2016-2017 Marion Co. 4-H INSTRUCTIONS FOR ESTABLISHED CLUBS AND NEW CHARTERING
Marion County Purdue Extension Service is committed to protecting its 4-H program, its members, the 4-H name andemblem in Indiana and the country. This protection comes through the commitment and requirement for all county, district, region, and state level 4-H clubs and groups to have current charters and understand the value of those charters.
Chartering 4-H clubs and affliated groups, or granting permission for groups to operate in the name of 4-H, dates back many decades. Indiana 4-H began to charter all clubs and affiliated groups following a directive from National 4-H Headquarters at USDA.
With changes at the national level, chartering is now state-based. As a result, all Indiana 4-H clubs/groups must charter to receive permission to operate and use the name/emblem of 4-H.
More specifically, this document provides an overview, as well as instructions for club/group leadership, to understand the need and requirements for chartering a 4-H club/group in Marion County Indiana.
PURPOSE OF ESTABLISHING AND CHARTERING A 4-H CLUB/GROUPChartering is a legal process which allows faculty to verify the financial status, business (with list of officers, volunteers, etc.) and legal documentation for each group operating in the name of 4-H. The chartering of a local 4-H club or group by the Indiana 4-H allows the club or group authorization to use the 4-H name and emblem, and be recognized as an Internal Revenue Service 501(c)3 not-for-profit group under the umbrella of Indiana 4-H.
WHAT IS A CHARTER?A 4-H charter is a “permit” issued annually for use of the 4-H club name and emblem. It allows a group to function with all the rights and privileges of 4-H membership. Once a club/group is officially chartered, the county office will send a letter with the club name and 4-H year to validate their charter recognition.
WHO MUST BE ESTABLISHED AND CHARTERED IN ORDER TO USE THE 4-H NAME AND EMBLEM?In Marion County Indiana, all 4-H community, project, SPARK club or groups must be chartered.
REQUIREMENTS TO ESTABLISH A NEW CLUB/GROUP OR CHARTER AN EXISTING 4-H CLUB OR GROUP Below are the requirements necessary for establishing/chartering a club or group under Marion County Indiana 4-H.
_____Charter/Established Club or Group Application Form_____Club/Group Constitution_____Employer Identification Number or EIN_____Club Officer List and Annual Plan_____Tentative Annual Club Budget (if applicable)
For established clubs with bank accounts only______Bank Account Information (Most recient bank statements)_____Annual Review of Finances (Upon County office request)
It is the policy of the Purdue University Cooperative Extension Service, that all persons have equal opportunity and access to its educational programs, services, activities, and facilities without regard to race, religion, color, sex, age, national origin or ancestry, marital status, parental status, sexual orientation, disability or status as a veteran. Purdue University is an Affirmative Action institution.
_____Authorization Letter 4-H Clubs IRS
The purpose of a 4-H club is to provide youth with educational, fun learning experiences with their peers.
4-H Clubs may be organized in several forms.
These groups include at least five members from at least three families ranging in grades 3-12. TThe club is led by one or more approved adult volunteer leaders. Youth enroll in subject matter areas of interest (projects), participate in 9-12 meetings during the year, select youth officers, carry out club responsibilities, participate in service to the community, and receive recognition for their work. Club meetings typically are held once a month in a location such as a school, community center, church, or other public meeting space. The club often uses its meetings to develop group process skills, leadership ability, and communication skills.
Community ClubSchool ClubProject Club
After School ClubSpark Club
SPARKS Clubs are open to youth grades 3-12 to “spark” new interest in the Indiana 4-H program. SPARK Clubs are special interest groups designed to capture the attention of youth with single focus, “out of the box” interests that are likely different from state-recognized 4-H projects. These clubs are led by volunteers bringing their subject mastery to the club. SPARK Clubs include six hours of instructional time that can occur in one day or over a length of time.
