1023

This page is intended to answer all non confidential information for IRS form 1023 Application for Recognition of Exemption

PDF Form and Instructions

A to do list for this form can be found here

Most of the information on this page came from HacDC and Hive13 wiki

Part I - Identification of Applicant

1. Full name - LVL1 Inc.
2. c/o name (if applicable) - no
3. Mailing Address
   1. number and street - (To be filled in later)
   2. City, town, state, or country and ZIP+4 - (To be filled in later)
4. EIN - (Don't post the EIN here!)
5. Month the annual accounting period ends - (To be filled in later)
6. Primary contact
   1. name - (To be filled in later)
   2. phone - (To be filled in later)
   3. fax (optional) - (none)
7. represented by an attorney or accountant? - no
8. was (person from question 7) paid? - no
9. 1. website: www.lvl1.org/
   2. email (optional): - (do we want to give them an address?)
10. claiming exemption from 990? - no, we are not claiming exemption
11. date incorporated - 12/07/2009
12. were you under the laws of a foreign country? - no

Part II - Organizational Structure

1. are you a corporation? - yes
   1. if yes, attach articles of incorporation - Articles of Incorporation
2. are you an LLC? - no
3. are you an unincorporated association? - no
4. 1. are you a trust? - no
   2. have you been funded? - no
5. have you adopted bylaws? - yes.
   1. if yes, attach a copy showing date of adoption - Bylaws

Part III - Required Provisions in Your Organizing Document

1. organizing document must state tax exempt purpose: - educational and scientific Article 2
2. 1. upon dissolution, assets must be used for exempt purposes. is it in the organizing document - Yes
   2. which section? - Article 6
   3. does state law provide for the distribution of assets? -

Part IV - 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 specific 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.

link

Part V - Compensation and Other Financial Arrangements With Your Officers, Directors, Trustees, Employees, and Independent Contractors

V.1

• (1a) "List the names, titles, and mailing addresses of all your officers, directors, and trustees. For each person listed, state their total annual compensation, or proposed compensation, for all services to the organization, whther as an officer, employee, or other position. Use actual figures if available. Enter "none" if no compensation is or will be paid."

Name	Title	Mailing Address	Compensation amount (annual actual or estimated)
Christopher Cprek	President	(Do not put in wiki)	None
Brian Wagner	Vice President	(Do not put in wiki)	None
Mark Endicott	Treasurer	(Do not put in wiki)	None
Tim Hardin	Secretary	(Do not put in wiki)	None
Cindy Harnett	Director	(Do not put in wiki)	None
Joseph Pugh	Director	(Do not put in wiki)	None
Todd Chandler	Director	(Do not put in wiki)	None

• (1b) "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, if available. Refer to the instructions for information on what to include as compensation. Do not include officers, directors, or trustees listed in line 1a." none

• (1c) "List the names, titles 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." none

V.2

• (2a) "Are any of your officers, directors, or trustees related to each other through family or business relationships? If yes identify the individuals and explain the relationship." Yes?(Brian & Mark co workers?) attachment
• (2b) "Do you have a business relationship with any of your officers, directors, or trustees other than through 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." No
• (2c) "Are any of your officers, directors, or trustees related to your highest compensated employees or highest compensated independent contractors listed on lines 1b or 1c through family or business relationships? If yes, identify the individuals and explain the relationship." No

V.3

• (3a) "For each of your officers, directors, trustees, highest compensated employees, and highest compensated independent contractors listed on line 1a, 1b, or 1c, attach a list showing their name, qualifications, average hours worked, and duties."

• (3b) "Do any of your ... receive compensation from any other organizations ... that are related to you through commons control. If yes explain ..." (yes/no) No

V.4

The following are recommended, but not required. All are yes/no.

