Qualified Charitable Distribution to CFSI (2026)

The form below is provided to expedite the process of establishing a designated pass-through fund using a Qualified Charitable Distribution (or IRA Rollover) gift.

The completed form you submit will be used to complete your fund agreement. The information in the form you submit, the Community Foundation will send a draft fund agreement to your email for review and signature. To comply with the law, no gift should be made until the final, signed fund agreement is received by the Foundation. At that time you can instruct your IRA administrator to process your Qualified Charitable Distribution and to deliver it directly to the Community Foundation of Southern Indiana (tax ID 35-1827813) at 4108 Charlestown Road, New Albany, IN 47150.

If at any time you have questions, please contact Kathy Watkins at 812-948-4662 ext 9 or kwatkins@cfsoutherindiana.com. You can also view this informational flyer with FAQs and more.

*Please Note: This agreement must be completed and fully executed by all parties BEFORE you initiate the QCD gift from your IRA. All distributions must be made to IRS approved public charities. Support shall be divided among the charitable organizations listed in the amounts designated below and shall be for each organization’s general use unless designated otherwise. The minimum required to establish this Fund is $15,000.00. The minimum amount for each distribution from the Fund is $1,000.00 unless the Foundation approves a lesser amount in advance, as shown below. The distributable amounts listed below shall be distributed by the Foundation, as closely as possible, in accordance with the time frames and to the charitable organizations detailed. If, before the distribution is made, any of these organizations ceases to exist as an I.R.S. approved public charity, the Foundation will pro rate that Designated Charitable Organization’s portion among the others listed.

"*" indicates required fields

Step 1 of 3

Qualified Charitable Distribution Fund Form

What is Your Name?*
Address*

CHARITABLE DISTRIBUTIONS

Please include a preferred fund name. Example: John Smith 2022 Charitable Fund.
Please insert the name of the person(s) who will be signing the fund agreement.
(Example: Mr. & Mrs. John Smith)
EXHIBIT A: Details of Your IRA*
Please provide the following information on your IRA Fund.
Company Name
Acct. #
Contact Info
Amount of Gift (Min. $15,000)
 
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