2016-2017 MARION CO. 4-H YOUTH DEVELOPMENT ESTABLISHED CLUBS AND NEW CLUB WORKSHEET
NOTE: This is only a worksheet for collecting data which will then be submitted to the Extension Educator ALL INFORMATION IN BOLD IS REQUIRED.
CLUB INFORMATION Charter Application Type New Club Establishing & Chartering
Chartering of Existing Club
Club Affiliation Indy Center Area
Decatur TownshipFranklin Township
Type of Club 4-H Community Club 4-H In-School Club 4-H After-School Club 4-H Project Club Administrative Club (Example: Council, Adult
Leaders, Boards – Club/Group not to be published forenrollment but needs to be chartered)
Club Name (Exactly as it appears in 4-H Online and on EIN document) Name of Primary Club Leader: Club Address Line 1: Club Address Line 2: City: State: Zip: Contact Phone Number: E-mail: Website/Social Media Site: What year was this club established?
CLUB/GROUP MEETING INFORMATION You are required to provide the physical address of the club/group meeting each month. The address should be the complete physical address, and not simply
"Fairgrounds" or "Courthouse." Incomplete/incorrect addresses will delay chartering approval.
Meeting Location (Official Name, ie 38th St. Library, Indiana): Physically Address 1: Physically Address 2: Location City: Location Zip: Regular Meeting Day (Example 2nd Tuesday of Month): Regular Meeting Time:
DEFINITIONS: Racially Ethnically Mixed Communities: An area or community in which more than one of the racial-ethnic groups make up the population of potential program participants. Racially Ethnically Integrated Group: A group composed of members of more than one of the racial-ethnic groups above.
Based on definition above, is this club in a racially mixed community? YES NO
Based on definition above, is this club integrated as to the race and ethnicity of the membership?
YES NO
Perry Township Pike Township Washington Township Wayne Township
ESTABLISHED CLUB: How many active members did this club have in the 15-16 year?
NEW CLUB: How many youth do you have committed to enroll in this club?
CLUB/GROUP OFFICERS MANAGERS
Does club have a slate of club officers? YES NO
Does club have adult volunteer(s) serving as club leader (s) who oversee the club operations?
YES NO
If YES, please provide their names
CLUB/GROUP FINANCIAL INFORMATION
Club/Group Employee Identification Number (EIN):
If club/group does not have an EIN, explain why?
Tax Filing Information Please indicate whether your last filing was under Indiana 4-H or another entity: Indiana 4-H
Other
If other, who was it filed under (school name, other foundation, organization):
Did you SUCCESSFULLY file the club/group IRS 990 form for 2015: YES NO
Each club/group under Marion County 4-H must go through an annual financial review. Provide the month/year of last review. (Ex: April 2016):
Bank Account Information Does this club/group have a bank account(s): YES
NOIf you have a bank account, you will be required to submit either an approved, or proposed budget with your chartering
List ALL Names on the Signature Card(s):
Bank Account #1 Savings or Checking: Financial Institution Name: City/State: Phone Number: Account #:
Bank Account #2 Savings or Checking: Financial Institution Name: City/State: Phone Number: Account #:
Constitution of Club of Marion County, IN
Article 1. This Constitution hereby revokes any prior Constitution or similar organizing
document adopted by the organization.
Article 2. The name of the organization shall be the Club.
The organization shall hereinafter be referred to as club.
Article 3. The club is organized exclusively for educational, scientific and charitable
purposes, specifically to provide the youth who comprise the membership with a non-
formal 4-H Youth Development educational experience through the Purdue University
Cooperative Extension Service.
Article 4. The membership shall be comprised of any young person in or below grade
12, who has indicated an interest in a 4-H Youth Development experience, has completed
an enrollment form, and who pays the 4-H program fee. The club will be organized and
led by a 4-H volunteer who has been screened, approved and appointed by the Purdue
Extension staff member of Marion County.
