PART 400 SOLICITATION FOR CHARITY ACT : Sections Listing

TITLE 14: COMMERCE
SUBTITLE B: CONSUMER PROTECTION
CHAPTER II: ATTORNEY GENERAL
PART 400 SOLICITATION FOR CHARITY ACT

AUTHORITY: Implementing and authorized by the Solicitation for Charity Act [225 ILCS 460].

SOURCE: Adopted and effective November 5, 1975; amended at 2 Ill. Reg. 37, p. 185, effective September 30, 1978; amended at 6 Ill. Reg. 9616, effective August 1, 1982; codified at 7 Ill. Reg. 879; amended at 24 Ill. Reg. 14684, effective September 21, 2000; amended at 29 Ill. Reg. 11775, effective July 15, 2005.

 

Section 400.10  General

 

The Charitable Trusts Bureau of the Attorney General's Office (hereafter Bureau) will maintain a file of all charitable organizations, professional fund raisers, professional fundraising consultants and professional solicitors registered under the Illinois Solicitation for Charity Act at its Chicago office.

 

(Source:  Amended at 24 Ill. Reg. 14684, effective September 21, 2000)

 

Section 400.20  Definitions

 

The words used in this Part are used with the same meaning assigned to them by statute unless clarified below.

 

"Charitable purposes" means any charitable, benevolent, philanthropic, patriotic, or eleemosynary purpose and includes the conduct described in Section 480.20(e) of Charitable Trust Act (14 Ill. Adm. Code 480).

 

"Contributions" means the gross amount of money raised and not merely the portion which after expenses is devoted to the charity.

 

(Source:  Amended at 2 Ill. Reg. 37, p. 185, effective September 30, 1978)

 

Section 400.30  Registration

 

a)         Charitable Organization

 

1)         Any charitable organization which solicits in Illinois must first register with the Attorney General unless it is exempt under the provisions of Section 3(b) of the Act.

 

2)         To register, a charitable organization must file a completed registration statement in the forms set forth in Appendix A, Illustrations A and B of this Part, all appropriate attachments, including a schedule of assets and investments, and all required statutory fees.  All registrations must be accompanied by a copy of the instrument under which the property is administered (for example, trust documents, articles of incorporation, constitution, by-laws) and a financial statement.  If the organization employs a professional fund raiser, a copy of its contract with the professional fund raiser must accompany the registration statement.

 

3)         If the organization has been in operation prior to registering, it must file, in addition to its registration statement, financial statements for each of the past three years and executed copies of annual reports or returns filed with the Internal Revenue Service for each of the past three years, must pay all filing fees and all late fees as provided by Sections 2 and 4 of the Act, and is subject to accounting for all past years of operation prior to registration.

 

4)         When a registration is canceled, to return to compliance, a re-registration must be made.  Re-registration requires the submission of all of the above registration documents as applicable, including the re-registration penalty fees as provided by Section 2 of the Act.

 

5)         Registration by an organization under Section 2 of the Act may upon request also satisfy the organization's registration requirements under the Charitable Trust Act [760 ILCS 55/5].

 

6)         The Attorney General may by pre-approval accept registration forms used by other states which contain the information required in Appendix A, Illustration A.

 

b)         Professional Fund Raiser

 

1)         No professional fund raiser may be employed by a charitable organization in Illinois without prior registration with the Attorney General.

 

2)         To register, a professional fund raiser must file a completed registration statement in the forms set forth in Appendix B, Illustrations A and B of this Part, all required statutory fees, copies of all Illinois charitable fundraising contracts and a professional fund raiser's bond when a bond is required, as described in subsection (b)(3).

 

3)         If the applicant is a professional fund raiser that will control or possess charitable funds, a bond in the amount of $10,000, expiring upon the next June 30, issued with the professional fund raiser as a principal and a corporate surety licensed to do business in Illinois as surety, must accompany the registration.  The bond must be in the form provided by the Bureau as set forth in Appendix B, Illustration C of this Part.

 

c)         Professional Solicitor

 

1)         No professional solicitor may solicit in Illinois without prior registration with the Attorney General.  No person may register as a professional solicitor unless he is employed by a registered professional fund raiser.

 

2)         To register, a professional solicitor must file a completed registration statement in the form set forth in Appendix C, Illustration A of this Part.

 

d)         Professional Fundraising Consultant

 

1)         No person or entity may act as a professional fundraising consultant without prior registration with the Attorney General.

 

2)         To register, a professional fundraising consultant must file a completed registration statement in the form set forth in Appendix D, Illustration A of this Part, copies of all Illinois charitable fundraising consultant contracts and an affidavit stating that the professional fundraising consultant has not or will not at any time have custody or control of contributions.

 

e)         A registrant shall notify the Attorney General of any changes in registration information within ten days after the change.

 

(Source:  Amended at 24 Ill. Reg. 14684, effective September 21, 2000)

 

Section 400.40  Religious Exemption

 

a)         Religious organizations are subject to the Act and must register under the Act. If the Attorney General has issued a religious exemption to an organization pursuant to the provisions of Section 3(a) of the Act, that organization is exempt from filing annual reports.

 

b)         To obtain a religious exemption, an organization must file a completed registration statement, request an exemption and submit a religious exemption questionnaire in the form set forth in Appendix A, Illustration C of this Part.

 

c)         The Attorney General may require the organization to supply supplemental information as is necessary to determine its religious character.

 

d)         The Attorney General may issue either a blanket or an individual religious exemption.

 

e)         An individual religious exemption covers a single named religious group.

 

f)         A blanket religious exemption is issued to and upon the request of the central body of a church or denomination and covers the church and all of the affiliated agencies listed in the exemption request.

 

g)         Any religious organization with multiple subdivisions may request a blanket exemption.

 

h)         An application for a blanket religious exemption must be filed by the central governing authority of the church and shall contain the information required by Section 400.40(b) and also a list of the affiliated organizations and agencies which are directed and controlled by the central church.

 

i)          If, upon the filing of an application for religious exemption, the Attorney General determines that the organization is religious within the definition of Section 3(a) of the Act and that its purposes are actual and genuine, a religious exemption will be issued.

 

j)          Organizations receiving blanket exemptions shall periodically supply the Attorney General with current lists of their affiliates.

 

(Source:  Amended at 24 Ill. Reg. 14684, effective September 21, 2000)

 

Section 400.50  Not Subject Organizations (Repealed)

 

(Source:  Repealed at 24 Ill. Reg. 14684, effective September 21, 2000)

 

Section 400.60  Annual Reports for Charitable Organizations

 

a)         To complete a proper annual report filing, all annual reports required under the Act must be filed on the form set forth in Appendix A, Illustration D of this Part and with the attachments prescribed by the form and this Section, signed by both the president of the organization or other authorized officer, and the chief fiscal officer, and with all required statutory fees paid prior to the due date.

 

b)         Each annual financial report is due within six months after the close of the organization's fiscal year.  An organization may request a 60 day extension of the due date pursuant to Section 4(f) of the Act.

 

c)         Failure to file a complete annual report including all required attachments, along with payment of fees due prior to the due date, shall result in the organization being classified delinquent, and shall subject the organization to the payment of a late filing fee.

 

d)         On each annual report an organization must report separately all program costs associated with a joint cost fundraising appeal to the extent such was allocated to charitable program service expense and included on the annual report as charitable program service expense.  The organization must maintain written records showing how the allocation was determined and the reasoning behind it.

