East Missouri Foundation

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Grant Compliance

It is necessary for you to certify the following items within 20 days of receipt of grant so that the East Missouri Foundation can comply with federal law regarding grants made by it to supporting organizations. Thank you for your cooperation.

CERTIFICATE
U.S. Based Foundations – Grant Compliance

Attention Grantee: Please complete and return this Certificate to East Missouri Foundation within 20 days of receipt of grant.
Name of Organization*
I certify that:
1. I am an officer/representative of the Organization and am authorized to execute this Certificate on behalf of the Organization.
2. The information contained in this Certificate, the Organization’s application for funds, and all accompanying information is true and correct.
3. The Organization has timely filed with the Internal Revenue Service (“IRS”) all required annual tax filings.
4. The Organization holds a determination letter from the IRS identifying it as a 501(c)(3) organization or is a public school or governmental body.
The Organization has provided to the East Missouri Foundation an updated IRS determination letter obtained by the Organization within the (check one of the following):*
- copy enclosed
- past 2 years
- past 3 years
5. The Organization holds the following public charity status (check one of the following):*
- 509(a)(1)
- 509(a)(2)
- 509(a)(3) - Type 1 supporting organization*
- 509(a)(3) - Type 2 supporting organization*
- 509(a)(3) - functionally integrated Type 3 supporting organization*
- 509(a)(3) - Type 3 supporting organization, not functionally integrated*
- Unknown (explain)
Explain*
* Note: To determine your proper classification, please review your governing instruments and Application for Tax-Exempt Status (Form 1023) filed with the Internal Revenue Service, copies of which must be provided upon request. Consultation with legal counsel may be necessary prior to making this certification.
6. All 509(a)(3) Supporting Organizations: Listed below are all of the Organization’s supported organizations:*
7. All 509(a)(3) Supporting Organizations: The Organization has provided to the East Missouri Foundation a list of the directors and officers of the Organization and all of its supported organizations. The Organization has designated on such list whether any of those directors and officers and/or their family members, if any, are employed by or serve on the board of directors of any disqualified person with respect to East Missouri Foundation.
8. Type I and Type III Supporting Organizations: The Organization has not accepted a gift from a person who directly or indirectly controls the Organization’s supported organization(s).
9. Type III Supporting Organizations: (Check one of the following) The Organization supports an organization outside the U.S.:*
- Yes
- No
Name*
Title*
Date*
MM slash DD slash YYYY
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