Article 5. No part of the net earnings of the club shall inure to the benefit of, or be
distributable to its members, officers or other private persons, except that the club shall
be authorized to make payments and distributions in furtherance of its purposes set forth
in Article 3. No substantial part of the activities of the club shall be the carrying on of
propaganda, or otherwise attempting to influence legislation, and the club shall not
participate in, or intervene in (including the publishing or distribution of statements) any
political campaign on behalf of or in opposition to any candidate for public office.
Article 6. Notwithstanding any other provision of this Constitution, the club shall not
carry on any other activities not permitted to be carried on by an organization exempt
from Federal income tax under section 501(c)(3) of the Internal Revenue Code, or the
corresponding section of any future federal tax code.
Article 7. The fiscal year of the club shall end on December 31st. An annual financial
report for the club will be presented to the Purdue Extension Office for a financial
review. The financial report shall be accompanied by a required annual report of the
club’s activities for the year. A formal, financial review of each club will be conducted
per 4-H policies and procedures every 4-5 years and at any time there is a change in the
volunteer who has signature authority on the club’s bank account or similar financial
account.
Article 8. In the event of termination or revocation of a charter for, or dissolution of, this
club, all of the principal, income, and assets shall be transferred and assigned to the
Purdue Cooperative Extension Service of Marion County to be held to support future 4-H
educational program efforts to include the formation of new 4-H clubs.
Article 9. The club shall generate its federal tax exempt status under section 501(c)(3) of
the Internal Revenue Code through a Group Exemption Number (GEN) to be issued to
Purdue University, and it shall undertake any action so required by Purdue University and
by Internal Revenue Service rules and procedures to ensure its inclusion in the GEN
issued to Purdue University. The club shall obtain an Employer Identification Number
from the Internal Revenue Service irrespective of whether a bank account is maintained
by the club. The club shall comply with requirements for, and file with the Internal
Revenue Service, annual information returns on the Form 990 Series applicable to the
club, and the club shall file all other returns required by applicable law including Federal,
State and local law. No consolidated Form 990 for subordinate organizations (i.e. clubs)
shall be prepared by Purdue University under the group exemption issued to it.
Article 10. It is the policy of Purdue Cooperative Extension that all 4-H clubs and
acknowledged 4-H groups shall have equal opportunity and access to programs and
activities.
Article 11. No amendment to this Constitution shall be effective without the written
consent of the Assistant Director and Program Leader 4-H Youth Development at Purdue
University or such person as may be delegated such authority by the said Assistant
Director and Program Leader. The club may adopt or amend By-Laws or similar
operational documents which may contain additional provisions as long as they do not
contradict the provisions of this Constitution.
Date Adopted:
Signature:
Printed name:
Title:
587573.1
Application for Employer Identification Number Form SS-4 EIN(Rev. January 2010) (For use by employers, corporations, partnerships, trusts, estates, churches,
government agencies, Indian tribal entities, certain individuals, and others.)
OMB No. 1545-0003
Department of the TreasuryInternal Revenue Service
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Executor, administrator, trustee, “care of” name3Trade name of business (if different from name on line 1)2
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1211 Closing month of accounting yearDate business started or acquired (month, day, year). See instructions.
15 First date wages or annuities were paid (month, day, year). Note. If applicant is a withholding agent, enter date income will first be paid tononresident alien (month, day, year) ©
HouseholdAgricultural
13 Highest number of employees expected in the next 12 months (enter -0- if none).
17 Indicate principal line of merchandise sold, specific construction work done, products produced, or services provided.
18 Has the applicant entity shown on line 1 ever applied for and received an EIN? Yes No
Complete this section only if you want to authorize the named individual to receive the entity’s EIN and answer questions about the completion of this form.
Designee’s telephone number (include area code)
Date ©Signature ©
For Privacy Act and Paperwork Reduction Act Notice, see separate instructions. Form SS-4 (Rev. 1-2010)
Typ
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arly
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Cat. No. 16055N
Foreign countryState
Designee’s fax number (include area code)
© See separate instructions for each line.