 

e)         The form and attachments required for an organization's annual report is determined by the amount of its revenue and assets during the reporting fiscal period or whether it has used the services of a paid professional fund raiser as follows:

 

1)         Any organization which received contributions of more than $150,000 in any reporting fiscal year or any organization which employed professional fund raisers during any part of the fiscal year who raised contributions totaling more than $25,000 during the organization's fiscal year must file:

 

A)        The Illinois Charitable Organization Annual Report form signed by the president and the treasurer and/or two trustees;

 

B)        A copy of the Federal Internal Revenue return and/or report as required by the Internal Revenue Codes and incorporated attachments for the same period;

 

C)        A financial report accompanied by financial statements and the certification of an independent certified public accountant.  Certification must be in the form of an unqualified opinion letter;

 

D)        All required statutory fees, including all late fees and re-registration fees; and

 

E)        If the organization employs a professional fund raiser, the Illinois Fundraising Campaign form for each professional fundraising campaign conducted during the fiscal period in the form set forth in Appendix A, Illustration E of this Part.

 

2)         Any organization with contributions more than $25,000 but not in excess of $150,000, or any organization which employed professional fund raisers who raised contributions of $25,000 or less during the organization's fiscal year, need not file an independent certified public accountant's opinion but must submit all of the other items required and listed in subsection (e)(1) above.

 

3)         Any organization which received contributions of more than $15,000 but not in excess of $25,000 during its fiscal year must file an annual report, but it may make a simplified filing by submitting:

 

A)        A financial statement using the Illinois Charitable Organization Annual Report form disclosing total receipts, total disbursements and assets on hand at the fiscal year end, accompanied by an attestation to the truth of the financial statement; and

 

B)        All required statutory fees.

 

4)         Certain organizations registered under the Act that are not required to file an annual report for a specific fiscal year under the Act, may be required to file under the Charitable Trust Act [760 ILCS 55].

 

f)         Charitable organizations which have made a consolidated registration pursuant to Section 2(g) of the Act shall include in their annual report such additional detailed financial information as will fairly represent the financial position of each of the affiliated groups.

 

g)         The Attorney General shall, upon written request, extend for 60 days the time for filing the annual financial report.

 

h)         If an organization is entitled to an additional extension for good cause by the Internal Revenue Service, which would extend its federal tax return or report due date to a date later than the Attorney General's due date, the organization may obtain an additional extension from the Attorney General coinciding with the same Internal Revenue Service due date.  Extension requirements are:

 

1)         This extension request must be made prior to the due date for the Attorney General's annual financial reports and must include:

 

A)        A written request for such additional extension;

 

B)        A completed and signed Illinois Charitable Organization Annual Report form;

 

C)        Financial statements, including a balance sheet and report of income and expenses for the subject period in final or interim form;

 

D)        All required statutory fees; and

 

E)        A copy of the application for extension of time filed with the Internal Revenue Service.

 

2)         The filing of all required reports must be done on or before the Internal Revenue Service extended filing date and shall include:

 

A)        A copy of the approved Internal Revenue Service application for extension;

 

B)        A copy of the Federal tax return or report; and

 

C)        Audited financial statements if required by the Attorney General and not previously filed.

 

i)          Failure to file a timely and complete financial report will result in penalty fees and/or a fine and subjects the organization's registration to cancellation.

 

j)          Upon cancellation the organization must cease operations.

 

(Source:  Amended at 24 Ill. Reg. 14684, effective September 21, 2000)

 

Section 400.65  Mid-Year and Annual Reports for Professional Fund Raisers

 

a)         Mid-Year Reports:

 

1)         Every registered professional fund raiser who takes possession or control of charitable funds directly, indirectly, by an agent, or as an escrowee shall file a full written accounting to the charitable organization of all funds it or its agents collected on behalf of the charitable organization during the six month period ending June 30 of each year, and file a copy of the accounting with the Attorney General by September 30 of each year.

 

2)         The accounting shall be in writing and signed under oath on forms prescribed by the Attorney General as set forth in Appendix B, Illustrations D through G of this Part.

 

b)         Annual Reports:

 

1)         Every registered professional fund raiser shall file a calendar year written financial report with the Attorney General.  The report shall contain such information as the Attorney General may require, and shall use forms prescribed by him as set forth in Appendix B, Illustrations D through G of this Part.  Separate financial reports for each  fundraising campaign conducted shall be filed, together with the statutory report filing fee.

 

2)         The required report shall be filed on or before April 30 of the following calendar year, signed and verified under penalty of perjury, together with the required statutory fees.  The Attorney General will grant a 30 day extension of the due date pursuant to Section 6(d) of the Act if such extension is requested in writing prior to the due date.

 

3)         The professional fund raiser shall provide a copy of the report to the charitable organization by the due date of the filing.

 

(Source:  Added at 24 Ill. Reg. 14684, effective September 21, 2000)

 

Section 400.70  Professional Fund Raiser Renewal

 

a)         The registration of all professional fund raisers expires on the next June 30 following their registration.

 

b)         A registered professional fund raiser who wishes to continue to act as professional fund raiser in Illinois must apply for renewal of its registration during June of the year in which his registration expires.

 

c)         To renew, a professional fund raiser must file a new, completed registration statement, an annual financial report as provided by the Attorney General, professional fund raiser bond which meets the requirements of Section 400.30(b)(3) for the period beginning July 1 and ending June 30 of the next year, and copies of active contracts and all required statutory fees.

 

d)         All Illinois professional fund raisers must file a copy of each professional fundraising contract prior to conducting a fundraising campaign.

 

e)         All charitable organizations and professional fund raisers shall retain copies of their professional fundraising contracts for three years following the completion of the contract.

 

(Source:  Amended at 24 Ill. Reg. 14684, effective September 21, 2000)

 

Section 400.80  Professional Solicitor Renewal

 

a)         The registration of all professional solicitors shall expire on the next June 30 following their registration.

 

b)         A registered professional solicitor who intends to continue to act as a professional solicitor in Illinois must apply for renewal of its registration during June of the year in which its registration expires.

 

c)         To renew, a professional solicitor must file a new, completed registration statement.

 

(Source:  Amended at 24 Ill. Reg. 14684, effective September 21, 2000)

 

Section 400.85  Professional Fundraising Consultant Renewal

 

a)         The initial registration of all professional fundraising consultants shall expire on the June 30 following two years of registration.  Successive two year re-registration periods shall also expire on June 30.

 

b)         A registered professional fundraising consultant who intends to continue to act as a consultant in Illinois must apply for renewal of its registration during the month preceding expiration of the two year registration period.

 

(Source:  Added at 24 Ill. Reg. 14684, effective September 21, 2000)

 

Section 400.90  Public Records

 

All registrations and reports filed with the Attorney General under the Act are public records and may be inspected in the office of the Attorney General during ordinary business hours.

 

(Source:  Amended at 24 Ill. Reg. 14684, effective September 21, 2000)

 

Section 400.100  Registration Not an Endorsement

 

a)         Any representation made by a charitable organization, professional fund raiser, or professional solicitor in connection with its solicitation that it is registered or has otherwise complied with the Act, or that indicates the Attorney General endorses the organization, is unlawful, except as provided in Section 17 of the Solicitation for Charity Act [225 ILCS 460/17].

 

b)         The Attorney General may immediately cancel the registration of any person or organization violating Section 400.100(a).  An affidavit from a person to whom such an illegal representation was made shall be sufficient to warrant an immediate cancellation.

