childcare so that parents or caretakers of children you care for can be gainfully [1 Yes No employed (see instructions)? If explain how you qualify as a childcare organization described in section 501(k). 6 Of the children for whom you provide childcare, are 85% or more of them cared for by you to enable their [3 Yes No parents or caretakers to be gainfully employed (see instructions)? If explain how you qualify as a chiidcare organization described in section 501(k). Are your services available to the general public? If describe the specific group of people for whom Yes [3 No your activities are available. Also, see the instructions and explain how you qualify as a childcare organization described in section 501(k). 10 Do you or will you publish, own, or have rights in music, literature, tapes, artworks, choreography, Yes No scientific discoveries, or other intellectual property? If "Yes," explain. Describe who owns or will own any copyrights, patents, or trademarks, whether fees are or will be charged. how the fees are determined, and how any items are or will be produced, distributed, and marketed. Form 1023 (sewn-2017) Form 1023 (REV. 12-2017) Name: States Newsroom Page 7 Part Your Specific Activities (Continuedwill you accept contributions of: real property; conservation easements: closely held DYes No securities; intellectual property such as patents. trademarks. and copyrights; works of music or art; - licenses; royalties; automobiles, boats, planes, or other vehicles; or collectibles of any type? if "Yes," describe each type of contribution, any conditions imposed by the donor on the contribution, and any agreements with the donor regarding the contribution. 128 Do you or will you operate in a foreign country or countries? If ?Yes,? answer lines 12b through 12d. If Yes No go to line 133. Name the foreign countries and regions within the countries in which you operate. Describe your operations in each country and region in which you operate. Describe how your operations in each country and region further your exempt purposes. 13a Do you or will you make grants, loans, or other distributions to organization(s)? If "Yes," answer lines 13b Yes No through 139. If go to line 14a. Describe how your grants, loans, or other distributions to organizations further your exempt purposes. Do you have written contracts with each of these organizations? If "Yes," attach a copy of each contract. Yes Ci No identify each recipient organization and any relationship between you and the recipient organization. Describe the records you keep with respect to the grants, loans, or other distributions you make. Describe your selection process, including whether you do any of the following. Do you require an application form? If "Yes," attach a copy of the form. Yes No (ii) Do you require a grant proposal? if ?Yes,? describe whether the grant proposal specifies your Yes No responsibilities and those of the grantee. obligates the grantee to use the grant funds only for the purposes for which the grant was made, provides for periodic written reports concerning the use of grant funds, requires a final written report and an accounting of how grant funds were used, and? acknowledges your authority to withhold and/or recover grant funds in case such funds are. or appear to be, misused. 0.0 ?0.00.09 9 Describe your procedures for oversight of distributions that assure you the resources are used to further your exempt purposes, including whether you require periodic and final reports on the use of resources. 14a Do you or will you make grants, loans, or other distributions to foreign organizations? If ?Yes,? answer El Yes No lines 14b through 14f. it go to line 15. Provide the name of each foreign organization. the country and regions within a country in which each foreign organization operates, and describe any relationship you have with each foreign organization. Does any foreign organization listed in line 14b accept contributions earmarked for a specific country or Yes No specific organization? If "Yes," list all earmarked organizations or countries. Do your contributors know that you have uitimate authority to use contributions made to you at your Ci Yes No discretion for purposes consistent with your exempt purposes? if ?Yes.? describe how you relay this information to contributors. . Do you or wilt you make pre-grant inquiries about the recipient organization? If ?Yes,? describe these Yes No inquiries, including whether you inquire about the recipient's financial status, its tax-exempt status under the lntemal Revenue Code, its ability to accomplish the purpose for which the resources are provided, and other relevant information. Do you or will you use any additional procedures to ensure that your distributions to foreign l] Yes No organizations are used in furtherance of your exempt purposes? If "Yes," describe these procedures, including site visits by your employees or compliance checks by impartial experts, to verify that grant funds are being used appropriately. Form 1023 (Rev. 12-2017) 'i Form 1023 (Rev. 12-201 7) Name: States Newsroom A i a a Page 8 Your Specific Activities (Continued) 15 Do you have a close connection with any organizations? If ?Yes,? explain. Yes No 16 Are you applying for exemption as a cooperative hospital service organization under section 501(e)? If Yes No "Yes," explain. 17 Are you applying for exemption as a cooperative service organization of operating educational Yes No organizations under section 501(0? If "Yes," explain. 18 Are you applying for exemption as a charitable risk pool under section 501(n)? it ?Yes,? explain. El Yes No 19 Do'you or will you operate a school? if "Yes," complete Schedule B. Answer "Yes," whether you operate Yes No a school as your main function or as a secondary activity. 