Non-Profit Startup: Intake Form Please submit the following information via this online form, which is encrypted with SSL to help ensure the data you enter is secure. Name* Prefix Mr.Ms.Other First Middle Last Suffix Email* Enter Email Confirm Email Phone*Address* Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country AfghanistanAlbaniaAlgeriaAmerican SamoaAndorraAngolaAnguillaAntarcticaAntigua and BarbudaArgentinaArmeniaArubaAustraliaAustriaAzerbaijanBahamasBahrainBangladeshBarbadosBelarusBelgiumBelizeBeninBermudaBhutanBoliviaBonaire, Sint Eustatius and SabaBosnia and HerzegovinaBotswanaBouvet IslandBrazilBritish Indian Ocean TerritoryBrunei DarussalamBulgariaBurkina FasoBurundiCambodiaCameroonCanadaCape VerdeCayman IslandsCentral African RepublicChadChileChinaChristmas IslandCocos IslandsColombiaComorosCongo, Democratic Republic of theCongo, Republic of theCook IslandsCosta RicaCroatiaCubaCuraçaoCyprusCzech RepublicCôte d'IvoireDenmarkDjiboutiDominicaDominican RepublicEcuadorEgyptEl SalvadorEquatorial GuineaEritreaEstoniaEswatini (Swaziland)EthiopiaFalkland IslandsFaroe IslandsFijiFinlandFranceFrench GuianaFrench PolynesiaFrench Southern TerritoriesGabonGambiaGeorgiaGermanyGhanaGibraltarGreeceGreenlandGrenadaGuadeloupeGuamGuatemalaGuernseyGuineaGuinea-BissauGuyanaHaitiHeard and McDonald IslandsHoly SeeHondurasHong KongHungaryIcelandIndiaIndonesiaIranIraqIrelandIsle of ManIsraelItalyJamaicaJapanJerseyJordanKazakhstanKenyaKiribatiKuwaitKyrgyzstanLao People's Democratic RepublicLatviaLebanonLesothoLiberiaLibyaLiechtensteinLithuaniaLuxembourgMacauMacedoniaMadagascarMalawiMalaysiaMaldivesMaliMaltaMarshall IslandsMartiniqueMauritaniaMauritiusMayotteMexicoMicronesiaMoldovaMonacoMongoliaMontenegroMontserratMoroccoMozambiqueMyanmarNamibiaNauruNepalNetherlandsNew CaledoniaNew ZealandNicaraguaNigerNigeriaNiueNorfolk IslandNorth KoreaNorthern Mariana IslandsNorwayOmanPakistanPalauPalestine, State ofPanamaPapua New GuineaParaguayPeruPhilippinesPitcairnPolandPortugalPuerto RicoQatarRomaniaRussiaRwandaRéunionSaint BarthélemySaint HelenaSaint Kitts and NevisSaint LuciaSaint MartinSaint Pierre and MiquelonSaint Vincent and the GrenadinesSamoaSan MarinoSao Tome and PrincipeSaudi ArabiaSenegalSerbiaSeychellesSierra LeoneSingaporeSint MaartenSlovakiaSloveniaSolomon IslandsSomaliaSouth AfricaSouth GeorgiaSouth KoreaSouth SudanSpainSri LankaSudanSurinameSvalbard and Jan Mayen IslandsSwedenSwitzerlandSyriaTaiwanTajikistanTanzaniaThailandTimor-LesteTogoTokelauTongaTrinidad and TobagoTunisiaTurkeyTurkmenistanTurks and Caicos IslandsTuvaluUS Minor Outlying IslandsUgandaUkraineUnited Arab EmiratesUnited KingdomUnited StatesUruguayUzbekistanVanuatuVenezuelaVietnamVirgin Islands, BritishVirgin Islands, U.S.Wallis and FutunaWestern SaharaYemenZambiaZimbabweÅland Islands Organization InformationOrganization Name*Please enter the desired full legal organization name including punctuation and the entity suffix (LLC, Inc., etc.)Organization Entity Type*CorporationLimited Liability Company (LLC)Organization DBA ("Assumed Name")The name the business goes by other than its legal name, if applicable.Organization Address* Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country AfghanistanAlbaniaAlgeriaAmerican SamoaAndorraAngolaAnguillaAntarcticaAntigua and BarbudaArgentinaArmeniaArubaAustraliaAustriaAzerbaijanBahamasBahrainBangladeshBarbadosBelarusBelgiumBelizeBeninBermudaBhutanBoliviaBonaire, Sint Eustatius and SabaBosnia and HerzegovinaBotswanaBouvet IslandBrazilBritish Indian Ocean TerritoryBrunei DarussalamBulgariaBurkina FasoBurundiCambodiaCameroonCanadaCape VerdeCayman IslandsCentral African RepublicChadChileChinaChristmas IslandCocos IslandsColombiaComorosCongo, Democratic Republic of theCongo, Republic of theCook IslandsCosta RicaCroatiaCubaCuraçaoCyprusCzech RepublicCôte d'IvoireDenmarkDjiboutiDominicaDominican RepublicEcuadorEgyptEl SalvadorEquatorial