 

(Source:  Amended at 24 Ill. Reg. 14684, effective September 21, 2000)

Section 400.APPENDIX A   Charitable Organization Forms

 

Section 400.ILLUSTRATION A   Registration Statement and Instructions

 

Form CO-1

CHARITABLE ORGANIZATION

JIM  RYAN

 

- REGISTRATION STATEMENT -

ATTORNEY GENERAL

 

PLEASE TYPE OR PRINT IN INK.  This registration statement is required by the Illinois Charitable Trust Act and "An

Act to Regulate Solicitation and Collection of Funds for Charitable Purposes."  Please answer all items which are applicable to

your organization.  If you are unable to answer any question fully in the space provided, please attach a sheet containing the remainder

of your answer.  No further registration statement is required, provided that every registered organization shall notify the Attorney

General within 10 days of any change in the information submitted herein.  One copy of this Registration Statement and attachments

are to be filed with the Office of the Attorney General, Charitable Trust and Solicitations Bureau, 100 West Randolph Street, Chicago,

Illinois 60601.

 

1.

This is a registration under:

 

Illinois Charitable Trust Act;

 

 

 

An Act to Regulate Solicitation and Collection of Funds for Charitable Purposes;

 

 

 

Both Acts

 

 

2.

Name of Organization

 

Telephone Number

Federal Employer ID#

 

 

 

Street and Number

City

County

State

Zip Code

 

 

 

 

 

 

3.

Type of legal entity (Corporation, Trust, Unincorporated Association or Other) and date, method and place organization

 

legally established.

 

 

If a foreign corporation, when was it authorized to do business in Illinois?

 

 

If a corporation, Illinois Secretary of State's File No.

 

 

 

* A copy of the Articles of Incorporation or Certificate of Authority issued by the Secretary of State must be attached.

 

 

4.

Name, address and telephone number of Illinois registered agent.

 

 

 

 

 

5.

Address of all offices in the State of Illinois.

 

 

 

 

 

 

 

6.

Date on which the annual period of the organization ends.

Month

 

Day

 

 

 

 

 

 

7.

State the purposes of the organization and purposes for which contributions are to be used. (Be specific)

 

 

 

 

 

 

 

 

 

 

8.

If the name under which the organization intends to solicit funds differs from the name listed in No. 2 provide name(s) under

 

which contributions will be solicited, and the reason for the use of such other name(s).

 

 

 

 

 

9.

If the organization has previously been registered with the Attorney General under either Act, give name under which registered

 

(if different than that shown in No. 2), last registration number, and date registered.

 

 

 

 

 

10.

Has the organization been registered with any other governmental authority to solicit contributions?

Yes

No

 

Name of authority and date of authorization.

 

 

Is such registration current?

Yes

No

 

 

 

11.

Has the organization or any of its officers, directors or trustees ever been enjoined or prohibited by any court or other

 

governmental agency from soliciting contributions, or is such action pending?

Yes

No

 

If "Yes", attach an explanation.

 

 

12.

Do you intend to use the services of a professional fund raiser as defined by "An Act to Regulate Solicitation and Collection of Funds

 

for Charitable Purposes"?

Yes

No

 

If "Yes", answer a, b, and comply with c below.

 

a.

Name and address of professional fund raiser(s):

 

 

 

 

 

b.

Has the professional fund raiser registered and filed a bond with the Office of the Attorney General as required?

Yes

No

 

c.

Attach copies of all contracts with professional fund raiser(s).

 

13.

Have any of organization's officers, directors, executive personnel, or have any of the organization's employees who have access to

 

funds, ever been charged with or convicted of a misdemeanor involving the misapplication or misuse of money of another, or any

 

felony?

Yes

No

If "Yes", give the following information:

 

NAME AND ADDRESS OF COURT

NATURE OF OFFENSE

DATE OF CONVICTION   (Mo./Yr.)

 

 

 

 

 

14.

State the board, group or individual having final discretion as to the distribution and use of contributions received.

 

 

 

15.

Will you use any of the following methods of solicitation?

Unordered Merchandise

Distribution or Sale of Seals

 

Telephone Appeals

Coin Collection Containers

Special Events

Ad Books

Direct Mail

 

Other – If other, attach an explanation.

 

 

16.

List name, mailing address and title of the chief executive or staff officer of the organization.

 

 

 

 

 

17.

Attach a list of names, mailing addresses, and daytime phone numbers of all officers and directors, or trustees of the organization.

 

18.

Has the United States Internal Revenue Service determined that this organization is tax exempt?

Yes

No

 

If "Yes", attach a copy of the determination letter. Is application pending?

Yes

No

 

* All organizations with tax exempt status or an application pending must attach a copy of

 

 

Federal Form 1023 "Application for Recognition of Exemption" or an exemption letter.

 

 

19.

Has organization's tax exempt status ever been questioned, audited, denied or cancelled at any time by any governmental agency?

 

Yes

No

If "Yes", attach the facts.

 

20.

Organizations which have been in operation for over one (1) year must attach a copy of the Federal return, or AG990IL if no Federal return was filed for each year the organization was in existence, completed in detail. Organizations which have been in operation less than one (1) year must attach a completed Financial Information Form CO-2, notarized.  Please note charitable organization's are required to maintain accurate and detailed accounting records.

 

 

 

 

21.

Approximate amount of contributions solicited or income received from persons in this State during the organization's last

 

annual accounting period

$

 

 

 

22.

EVERY REGISTERING ORGNAIZATION MUST ATTACH THE FOLLOWING APPLICABLE DOCUMENTS:

 

Corporation

                                                

The Article of Incorporation, or Certificate of Authority, Amendments and By-Laws

 

Unincorporated Association

                                                

Constitution and By-Laws

 

Testamentary Trust

                                                

Will, Probate Number and Decree of Distribution

 

Inter Vivos Trust

                                                

Instrument Creating Trust

 

 

NOTE:

The President and the Chief Financial Officer or other authorized officer both are required to sign. This must

 

 

be two different individuals.  If entry is a Trust, all Trustees must sign.

 

UNDER PENALTY OF PERJURY, THE UNDERSIGNED DECLARE AND CERTIFY THAT THE INFORMATION CONTAINED IN THIS STATEMENT AND ALL ATTACHED SHEETS IS TRUE AND CORRECT TO THE BEST OUR KNOWLEDGE.

 

Signature

 

Title

Date

 

Signature

 

Title

Date

 

 

 

TO REGISTER WITH THE ILLINOIS ATTORNEY GENERAL'S OFFICE

ALL ORGANIZATIONS AND TRUSTS MUST SUBMIT:

 

1.

All fees due, including a $15.00 initial Registration Fee: payable to: "Illinois Charity Bureau Fund".

 

2.

"Charitable Organization Registration Statement" (Form CO-1), note all attachments required on form.

 

3.

A copy of the Federal Returns for past 3 years or if no federal returns were filed an AG990IL form for each year of the

 

organization's existence (if more than three years prior to registration attach 3 years subject to further requests); or if the

 

organization has been in existence  less than 1 year submit the "Charitable Organization Financial Information Form" (Form

 

CO-2)).

 

4.

A list of names, mailing addresses, and day time phone numbers of all Officers, Directors and/or Trustees.

 

5.

A copy of the IRS Determination Letter or if pending, submit a copy of IRS Form 1023 or 1024.

 

6.

If applicable, copies of all contracts with Professional Fund Raisers.

 

7.

If applicable, the "Religious Organization Exemption Form" (Form CO-3).

 

8.