( )
( )
© Keep a copy for your records.
Compliance with IRS withholding regulations
SSN, ITIN, or EIN7b
Other
Applicant’s telephone number (include area code)
Applicant’s fax number (include area code)
( )
( )
Under penalties of perjury, I declare that I have examined this application, and to the best of my knowledge and belief, it is true, correct, and complete.
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ThirdPartyDesignee
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If you expect your employment tax liability to be $1,000or less in a full calendar year and want to file Form 944annually instead of Forms 941 quarterly, check here.(Your employment tax liability generally will be $1,000or less if you expect to pay $4,000 or less in totalwages.) If you do not check this box, you must fileForm 941 for every quarter.
Is this application for a limited liability company (LLC) (or a foreign equivalent)?
NoYes8a If 8a is “Yes,” enter the number of
LLC members ©
8b
If 8a is “Yes,” was the LLC organized in the United States?
8c
NoYes
14
Check one box that best describes the principal activity of your business.
16 Construction Real estate
Rental & leasing Manufacturing
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Health care & social assistance Accommodation & food service Other (specify)
Wholesale-agent/broker Wholesale-other Retail
If “Yes,” write previous EIN here ©
If no employees expected, skip line 14.
Club Officers and Annual Planning Form
4-H Club (Name)2016-2017
Club Officers Office Position Member’s Name
Club Annual Planning Month Club plans
August:
September:
October:
November:
December:
January:
February:
March:
April:
May:
June:
July:
Marion County
Club Name:
October 1, to September 30,
BUDGETED ACTUAL
Total Income -$ -$
BUDGETED ACTUAL
Total Expenses -$ -$
Closing Balance -$ -$
Total Opening Balance:
ESTIMATED INCOME (SOURCE, USE, PURPOSE)
PROJECTS (SUB-ACCOUNTS)
Club Leader's Signature/Date
4-H CLUB BUDGET (Marion County)
We certify that this budget was approved by the club members on (date):
President's Signature/Date
Treasurer's Signature/Date
PROJECTS (SUB-ACCOUNTS)
ESTIMATED EXPENSES (DESCRIBE)
Marion County
AUTHORIZATION OF SUBORDINATE (4-H CLUB) TO BE INCLUDED
IN INTERNAL REVENUE SERVICE GROUP EXEMPTION LETTER FOR
PURDUE UNIVERSITY
Internal Revenue Service Procedure 80-27*, 1980-1 C.B. 677 describes the process
under which the _______________________ Club of Marion County, IN may generate its
federal tax exempt status under section 501(c)(3) of the Internal Revenue Code through a
Group Exemption Letter issued by the Internal Revenue Service upon an application filed by
Purdue University as a Central Organization on behalf of 4-H Clubs and Affiliates situated in
Indiana which are subject to the general supervision and control of Purdue University. Such
4-H Clubs and Affiliates are referred to in Revenue Procedure 80-27 as a subordinate of
Purdue University.
One of the requirements for the issuance of a Group Exemption Letter by the Internal
Revenue Service contained in Section 4.03 of Revenue Procedure 80-27 is that each
subordinate of a Central Organization must authorize the Central Organization to include it in
the application for the Group Exemption Letter made by the Central Organization pursuant to
Section 4 of Revenue Procedure 80-27.
Based on my understanding that Purdue University as Central Organization will
submit to the Internal Revenue Service an application for the issuance of a Group Exemption
Letter covering 4-H Clubs and Affiliates as subordinates, the ______________________ Club
of Marion County, IN through the undersigned, hereby authorizes Purdue University to
include it in the application for the Group Exemption Letter.
Dated this _____________________ day of __________________________,
________________ (year).
______________________________ Club of __________________________ County, IN
by __________________________________ Signature of Authorized Individual
Printed name ________________________________
*587634.1