• (4a) have a conflict of interest policy? Yes
• (4b) approve compensation agreements in advance of paying compensation? No
• (4c) document in writing date and terms of compensation arrangements? No
• (4d) record in writing decision made by each individual who decided or voted on compensation arrangements? No
• (4e) approve compensation arrangements based on similar organizations for similar services? No
• (4f) record in writing information on which you relied to make decisions and its source? No
• (4g) if you answered "no" to any of (a) through (f), explain how you set compensation that is reasonable. Bylaws#Officers attachment

V.5

• (5a) Have you adopted a conflict of interest policy consistent with the sample conflict of interest policy in 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. If “No,” answer lines 5b and 5c. Yes Conflict of interest attachment
• (5b) 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?
• (5c) 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?
• (5-Note) Note: A conflict of interest policy is recommended though it is not required to obtain exemption. Hospitals, see Schedule C, Section I, line 14

V.6

• (6a) Do you or will you compensate any of your officers, directors, trustees, highest compensated employees, and highest compensated independent contractors listed in lines 1a, 1b, or 1c 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. No
• (6b) Do you or will you compensate any of your employees, other than your officers, directors, trustees, or your five 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. No

V.7

• (7a) Do you or will you purchase any goods, services, or assets from any of your officers, directors, trustees, highest compensated employees, or highest compensated independent contractors listed in lines 1a, 1b, or 1c? 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. No
• (7b) Do you or will you sell any goods, services, or assets to any of your officers, directors, trustees, highest compensated employees, or highest compensated independent contractors listed in lines 1a, 1b, or 1c? 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 value. Attach copies of any written contracts or other agreements relating to such sales. No

V.8

• (8a) "Do you or will you have any leases, contracts, loans, or other agreements with your officers, directors, trustees, highest compensated employees, or highest compensated independent contractors listed in lines 1a, 1b, or 1c? If “Yes,” provide the information requested in lines 8b through 8f. No

• (8b) Describe any written or oral arrangements that you made or intend to make. N/A

• (8c) Identify with whom you have or will have such arrangements. N/A

• (8d) Explain how the terms are or will be negotiated at arm’s length. N/A

• (8e) Explain how you determine you pay no more than fair market value or you are paid at least fair market value. N/A

• (8f) Attach copies of any signed leases, contracts, loans, or other agreements relating to such arrangements. N/A

V.9

• (9a) Do you or will you have any leases, contracts, loans, or other agreements with any organization in which any of your officers,... are also officers,... more then a 35% interest? No
• (9b) Describe any written or oral arrangements you made or intend to make. NA
• (9c) Identify with whom you have or will have such arrangements. NA
• (9d)Explain how the terms are or will be negotiated at arm’s length. NA
• (9e)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. NA
• (9f) Attach a copy of any signed leases, contracts, loans, or other agreements relating to such arrangements. NA

Part VI - Your Members and Other Individuals and Organizations That Receive Benefits From You

1a. In carrying out your exempt purposes, do you provide goods, services, or funds to individuals? (We need to edit this to be customized to what we actually do:) - Yes. Our core program is providing a space for the creative exploration of technology. Members and other individuals use the space and incidental services provided. Our educational program, through more formalized classes, provide individuals with introductory knowledge in electronics, open source software and other technical pursuits Informally, we serve as a hub for donated equipment which individuals may avail themselves of for their own benefit. However, we do not as a rule provide individualized goods or services to individuals. While we anticipate funding specific projects or pursuits, we do not provide funds to individuals.

1b. In carrying out your exempt purposes, do you provide goods, services, or funds to organizations? No

2. Do any of your programs limit the provision of goods, services, or funds to a specific individual or group of specific individuals? No

3. Do any individuals who receive goods, services, or funds through your programs have a family or 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 1c?

Part VII - Your History

1. Are you a successor to another organization? No

2. Are you submitting this application more than 27 months after the end of the month in which you were legally formed? No

Part VIII - Your Specific Activites

1. Do you support or oppose candidates in political campaigns in any way? No

2a. Do you attempt to influence legislation? No

2b. (N/A)

3a. Do you or will you operate bingo or gaming activities? No

4a. Do you or will you undertake fundraising? Yes. Email solicitations, Personal Solicitations, Foundation Grant Solicitations, Accept Donations on Your Website, Receive Donations from Another Organization’s Website, Government Grant Solicitations attachment

Attach a description of each fundraising program:

• General Fundraising: We have pursued general fundraising to support the efforts of LvL1. Such fundraising has taken place through our website, at events in our space, external events we participate in and through various channels by our members' individual initiative.
• Equipment Donations: Most of LvL1's equipment is donated and we plan on pursuing other equipment donations
• Specific Fundraising: Members have expressed interested and plan on targeting fundraising efforts towards the acquisition of larger pieces of equipment or capital intensive projects.