IF A CORPORATION:  Illinois Articles of Incorporation or Articles of Incorporation other than those from Illinois and a

 

Certificate of Authority to do business from the Illinois Secretary of State.  All amendments to the Articles of Incorporation,

 

By-Laws of the Corporation.

 

9.

IF AN UNINCORPORATED ASSOCIATION:  Constitution and all amendments and By-Laws of the Association.

 

10.

IF A REPRESENTATIVE OF A PROBATE ESTATE (Containing Charitable Gifts):  Will and Letters of Office.

 

Inventory; Declarations of Trust for any trusts into which the Will pours over and all Amendments thereto.

 

11.

IF A CHARITABLE TRUST OR A LIVING INTER VIVOS TRUST: Declaration of Trust, and all Amendments thereto;

 

Inventory and recent accounting.

 

NOTE:  Illinois law requires charitable organizations and trusts to file an annual financial report each year and pay an

annual filing fee of $15 (and pay a $100 late report fee for each late report).

 

 

Direct the above registration materials, including all required fees payable to the "Illinois Charity Bureau Fund" to:

 

Office of the Illinois Attorney General

Charitable Trust Bureau

100 West Randolph Street,

Chicago, Illinois  60601-3175

(312) 814-2595

 

NOTE:

LATE REGISTRATION FEES:

 

 

-

The Solicitation for Charity Act requires that an organization which registers late must pay a late registration fee of $200.

 

-

The Trust Act and Solicitation Act both also imposes a $100 late annual financial report filing fee for each annual report filed late.

 

-

Reports mailed prior to registration are not considered filed.

 

-

All fees due must accompany registrations.

 

SEE:

 

CHARITABLE TRUST ACT

760 ILCS 55/1 et. seq.

 

SOLICITATION FOR CHARITY ACT

225 ILCS 460/1 et. seq.

 

CHECKLIST2.WPD

 

(Source:  Added at 24 Ill. Reg. 14684, effective September 21, 2000)

 

Section 400.APPENDIX A   Charitable Organization Forms

 

Section 400.ILLUSTRATION B   Financial Information Form

 

Form CO-2

CHARITABLE ORGANIZATION

─ FINANCIAL INFORMATION FORM ─

JIM RYAN

ATTORNEY GENERAL

PLEASE TYPE OR PRINT IN INK. Organizations that have been in operation less than one (1) year are required to complete this form, in compliance with the "Charitable Organization Registration Statement" Form CO-1 Line 20, and file each form with the Attorney General's Office, Charitable Trust and Solicitations Bureau, 100 West Randolph Street,  Chicago, Illinois 60601.

1.

Name, address and telephone number of the organization:

 

 

 

2.

The books and records are located at the following address and telephone number:

 

 

 

3.

Are the gross receipts for the current calendar/fiscal year expected to exceed $10,000.00?

Yes

No

4.

Please provide the following financial information:

 

 

From inception

 

thru

 

 

 

 

Month/Day/Year

 

Month/Day/Year

 

 

 

 

 

 

 

 

GROSS RECEIPTS TO DATE

ASSETS

 

Contributions, Gifts & Grants

$

 

Cash

$

 

 

Program Service Revenue

 

 

Accounts Receivable

 

 

 

Dues

 

 

Other Receivables

 

 

 

Interest & Dividends

 

 

Inventory

 

 

 

Rents

 

 

Investments

 

 

 

Fund Raising Events

 

 

Land, Buildings, Equip.

 

 

 

Other Revenue

 

 

Other Assets

 

 

 

TOTAL

$

 

TOTAL

$

 

 

(IN LIEU OF THE ABOVE FINANCIAL INFORMATION, A CURRENT TREASURERS REPORT MAY BE SUBSTITUTED, PROVIDED THAT IT PROVIDES SUBSTANTIALLY THE SAME INFORMATION)

CERTIFICATION

NOTE:

At least two different persons, familiar with the financial affairs of the organization, are required to sign.  These parties should be the President and the Chief Financial Officer, other authorized Officer or two Trustees.

Name and Title

Date Signed

 

 

 

Address

 

 

Name and Title

 

Date Signed

Address

 

 

Subscribed and sworn by me this

 

day of

 

, 19

 

A.D.

Notary Public:

 

 

 

(Source:  Added at 24 Ill. Reg. 14684, effective September 21, 2000)

Section 400.APPENDIX A   Charitable Organization Forms

 

Section 400.ILLUSTRATION C   Religious Organization Exemption Form

 

Form CO-3

CHARITABLE ORGANIZATION

JIM RYAN

 

─  RELIGIOUS ORGANIZATION EXEMPTION FORM ─

ATTORNEY GENERAL

 

 

PLEASE TYPE OR PRINT IN INK.  A religious organization seeking an exemption from filing annual reports is required to file this form and the "Charitable Organization Registration Statement" Form CO-1 with the Office of the Attorney General, Charitable Trust and Solicitations Bureau, 100 West Randolph Street, Chicago, Illinois 60601.

 

 

1.

Name, address and telephone number of the organization:

 

 

 

 

2.

Briefly state your purposes as set forth in your charter or By-Laws.

 

 

 

 

 

 

 

 

 

 

 

YES

NO

3.

Are you an organization established for religious purposes?............................................................................

3.

 

 

4.

Are you an agency or affiliate of an organization established for religious purposes?.........................................

4.

 

 

 

If "Yes", state the name and address of the religious organization with which you are affiliated.

 

 

 

 

 

 

 

5.

Do you maintain a house of worship?...........................................................................................................

5.

 

 

 

If "Yes", state the address.

 

 

 

6.

Do you conduct weekly classes in religion or religious services?.....................................................................

6.

 

 

 

If "Yes", where and when are these classes or services held?

 

 

 

7.

Are you affiliated with any regional or national religious denomination or council?...........................................

7.

 

 

 

If "Yes", state the name of said denomination council.

 

 

 

8.

Is your religious organization listed in any official yearbook or denominational directory?.................................

8.

 

 

 

If "Yes", state the title and place of publication of the directory.

 

 

 

 

 

YES

NO

9.

Does your organization have a religious leader?.................................................................................................... 9.

 

 

 

If "Yes", state the leader's name, address, and seminary or university attended, if any, year of ordination, from what higher body, if any, received authority to act.

 

 

 

 

 

 

If "Yes", state whether the organization's spiritual leaders have performed any marriages, burials, baptisms, or other sacerdotal functions for members of the organization within the past year and, if yes, how many?

 

 

 

 

 

 

 

10.

Is solicitation of funds confined to your membership?........................................................................................... 10.

 

 

 

If "No", please describe the method of solicitation.

 

 

 

 

 

 

12.

State any other facts you consider pertinent to the consideration of your exemption request.

 

 

 

 

 

 

 

 

 

I swear under oath that this exemption form and the accompanying registration statement have been examined by me and all information contained therein is true and correct to the best of my knowledge.

 

Signature and Title

 

Date

 

Subscribed and sworn to before me

 

this

 

day of

 

, 19

 

A.D.