20 is your main function to provide hospital or medical care? If "Yes," complete Schedule will you provide low-income housing 0r housing for the elderly or handicapped? it "Yes." Yes No complete Schedule F. . 22 Do you or will you provide scholarships. fellowships, educational loans, or other educational grants to Yes No individuals, including grants for travel, study, or other similar purposes? If ?Yes.? complete Schedule H. Note: Private foundations may use Schedule to request advance approval of individual grant procedures. Form 1023 (Rev. 12-2017) Form 1023 (Rev. 12-2017) Name: States ?aws,er Financial Data For purposes of this schedule, years in existence refer to completed tax years. 1. If in existence less than 5 years, complete the statement for each year in existence and provide projections of your likely revenues and expenses based on a reasonable and good faith estimate of your future finances for a total of: a. Three years of financial information if you have not completed one tax year, or b. Four years of financial information if you have completed one tax year. See instructions. If in existence 5 or more years. complete the schedule for the most recent 5 tax years. You will need to provide a separate statement that includes information about the most recent 5 tax years because the data table in Part IX hasnot been updated to provide for a 5th year. See instructions. A. Statement of Revenues and Expenses Current tax year Privacv Redactio face 9 5" Type of revenue or expense 3 prior tax years or 2 succeeding tax years From 612019 From 112020 From ?2021 From To 1212019 To 1 212020 To Provide Total for through 1212021 To 1 Gifts, grants. and contributions received (do not include unusual grants) 2 Membership fees received 3 Gross investment income 4 Net unrelated business income 5 Taxes levied for your benefit 6 Value of services or facilities furnished by a governmental unit without charge (not including the value of services generally furnished to the public without charge) $5,112,000 $9,211,000 $27,438,000 $1 2,115,000 7 Any revenue not othenrvise listed above or in lines 9-12 below (attach an itemized list) 8 Total of lines1 through 7 9 Gross receipts from admissions, merchandise sold or services performed, or furnishing of facilities in any activity that is related to your exempt purposes (attach itemized list) 10 Total of lines 8 and 9 11 Net gain or loss on sale of capital assets (attach schedule and see instructions) 12 Unusual grants 13 Total Revenue Add llnes 10 through 12 14 Fundraising expenses Revenues $6,112,000 $9,211,000 $12.1 15,000 $27,438,000 $6,112,000 $9,211,000 512,1 15,000 $27,438,000 $6,112,000 $9,211,000 $12,115,000 $27,438,000 15 Contributions, gifts, grants, and similar amounts paid out (attach an itemized list) $1,165,000 $1,165,000 $1,165,000 16 Disbursements to or for the benefit of members (attach an itemized list) directors, and trustees $160,000 $160,000 $160,000 18 Other salaries and wages $2,412,000 $4,535,000 $5,772,000 Expenses 19 interest expense 2O Occupancy (rent, utilities, etc.) $265,000 $386,000 $512,000 21 Depreciation and depletion 22 Professional fees $150,000 $300,000 $300,000 23 Any expense not othemrise . classified, such as program services (attach itemized list) $1,010,000 $1,975,000 1, 17 Compensation of officers, I $2,125,000 24 Total Expenses Add lines 14 through 23 $5,162,000 $8,521,000 $1 0,094,000 Form 1023 (99012-2017) Form 1023 (Rev. 12-2017) Name: States Newsroom Financial Data (Continued) 3 Privacy Redac _Pa991? B. Balance Sheet (for your most recently completed tax year) Year and; snow Assets (Whole dollars) 1 Cash . . . 1 $3,224,628 2 Accounts receivable, net . 2 $75,000 3 Inventories . . . . . . . . . . . 3 4 Bonds and notes reCeivable (attach an itemized list) . 4 5 Corporate stocks (attach an itemized list) 5 6 Loans receivable (attach an itemized list) 6 7 Other investments (attach an itemized listDepreciable and depletable assets (attach an itemized list) 8 9 Land . . . . . . . . 9 10 Other assets (attach an itemized list) . 10 $45,610 11 Total Assets (add lines1 through 10) . . . 11 $3,345,233 Liabilities 12 Accounts payable . . . . . . . . . 12 13 Contributions, gifts, grants, etc. payable . . . . 13 14 Mortgages and notes payable (attach an itemized list 14 15 Other liabilities (attach an itemized list) . . . 15 16 Total Liabilities (add lines 12 through 15Fund Balances or Net Assets 17 Total fund balances or net assets . . .. . . . . . . . . . . . . 17 $3,345,238 18 Total Liabilities and Fund Balances or Net Assets (add lines $3,345,238 19 Have there been any substantial changes in your assets or liabilities since the end of the period - Yes No Part is designed to classify you as an organization that is either a private foundation or a pubiic shown above? if ?Yes,? explain. Public Charity Status charity. Public charity status is a more favorable tax status than private foundation status. If you are a private foundation, Part is designed to further determine whether you are a private operating foundation. See instructions. 