GuineaEritreaEstoniaEswatini (Swaziland)EthiopiaFalkland IslandsFaroe IslandsFijiFinlandFranceFrench GuianaFrench PolynesiaFrench Southern TerritoriesGabonGambiaGeorgiaGermanyGhanaGibraltarGreeceGreenlandGrenadaGuadeloupeGuamGuatemalaGuernseyGuineaGuinea-BissauGuyanaHaitiHeard and McDonald IslandsHoly SeeHondurasHong KongHungaryIcelandIndiaIndonesiaIranIraqIrelandIsle of ManIsraelItalyJamaicaJapanJerseyJordanKazakhstanKenyaKiribatiKuwaitKyrgyzstanLao People's Democratic RepublicLatviaLebanonLesothoLiberiaLibyaLiechtensteinLithuaniaLuxembourgMacauMacedoniaMadagascarMalawiMalaysiaMaldivesMaliMaltaMarshall IslandsMartiniqueMauritaniaMauritiusMayotteMexicoMicronesiaMoldovaMonacoMongoliaMontenegroMontserratMoroccoMozambiqueMyanmarNamibiaNauruNepalNetherlandsNew CaledoniaNew ZealandNicaraguaNigerNigeriaNiueNorfolk IslandNorth KoreaNorthern Mariana IslandsNorwayOmanPakistanPalauPalestine, State ofPanamaPapua New GuineaParaguayPeruPhilippinesPitcairnPolandPortugalPuerto RicoQatarRomaniaRussiaRwandaRéunionSaint BarthélemySaint HelenaSaint Kitts and NevisSaint LuciaSaint MartinSaint Pierre and MiquelonSaint Vincent and the GrenadinesSamoaSan MarinoSao Tome and PrincipeSaudi ArabiaSenegalSerbiaSeychellesSierra LeoneSingaporeSint MaartenSlovakiaSloveniaSolomon IslandsSomaliaSouth AfricaSouth GeorgiaSouth KoreaSouth SudanSpainSri LankaSudanSurinameSvalbard and Jan Mayen IslandsSwedenSwitzerlandSyriaTaiwanTajikistanTanzaniaThailandTimor-LesteTogoTokelauTongaTrinidad and TobagoTunisiaTurkeyTurkmenistanTurks and Caicos IslandsTuvaluUS Minor Outlying IslandsUgandaUkraineUnited Arab EmiratesUnited KingdomUnited StatesUruguayUzbekistanVanuatuVenezuelaVietnamVirgin Islands, BritishVirgin Islands, U.S.Wallis and FutunaWestern SaharaYemenZambiaZimbabweÅland Islands Organization Phone Number*Organization Fax NumberOrganization Email Address* Organization Website Status of Members*Will the Non-Profit have Members? Members vote on issues pertaining to the non-profit’s operations but do not directly participate in such operations themselves. They serve a similar purpose to shareholders in a for-profit corporation. If members are not included, directors make all decisions for the non-profit. Generally speaking, smaller non-profits go without members while larger ones include members.YesNoSite of Initial Corporate Meeting*Do you prefer to have your initial corporate meeting at our law office or have our attorneys draft written consents whereby owners/managers do not actually meet?At Wolfe & Houlehan Law Office (Lexington, Kentucky)Without Actual Meeting Via Written ConsentsPersonalized ProvisionsAre there any particular provisions you definitely want to include in the Bylaws? Consider issues relating to the company owners, officers, powers, liability, voting, termination, etc.Member-Managed or Manager-Managed*In a member-managed LLC, the members both own and operate/manage the LLC. In a manager-managed LLC, the members own the LLC while the managers operate/manage the LLC. The managers in a manager-managed LLC may simultaneously be members, thereby also holding ownership rights. In most cases, the owners will be expected to also operate/manage the LLC, and therefore a member-managed LLC is preferred. But if there are certain individuals who have ownership rights in the LLC but who will not be operating/managing the LLC, a manager-managed LLC is the best option.Member-ManagedManager-ManagedOrganization Directors and Officers*There must be at least 3 directors. Please list each person's address and title in the business next to their name.Registered Agent*The registered agent may be any owner or officer of the company.Registered Office Address*The registered office may be any physical address in Kentucky (not a P.O. Box). Street Address City State AlabamaAlaskaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific ZIP Code Date Organization Started*Approximate