 

 

 

Notary Public

 

(Source:  Added at 24 Ill. Reg. 14684, effective September 21, 2000)

 

Section 400.APPENDIX A   Charitable Organization Forms

 

Section 400.ILLUSTRATION D   Annual Report and Instructions

 

For Office Use Only

PMT#

 

 

ILLINOIS CHARITABLE ORGANIZATION ANNUAL REPORT

Form AG990-IL

 

 

 

Attorney General LISA MADIGAN State of Illinois

 

AMT

 

 

Charitable Trust Bureau, 100 West Randolph

 

 

 

 

3rd Floor, Chicago, Illinois  60601

CO

#

INIT

 

 

 

 

 

Check all items attached:

 

 

 

 

Report for the Fiscal Period:

Make checks

Copy of IRS Return

 

 

Beginning

        /         /

 

Payable to

Audited Financial Statements

 

 

& Ending

       /         /

 

the Illinois

Copy of Form IFC

 

 

 

MO

DAY

YR

Charity

$15 Annual Report Filing Fee

 

 

 

Bureau Fund

$100 Late Report Filing Fee

Federal ID

#

 

 

MO   Day  Year

Are contributions to the organization tax deductible?

Yes

No

Date Organization was created:

  /     /     

LEGAL

 

 

Year-end

 

NAME

 

 

amounts

 

MAIL

 

 

A)

ASSETS

A)

$

ADDRESS

 

 

B)

LIABILITIES

B)

$

CITY, STATE

 

 

C)

NET ASSETS

C)

$

ZIP CODE

 

 

 

 

I.

SUMMARY OF ALL REVENUE ITEMS DURING THE YEAR:

PERCENTAGE

AMOUNT

 

D)

PUBLIC SUPPORT, CONTRIBUTIONS & PROGRAM SERVICE REV. (GROSS AMTS.)

%

 

D)

$

 

E)

GOVERNMENT GRANTS & MEMBERSHIP DUES

%

 

E)

$

 

F)

OTHER REVENUES

%

 

F)

$

 

G)

TOTAL REVENUE, INCOME AND CONTRIBUTIONS RECEIVED (ADD D, E, & F)

100%

 

G)

$

II.

SUMMARY OF ALL EXPENDITURES DURING THE YEAR:

 

 

 

H)

OPERATING CHARITABLE PROGRAM EXPENSE

%

 

H)

$

 

I)

EDUCATION PROGRAM SERVICE EXPENSE

%

 

I)

$

 

J)

TOTAL CHARITABLE PROGRAM SERVICE EXPENSE (ADD H & I)

%

 

J)

$

 

J1)

JOINT COSTS ALLOCATED TO PROGRAM SERVICES (INCLUDED IN J):

$

 

 

 

 

K)

GRANTS TO OTHER CHARITABLE ORGANIZATIONS

%

 

K)

$

 

L)

TOTAL CHARITABLE PROGRAM SERVICE EXPENDITURE (ADD J & K)

%

 

L)

$

 

M)

MANAGEMENT AND GENERAL EXPENSE

%

 

M)

$

 

N)

FUNDRAISING EXPENSE

%

 

N)

$

 

O)

TOTAL EXPENDITURES THIS PERIOD (ADD L, M, & N)

100%

 

O)

$

III.

SUMMARY OF ALL PAID FUNDRAISER AND CONSULTANT ACTIVITIES:

 

 

 

(Attach Attorney General Report of Individual Fundraising Campaign Form IFC. One for each PFR.)

 

 

 

PROFESSIONAL FUNDRAISERS:

 

 

 

P)

TOTAL AMOUNT RAISED BY PAID PROFESSIONAL FUNDRAISERS

100%

 

P)

$

 

Q)

TOTAL FUNDRAISERS FEES AND EXPENSES

%

 

Q)

$

 

R)

NET RECEIVED BY THE CHARITY (P MINUS Q=R)

%

 

R)

$

 

PROFESSIONAL FUNDRAISING CONSULTANTS:

 

 

 

 

S)

TOTAL AMOUNT PAID TO PROFESSIONAL FUNDRAISING CONSULTANTS

S)

$

IV.

COMPENSATION TO THE 3 HIGHEST PAID PERSONS DURING THE YEAR:

 

 

T)

NAME, TITLE

 

 

T)

$

 

U)

NAME, TITLE

 

 

U)

$

 

V)

NAME, TITLE

 

 

V)

$

V.

CHARITABLE PROGRAM DESCRIPTION: CHARITABLE PROGRAM (3 HIGHEST BY $ EXPENDED) CODE CATEGORIES

List on back side of instructions CODE

 

W)

DESCRIPTION

 

 

W)

#

 

X)

DESCRIPTION

 

 

X)

#

 

Y)

DESCRIPTION

 

 

Y)

#

 

 

 

 

 

 

 

 

IF THE ANSWER TO ANY OF THE FOLLOWING IS YES, ATTACH A DETAILED EXPLANATION:

YES

NO

1.

WAS THE ORGANIZATION THE SUBJECT OF ANY COURT ACTION, FINE, PENALTY OR JUDGMENT?..................................

1.

 

 

 

 

 

 

 

2.

HAS THE ORGANIZATION OR A CURRENT DIRECTOR, TRUSTEE, OFFICER OR EMPLOYEE THEREOF EVER BEEN CONVICTED BY ANY COURT OF ANY MISDEMEANOR INVOLVING THE MISUSE OR MISAPPROPRIATION OF FUNDS OR ANY FELONY?.........................................................................................................................................................................................................................................................

2.

 

 

 

 

 

 

 

 

 

3.

DID THE ORGANIZATION MAKE A GRANT AWARD OR CONTRIBUTION TO ANY ORGANIZATION IN WHICH ANY OF ITS OFFICERS, DIRECTORS OR TRUSTEES OWNS AN INTEREST;  OR WAS IT A PARTY TO ANY TRANSACTION IN WHICH ANY OF ITS OFFICERS, DIRECTORS OR TRUSTEES HAS A MATERIAL FINANCIAL INTEREST; OR DID ANY OFFICER, DIRECTOR OR TRUSTEE RECEIVE ANYTHING OF VALUE NOT REPORTED AS COMPENSATION?.........................................................................................................................................................................................................................................................

3.

 

 

 

 

 

 

 

 

4.

HAS THE ORGANIZATION INVESTED IN ANY CORPORATE STOCK IN WHICH ANY OFFICER, DIRECTOR OR TRUSTEE OWNS MORE THAN 10% OF THE OUTSTANDING SHARES?.........................................................................................................................................................................................................................................................

4.

 

 

 

 

 

 

 

 

 

5.

IS ANY PROPERTY OF THE ORGANIZATION HELD IN THE NAME OF OR COMMINGLED WITH THE PROPERTY OF ANY OTHER PERSON OR ORGANIZATION?.........................................................................................................................................................................................................................................................

5.

 

 

 

 

 

 

 

 

 

6.

DID THE ORGANIZATION USE THE SERVICES OF A PROFESSIONAL FUNDRAISER? (ATTACH FORM IFC).........................................................................................................................................................................................................................................................

6.

 

 

 

 

 

 

 

7a.

DID THE ORGANIZATION ALLOCATE THE COST OF ANY SOLICITATION MAILING, ADVERTISEMENT OR LITERATURE COSTS BETWEEN PROGRAM SERVICE AND FUNDRAISING EXPENSES?.........................................................................................................................................................................................................................................................

7.

 

 

 

 

 

 

 

 

 

7b.

IF "YES", ENTER (i) THE AGGREGATE AMOUNT OF THESE JOINT COSTS $                             ; (ii) THE AMOUNT ALLOCATED TO PROGRAM SERVICES $                              ; (iii) THE AMOUNT ALLOCATED TO MANAGEMENT AND GENERAL $                               ; AND (iv) THE AMOUNT ALLOCATED TO FUNDRAISING $                                      .

 

 

 

 

 

 

 

 

8.

DID THE ORGANIZATION EXPEND ITS RESTRICTED FUNDS FOR PURPOSES OTHER THAN RESTRICTED PURPOSES?.........................................................................................................................................................................................................................................................