1 a Are you a private foundation? If "Yes," go to line 1b. if go to line 5 and proceed as instructed. If you Yes are unsure, see the instructions. As a private foundation, section 508(9) requires special provisions in your organizing document in addition to those that apply to ail organizations described in section 501(c)(3). Check the box to confirm that your organizing document meets this requirement, whether by express provision or by reliance on operation of state law. Attach a statement that describes specifically where your organizing document meets this requirement, such as a reference to a particular article or section in your organizing document or by operation of state law. See the instructions, including Appendix B. for information about the special provisions that need to be contained in your organizing document. Go to line 2. No Are you a private operating foundation? To be a private operating foundation you must engage directly in the active conduct of charitable, religious, educational, and similar activities, as opposed to indirectly carrying out these activities by providing grants to individuals or other organizations. If "Yes," go to line 3. it go to the signature section of Part XI. Yes No Have you existed for one or more years? if ?Yes,? attach financial information showing that you are a private operating foundation; go to the signature section of Part Xi. If continue to line 4. Cl Yes No Have you attached either (1) an affidavit or opinion of counsel, (including a written affidavit or opinion from a certified public accountant or accounting firm with expertise regarding this tax law matter), that sets forth facts concerning your operations and support to demonstrate that you are likely to satisfy the requirements to be classified as a private operating foundation: or (2) a statement describing your proposed operations as a private operating foundation? Yes No CT If you answered ?No? to line 1a, indicate the type of public charity status you are requesting by checking one of the choices below. You may check only one box. The organization is not a private foundation because it is: 509(a)(1) and church or a convention or association of churches. Complete and attach Schedule A. 509(a)(1) and school. Complete and attach Schedule B. El 509(a)(1) and hospitai, a cooperative hospital service organization, or a medical research organization operated in conjunction with a hospital. Complete and attach Schedule C. organization supporting either one or more organizations described in line 5a through publicly supported section 501(c)(4). (5), or (6) organization. Complete and attach Schedule D. Form 1023 (Flev.12-2017) Form 1023(Rev. 12-2017) Name: States Newsroom EIN Privac Red a Page 11 Public Charity Status (Continued) 509(a)(4) an organization organized and operated exclusively for testing for public safety. 509(a)(1) and 170(b)(1)(A)(iv) an organization operated for the benefit of a college or university that is owned or operated by a governmental unit. 9 509(a)(1) and 170(b)(1)(A)(ix) - an agricultural research organization directly engaged in the continuous active conduct of agricultural research in conjunction with a college or university. 509(a)(1) and 170(b)(1)(A)(vi) - an organization that receives a substantial part of its financial support in the form Cl of contributions from pubiicly supported organizations. from a governmental unit, or from the general public. i 509(a)(2) an organization that normally receives not more than one-third of its financial support from gross investment income and receives more than one-third of its financial support from contributions, membership fees. and gross receipts from activities related to its exempt functions (subject to certain exceptions). A publicly supported organization, but unsure if it is described in 5h or 5i. You would like the ERS to decide the correct status. 6 if you checked box h, i, or in question 5 above, and you have been in existence more than 5 years, you must confirm your public support status. Answer line 6a if you checked box in tine 5 above. Answer line 6b if you checked box i in tine 5 above. If you checked box] in line 5 above, answer both lines 6a and 6b. a Enter 2% of line 8. column on Part Statement of Revenues and Expenses (ii) Attach a list showing the name and amount contributed by each person, company, or organization whose gifts totaled more than the 2% amount. If the answer is "None," state this. For each year amounts are included on lines 1. 2, and 9 of Part Statement of Revenues and Expenses. attach a list showing the name and amount received from each disquali?ed person. If the answer is "None," state this, (ii) For each year amounts were included on line 9 of Part Statement of Revenues and Expenses. attach a list showing the name of and amount received from each payer. other than a disqualified person, whose payments were more than the larger of (1) 1% of Line 10, Part Statement of Revenues and Expenses. or (2) $5.000. if the answer is "None," state this. 7 Did you receive any unusual grants during any of the years shown on Part IX-A Statement of Cities No Revenues and Expenses? It ?Yes,? attach a list including the name of the contributor, the date and amount of the grant, a brief description of the grant, and explain why it is unusual. Part Xi User Fee Information and Signature You must include the correct user fee payment with this application. if you do not submit the correct user fee, we will not process the application and we will return it to you. Your check or money order must be made payable to the United States Treasury. User fees are subject to change. Check our website at and type "Exempt Organizations User Fee" in the search box, or call Customer Account Services at 1-877-829-5500 for current information. Enter the amount of the user fee paid: $600 I declare under the penalties of perjury that I am authorized to sign this on behalf oi the above organization and that I have examined this application, Including the accompanying schedules and attachments. and to the best of my knewledge It Is true, correct. and complete. A a Please President, Director a. Publisher old I 6] Sig (Signature of Of?cerfoirector, Trustee. or other (T ype or print name of signer) (0515) authorized of?cial) Chris Fitzsimon Hype or print title or authority of signer) Here Form 1023? (Rev. 12-2017)