4b. Do you or will you have written or oral contracts with any individuals or organizations to raise funds for you? No

4c. Do you or will you engage in fundraising activities for other organizations? No

4d. List all states and local jurisdictions in which you conduct fundraising.

4e. Do you or will you maintain separate accounts for any contributor under which the contributor has the right to advise on the use or distribution of funds? No

5. Are you affiliated with a governmental unit? No

6. Do you or will you engage in economic development? No

7a. Do or will persons other than your employees or volunteers develop your facilities? No

7b. Do or will persons other than your employees or volunteers manage your activities or facilities? No

7c. We should not have any relationships which need to be documented in this section

8. Do you or will you enter into joint ventures, including partnerships or limited liability companies treated as partnerships, in which you share profits and losses with partners other than section 501(c)(3) organizations? No

9a. Are you applying for exemption as a childcare organization under section 501(k)? No

10. Do you or will you publish, own, or have rights in music, literature, tapes, artworks, choreography, scientific discoveries, or other intellectual property? No attachment

11. Do you or will you accept contributions of: real property; conservation easements; closely held 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? Yes, We accept contribution that assist in our exempt purposes such as tools and equipment.

12. Do you or will you operate in a foreign country or countries? No

13a. Do you or will you make grants, loans, or other distributions to organization(s)? No

14a. Do you or will you make grants, loans, or other distributions to foreign organizations? No

15. Do you have a close connection with any organizations? No

16. Are you applying for exemption as a cooperative hospital service organization under section? No

17. Are you applying for exemption as a cooperative service organization of operating educational organizations under section 501(f)? No

18. Are you applying for exemption as a charitable risk pool under section 501(n)? No

19. Do you or will you operate a school? No

20. Is your main function to provide hospital or medical care? If “Yes,” complete Schedule C. No

21. Do you or will you provide low-income housing or housing for the elderly or handicapped? No

22. Do you or will you provide scholarships, fellowships, educational loans, or other educational grants to individuals, including grants for travel, study, or other similar purposes? No

Part IX - Financial Data

"If in existence less than 1 year, provide projections of your likely revenues and expenses for the current year and the 2 following years, based on a reasonable and good faith estimate of your future finances for a total of 3 years of financial information. (See instructions.)"

Part X - Public Charity Status

1. Are you a private foundation?

2 - 4: all No.???????????? need to look up

5. 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.

5h. 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).

6. If you checked box g, h, or i in question 5 above, you must request either an advance or a definitive ruling by selecting one of the boxes below. Refer to the instructions to determine which type of ruling you are eligible to receive.

7. Did you receive any unusual grants during any of the years shown on Part IX-A. Statement of Revenues and Expenses? If “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. No

Part XI - User Fee Information

You must include a user fee payment with this application. It will not be processed without your paid user fee. If your average annual gross receipts have exceeded or will exceed $10,000 annually over a 4-year period, you must submit payment of $750. If your gross receipts have not exceeded or will not exceed $10,000 annually over a 4-year period, the required user fee payment is $300. See instructions for Part XI, for a definition of gross receipts over a 4-year period. Your check or money order must be made payable to the United States Treasury. User fees are subject to change. Check our website at www.irs.gov and type “User Fee” in the keyword box, or call Customer Account Services at 1-877-829-5500 for current information.

1. Have your annual gross receipts averaged or are they expected to average not more than $10,000?
   • If “Yes,” check the box on line 2 and enclose a user fee payment of $300 (Subject to change—see above).
   • If “No,” check the box on line 3 and enclose a user fee payment of $750 (Subject to change—see above).
2. Check the box if you have enclosed the reduced user fee payment of $300 (Subject to change).
3. Check the box if you have enclosed the user fee payment of $750 (Subject to change).