8.

 

 

 

 

 

 

 

 

 

9.

HAS THE ORGANIZATION EVER BEEN REFUSED REGISTRATION OR HAD ITS REGISTRATION OR TAX EXEMPTION SUSPENDED OR REVOKED BY ANY GOVERNMENTAL AGENCY?.........................................................................................................................................................................................................................................................

9.

 

 

 

 

 

 

 

 

 

10.

WAS THERE OR DO YOU HAVE ANY KNOWLEDGE OF ANY KICKBACK, BRIBE, OR ANY THEFT, DEFALCATION, MISAPPROPRIATION, COMMINGLING OR MISUSE OF ORGANIZATIONAL FUNDS?.........................................................................................................................................................................................................................................................

10.

 

 

 

 

 

 

 

 

 

11.

LIST THE NAME, ADDRESS AND THE ACCOUNT # OF THE FINANCIAL INSTITUTIONS WHERE THE ORGANIZATION MAINTAINS ITS THREE LARGEST ACCOUNTS:

 

 

 

 

 

12.

NAME AND TELEPHONE NUMBER OF CONTACT PERSON:

 

 

 

ALL ATTACHMENTS MUST ACCOMPANY THIS REPORT − SEE INSTRUCTIONS

UNDER PENALTY OF PERJURY, I (WE) THE UNDERSIGNED DECLARE AND CERTIFY THAT I (WE) HAVE EXAMINED THIS ANNUAL REPORT AND THE ATTACHED DOCUMENTS, INCLUDING ALL THE SCHEDULES AND STATEMENTS, AND THE FACTS THEREIN STATED ARE TRUE AND COMPLETE AND FILED WITH THE ILLINOIS ATTORNEY GENERAL FOR THE PURPOSE OF HAVING THE PEOPLE OF THE STATE OF ILLINOIS RELY THEREUPON. I HEREBY FURTHER AUTHORIZE AND AGREE TO SUBMIT MYSELF AND THE REGISTRANT HEREBY TO THE JURISDICTION OF THE STATE OF ILLINOIS.

BE SURE TO INCLUDE ALL FEES DUE:

 

1)

REPORTS ARE DUE WITHIN SIX MONTHS OF YOUR FISCAL YEAR END

PRESIDENT or TRUSTEE (PRINT NAME)

SIGNATURE

DATE

2)

FOR FEES DUE, SEE INSTRUCTIONS.

TREASURER or TRUSTEE (PRINT NAME)

SIGNATURE

DATE

3)

REPORTS THAT ARE LATE OR INCOMPLETE ARE SUBJECT TO A $100 PENALTY.

PREPARER (PRINT NAME)

SIGNATURE

DATE

 

Form AG990-IL INS

ILLINOIS CHARITABLE ORGANIZATION

– FORM AG990-IL FILING INSTRUCTIONS –

LISA MADIGAN

ATTORNEY GENERAL

 

A COMPLETE ANNUAL FINANCIAL REPORT (AG990-IL with all required attachments and applicable fees) is due within six months after the organization's fiscal year end.  A REPORT WILL NOT BE CONSIDERED FILED UNLESS IT IS COMPLETE. A COMPLETE ANNUAL FINANCIAL REPORT must include the following items:

 

1.         $15 Annual Filing Fee – Make check or money order payable to "ILLINOIS CHARITY BUREAU FUND."  An annual financial report submitted without proper fees will not be considered filed.  

 

▪    Soliciting Organizations are required to pay a $15 Annual Report Filing Fee if gross contributions are greater than $15,000 or assets are greater than $25,000.

 

▪    Trust Organizations registered under the Charitable Trust Act only are required to pay a $15 Annual Report Filing Fee if gross revenues or assets are greater than $25,000.

 

2.         Form AG990-IL – Complete all sections and line items applicable to the organization.  See 6 below for Simplified Filing Option for Small Organizations.  An annual financial report submitted with an incomplete Form AG990-IL will not be considered filed.

 

A.        CO#:  Include CO# on the Form AG990-IL.  Correct any incorrect name or address information if using preprinted form and highlight any corrections.

 

B.        SIGNATURES:  The Form AG990-IL must be signed by two different officers (president or other authorized officer and the chief fiscal officer) or by two trustees.  One signature shall be accepted if there is only one trustee.  A Form AG990-IL without required signatures is incomplete.

 

C.        Part I, Line D:  Report "contributions" as defined by the Solicitation for Charity Act.  The Solicitation for Charity Act defines "contributions" to include the gross amounts of cash donations as well as gross sums paid by the public for merchandise, special events, rights or services of the organization.  A Form AG990-IL that fails to report "contributions" as defined by the Solicitation for Charity Act is incomplete.  (A complete definition of "contribution" under the Solicitation for Charity Act is shown on the back of these instructions.)

 

D.        Part II, Line J1:  Report all program costs associated with a combined fundraising appeal to the extent such was allocated to Charitable Program Service Expense and entered on line J as Charitable Program Service Expense.  The amount should equal the amount reported on the back of the AG990-IL form, question 7b(ii).  You must have and maintain the documentation to support the allocations made.

 

E.        Part III, Line S:  List all fees paid to all fundraising consultants during the year.  Attach a list of these consultants listing the name and address of the consultant and the total of all fees paid to each.

 

F.        Part V, Lines W, X, Y Program Service Codes:  Select up to three codes from those on the back of these instructions that best describe the program services for which the organization spent funds.

 

3.         IRS Return or Report − IRS form 990 (excluding Schedule B), 990EZ (excluding Schedule B), 990PF, 1041, 1120 or other, must be attached if required by the IRS.  If the organization did not file a Federal return or report, attach explanation.  An annual financial report submitted without the required Federal return or report is incomplete.

 

4.         Audited Financial Statements must be attached by a public charity if contributions exceeded $150,000 or if the public charity raised contributions in excess of $25,000 through the services of a professional fundraiser.  The Solicitation for Charity Act defines contributions to include the gross amounts of cash donations as well as gross sums paid by the public for merchandise, special events, rights or services of the organization.  (A complete definition of "contribution" under the Solicitation for Charity Act is shown on the back of these instructions.)  An annual financial report without required audited financial statements is incomplete.

 

5.         Form IFC Report of Individual Fundraising Campaign – If the organization used a paid professional fundraiser, a separate Form IFC is required for each campaign, and each must be signed by both the professional fundraiser and an officer or director of the organization.  An annual financial report without the required Form IFC is incomplete.

 

6.         Simplified Filing Option for Small Organizations:

 

▪          Soliciting Organizations with gross contributions and assets of $25,000 or less during the fiscal year may file an AG990-IL with all required signatures, disclosing only total revenue, total expenditures, and assets at the fiscal year end (Lines A, G and O of the AG990-IL).  A $15 annual report filing fee is due only if gross contributions were more than $15,000.

 

▪          Trust Organizations registered solely under the Charitable Trust Act with gross revenue and assets of $25,000 or less during the fiscal year may file an AG990-IL with all required signatures, disclosing only total revenue, total expenditures, and assets at the fiscal year end (Lines A, G and O of the AG990-IL). A $15 annual report filing fee is not due.

 

60 DAY EXTENSION and LATE REPORT FILING FEES:

 

▪          A 60 day extension will be granted only upon the filing of a written request with the Attorney General prior to the report due date.