date the business started or will start. Date Format: MM slash DD slash YYYY Organization Activities*General description of what the business does, or which industry it is in.General Organizational Purpose*Which of the following describe the organization’s purposes? Charitable Religious Educational Scientific Literary Testing for public safety Fostering national or international amateur sports competition Preventing cruelty to children or animals 501(c)(3) Determination*Is the organization:A church or a convention or association of churchesA school, college, or universityA hospital or medical research organizationA governmental unitAn entity that undertakes testing for public safetyA publicly supported organization (museum, library, etc.)A home for the elderly or handicapped and low-income housingAn organization providing scholarships, fellowships, educational loans, or other educational grants for travel and study to individuals and private foundations requesting advance approval of individual grant proceduresA childcare organization providing care for children away from their homesA cooperative hospital service organizationA cooperative service organization of operating educational organizationsA charitable risk poolNone of theseDo not knowImpermissible Activities*Will the organization do any of the following? 1. Support or oppose candidates in political campaigns 2. Attempt to influence legislation 3. Operate bingo or other gaming activities 4. Provide disaster relief 5. Provide commercial-type insuranceYesNoOther Businesses Owned*Please include the full legal business name(s) - including punctuation and the entity suffix (LLC, Inc., etc.) - of the other business(es) you own.Annual Accounting Period / Tax Year*Calendar YearFiscal YearFiscal Year End Date*Your company's fiscal year ends on what month and day?Responsible Party*The responsible party controls, manages, or directs the applicant entity and the disposition of its funds and assets. The IRS describes it in greater detail here: https://www.irs.gov/Businesses/Small-Businesses-&-Self-Employed/Responsible-Parties-and-Nominees The responsible party may be an individual, in which case we will need the individual’s full name and social security number. We will not use the responsible party's social security number for any other purpose and will keep it strictly confidential. The responsible party may be another business entity, in which case we will need the business’ name and EIN.Responsible Party Tax ID*The responsible party's SSN or EIN.Status of Employees*Does the business have employees?YesNoDate Employees First Paid*Approximate date the first employee was paid / will be paid. Date Format: MM slash DD slash YYYY Employee Intention*Will the business have employees working in Kentucky within the next 6 months?YesNoEmployees Receiving W-2 Forms*Do you have or expect to have any employees who will receive W-2 forms in the next year? W-2 forms are Wage and Tax Statements issued by an employer to his or her employees showing taxes (federal income tax, Social Security, Medicare) deduced from their pay. The vast majority of businesses with employees must file W-2s. See an example of a W-2 here: http://www.irs.gov/pub/irs-pdf/fw2.pdfYesNoZoning Registration*Have you registered with the local building or zoning inspector?YesNoAdditional InformationPlease include any additional information you would like our attorneys to know.Disclaimer*Our attorneys may review the information you submit for the purposes described on this website. The use of this form for communication with our firm does not establish an attorney-client relationship. Our review of the information sent to us will not preclude us from representing any other client if confidential information is sent through this form.I agreeI do not agreeNameThis field is for validation purposes and should be left unchanged.