 

▪          If a proper and complete annual report (AG990-IL with all required attachments and applicable fees) or a written extension request is not received prior to the due date, a $100 late report filing fee (checks payable to the "Illinois Charity Bureau Fund") is required by Illinois law.  The report cannot be accepted and will not be considered filed if it is late and the late fee is not paid.

 

Submit the complete annual financial report (AG990-IL with all required attachments and applicable fees) or written extension request to:

 

OFFICE OF THE ATTORNEY GENERAL

CHARITABLE TRUST BUREAU

ATTN:  ANNUAL REPORT SECTION

100 WEST RANDOLPH STREET, 3rd FLOOR

CHICAGO, ILLINOIS  60601-3175

(312)814-2595

 

 

Section 1(b) of the Solicitation for Charity Act defines contributions as follows:

 

"Contribution."  The promise or grant of any money or property of any kind or value, including the promise to pay, except payments by union members of an organization.  Reference to the dollar amount of "contributions" in the Act means, in the case of promises to pay, or payments for merchandise or rights of any other description, the value of the total amount promised to be paid or paid for such merchandise or rights and not merely that portion of the purchase price to be applied to a charitable purpose.  Contribution shall not include the proceeds from the sale of admission tickets by any not-for-profit music or dramatic arts organization that establishes, by such proof as the Attorney General may require, that it has received an exemption under Section 501(c)(3) of the Internal Revenue Code (26 USC 501 et seq.) and which is organized and operated for the presentation of live public performances of musical or theatrical works on a regular basis.  For purposes of this definition, union member dues and donated services shall not be deemed contributions. (See 225 ILCS 460/1(b).)

 

Part V, Lines W, X, Y Program Service Codes:

 

Charitable activity code numbers (select up to three codes which best describe the activity and/or the program service for which your organization expends funds).  Enter in Part V of the first page of the AG990-IL.  Enter first the code which most accurately identifies you.

 

 

SCHOOLS

 

PUBLIC POLICY

 

001

Pre-School

100

Legislative and Political Activities

 

002

Elementary or High Schools

101

Lobbying & Advocacy

 

003

College & Universities

102

Consumer Interest Group (non-education)

 

004

Trade Schools, Vocational Schools & Job Training

103

Peace

 

 

104

Other Public Policy

 

 

PUBLIC EDUCATION OTHER THAN SCHOOLS

 

 

010

Public Education by Mail

 

HUMAN SERVICES

 

011

Seminars and Conferences

110

Day Care Centers

 

012

Other Educational Materials for the Public

111

Family and Individual Services

 

 

112

Neighborhood and Community Development

 

 

RELIGIOUS ACTIVITIES

113

Nursing Services (i.e., Home Care)

 

020

Church, Synagogue, etc.

114

Programs for Minority Advocacy

 

021

Missionary Activities

115

Programs for Needy Children

 

 

 

116

Rescue and Emergency Service

 

 

CULTURAL AND HISTORICAL

117

Services for the Aged

 

030

Performing Arts (Ballet, Symphony, Theatre)

118

Services for Alcohol or Drug Abuse

 

031

Art and/or Literature

119

Services for Blind Adults

 

032

Museum

120

Services for Blind Children

 

033

Library

121

Services for Developmentally Disabled Adults

 

034

Historical Societies

122

Services for Developmentally Disabled Children

 

 

 

123

Services for Handicapped Adults

 

 

RECREATIONAL & SOCIAL ACTIVITIES

124

Services for Handicapped Children

 

040

Youth

125

Services for the Hearing Impaired

 

041

Adult

126

Services for the Poor

 

042

Music Groups & Youth Bands

127

Services for Veterans

 

043

Youth Clubs (i.e., Boy Scouts, Girl Scouts, 4-H, Boys Club, etc.)

 

044

Community Recreational Facilities

 

HOUSING

 

 

 

130

Housing for Youth

 

 

RESEARCH

131

Housing for the Poor

 

050

Scientific Research

132

Housing for the Aged

 

051

Heart Disease Research

133

Women Shelter

 

052

Cancer Research

134

Housing for the Disabled

 

053

Other Medical and Disease Research

 

 

 

 

 

BENEFITTING PUBLIC SAFETY EMPLOYEES & FAMILY

 

HEALTH FACILITIES

140

Firemen & Families

 

060

Hospitals

141

Law Enforcement Personnel & Families

 

061

Nursing Homes

 

062

Health Clinics

 

ACTIVITIES INVOLVING OTHER ORGANIZATIONS

 

063

HMO

150

Grants to Other Charitable Organizations

 

064

Hospice

151

Furnished Services or Facilities to Other Organizations

 

 

 

152

Umbrella/Parent Organization

 

 

ANIMAL WELFARE

 

 

 

070

Animal Shelter, Humane Society and/or Anti-cruelty Society

 

OTHER PROGRAM SERVICES

 

071

Wildlife Preservation & Shelter for Wildlife

200

Scholarships and Student loans

 

 

 

 

 

 

 

ENVIRONMENT

 

MISCELLANEOUS PROGRAM SERVICES

 

080

Preservation/Conservation of Natural Resources

300

(Write in Description)

 

081

Prevention of Pollution

 

 

 

 

 

CIVIC ACTIVITIES

 

090

Legal Services and Legal Aid

 

091

Civil Rights Activities

 

 

(Source:  Amended at 29 Ill. Reg. 11775, effective July 15, 2005)

Section 400.APPENDIX A   Charitable Organization Forms

 

Section 400.ILLUSTRATION E   Report of Individual Fundraising Campaign

 

Form IFC

REPORT OF INDIVIDUAL

JIM RYAN

 

FUNDRAISING CAMPAIGN

ATTORNEY GENERAL

 

 

 

 

 

 

 

 

CHARITY:

 

 

 

 

 

 

 

Name

 

Campaign Beginning

and Ending

Mailing Address

 

CO#  1

 

City, State, Zip Code

 

Phone #

Contact Person

 

Title

Phone #

 

 

 

 

PROFESSIONAL FUND RAISER (PFR)

 

 

 

 

 

 

Name

 

PFR #02

 

 

NATURE OF FUNDRAISING ACTIVTY:

 

 

 

 

 

 

 

A.

Amount received by the charitable organization ........................................................... A.

$

 

 

 

 

 

 

 

 

PAID BY:

 

B.

Expenses:

 

PFR

Charity

 

 

1.

Professional Fundraiser Fee................. 1.

 

 

 

 

2.

Solicitor Compensation....................... 2.

 

 

 

 

3.

Salaries.............................................. 3.

 

 

 

 

4.

Printing.............................................. 4.

 

 

 

 

5.

Postage.............................................. 5.

 

 

 

 

6.

Telephone.......................................... 6.

 

 

 

 

7.

Rent & Utilities.................................. 7.

 

 

 

 

8.

Supplies............................................. 8.

 

 

 

 

9.

Travel................................................ 9.

 

 

 

 

10.

 

10.

 

 

 

 

11.

 

11.

 

 

 

 

12.

 

12.

 

 

 

 

13.

TOTAL EXPENSES (PFR + Charity)............. 13.

 

 

.............. B.

$

 

C.

Total Amount Raised........................................................................................................... C.

$

 

D.

Percentage of funds received by charity (Line A divided by Line C)......................................... D.

 

%

E

Bank and account number where funds are deposited?

 

F.

Who (charity or PFR) has signature control of the account(s) listed above?

 

F.

Attach a schedule explaining, in detail, how expenses are allocated between fundraising campaigns

 

 

 

 

 

We the undersigned, declare and certify under perjury that we have examined this report, including all the schedules, and statements, and the facts therein stated are true and complete and filed with the Illinois Attorney General for the purpose of having the people of the State of Illinois rely thereupon.

 

 

 

 

 

PFR CAMPGAIN

 

 

MANAGER (Print Name)

 

TITLE

SIGNATURE

 

DATE

 

 

 

 

 

OFFICE DIRECTOR

 

 

 

OF CHARITY (Print Name)

 

TITLE

SIGNATURE

 

DATE

 

(Source:  Added at 24 Ill. Reg. 14684, effective September 21, 2000)

Section 400.APPENDIX B   Professional Fund Raiser Forms

 

Section 400.ILLUSTRATION A   Registration Statement and Instructions

 

Form PFR-01

PROFESSONAL FUND RAISER

REGISTRATION STATEMENT

JIM RYAN

ATTORNEY GENERAL

 

 

 

 

For Fiscal Year July 1, ___Through June 30, ___

 

 

1. □ A NEW REGISTATION   □  RE REGISTRATION   □  CHANGE   □  ADDITION AS OF

       /         /

2. □ INDIVIDUAL □ PARTNERSHIP or □ CORPORATION Attach: Partnership Agreement or Articles of Incorporation

 

NAME of REGISTRANT

PFR NUMBER

02-

ADDRESS

PHONE NUMBER

(           )           -     

CITY, STATE, ZIP CODE

FEDERAL ID NUMBER

            -        

 

3.  NAME OF CHIEF MANAGEMENT PERSON(S)

 

TITLE

 

(Attach Schedules as needed)

 

TITLE

 

 

 

4.  NAME & ADDRESS OF ILLINOIS REGISTERED AGENT: (Address must be a street address for service)

 

Name:

 

Address:

 

 

 

5.  LIST ALL PRINCIPAL PARTIES, OFFICERS, DIRECTOR, EXECUTIVE PERSONNEL, AND OWNERS OF TEN PERCENT OR MORE OF THE CAPITAL STOCK (ATTACH SCHEDULE as needed INDICATING NAME, STREET ADDRESS, TITLE, % OF INTEREST, BIRTH DATE, DRIVERS LICENSE #, STATE OF ISSUE for each person listed).

 

Name

Title

Name

Title

Address

Address

□ Officer □ Director □ Executive Employee

□ Officer □ Director □ Executive Employee

□ Owner ____%

Birth Date

/       /

 

□ Owner ____%

Birth Date

/       /

 

Drivers License #

 

State

 

 

Drivers License #

 

State

 

 

 

 

 

 

Name

Title

Name

Title

Address

Address

□ Of ricer □ Director □ Executive Employee

□ Officer □ Director □ Executive Employee

□ Owner ____%

Birth Date

/       /

 

□ On nor ____%

Birth Date

/       /

 

Drivers License #

 

State

 

 

Drivers License #

 

State

 

 

 

 

 

 

 

6.  WERE ALL PROFESSIONAL SOLICITORS FURNISHED A 1099 OR W2 LAST YEAR?          □ Yes □ No

IF NO, EXPLAIN IN DETAIL.  COMPLETE AND ATTACH FORM PS-01.

 

7.  HAVE ANY OF THE FIRM'S PRINCIPAL PARTIES, EMPLOYEES, OFFICERS, DIRECTORS, EXECUTIVE PERSONNEL, OWNERS OF TEN PERCENT OR MORE OF THE CAPITAL STOCK OR THEIR RELATIONS EVER BEEN CONVICTED OF A MISDEMEANOR INVOLVING THE MISAPPROPRIATION OR MISUSE OF MONEY OF ANOTHER, OR OF ANY FELONY?   □ Yes  □ No

 

IF "YES", INDICATE WHO WAS CONVICTED, THE NATURE of OFFENSE, DATE of CONVICTION, and NAME and ADDRESS of COURT.

 

 

 

8.  LIST THE INTEREST OF ALL PRINCIPAL PARTIES, OFFICERS, DIRECTORS, EXECUTIVE PERSONNEL, OWNERS OF REGISTRANT AND THEIR FAMILY MEMBERS IN ANY OTHER FIRMS PROVIDING GOODS OR SERVICES USED IN FUND RAISING.

 

NATURE OF BUSINESS

NAME OF PARTY

%  INTEREST

NAME & STREET ADDRESS OF BUSINESS

 

 

 

9.  COMPLETE & ATTACH FORM PFR-06 FOR ALL CHARITIES HAVING CONTRACTS WITH PFR.

 

ATTACH THE FOLLOWING AS A PART OF REGISTRATION AND INDICATE BY AN "X" THOSE ATTACHED:

 

□            Partnership Agreement or Articles of Incorporation of professional Fund Raiser (PFR).

□            Certificate of Authority to Transact Business in Illinois (Out of state PFRs only).

□            Form CS-6 (PFR Bond).

□            Form PFR-06 (List of Charities for whom fund Raising services are to be provided.).

□            Form PS-01 (For all Solicitors employed by PFR).

□            List all business locations, other than above, used for fundraising. (attach a schedule indicating street address, city, state).

□            All schedules and explanations for any of the above questions.

□            Copies of all Fund Raising Contracts with Charities including Amendments, and Extensions.

 

NOTE: VERIFICATION MUST BE BY THE CORPORATE PRESIDENT, A GENERAL PARTNER OR THE SOLE PROPRIETOR

 

STATE OF

 

)

SS

AFFIDAVIT

COUNTY OF

 

)

I,

 

under penalty of perjury and being sworn on oath state that I am

(strike out) the CORPORATE PRESIDENT, a GENERAL PARTNER or the SOLE PROPRIETOR of the registrant professional fund raiser.

 

I have read the forgoing registration statement and personally know the contents thereof to be true, and each and every attachment, attached form and attached schedule, the content thereof as stated by me and filed by me with the Illinois Attorney General for the purpose of having the people of the State of Illinois rely thereupon. I herebv further authorize and agree to submit myself and the registrant hereby to the jurisdiction of the State of Illinois.

 

Subscribed and sworn to before me.

This

 

day of

 

, 19

 

 

 

 

(Signature)

 

 

 

Notary Public

 

(Print Name & Title)

Attach as many copies of this form and all schedules needed to complete your registration.

Send completed registration to:

Attorney General's Office, Charitable Trust Bureau, 100 West Randolph, 3rd Floor, Chicago, Illinois 60601

 

 

DOCUMENTS A PROFESSIONAL FUND RAISER MUST SUBMIT TO REGISTER

WITH THE ILLINOIS ATTORNEY GENERAL'S OFFICE

 

ALL PROFESSIONAL FUND RAISERS MUST SUBMIT:

 

1.       $100.00 Registration Fee. Check or Money Order payable to "Illinois Charity Bureau Fund" attached to Form PFR-01.

 

2.       "Professional Fund Raiser Registration Statement" (Form PFR-01).

 

3.       "Professional Fund Raiser (PFR) List of Charities & Contracts" (Form PFR-06).

 

4.       A copy of all contracts listed on Form PFR-06 along with the $25.00 Annual Filing Fee for Each Contract Filed or on File.  Check or Money Order payable to the "Illinois Charity Bureau Fund" attached to Form PFR-06.

 

5.       "Professional Fund Raisers Bond" (Form CS-6)  This Form must be filed by all Professional Fund Raisers that have access to or control of funds raised.

 

6.       "Professional Solicitor Registration Statement" (Form PS-01)  This Form must be filed for each Solicitor employed by the PFR.

 

7.       Partnership Agreement or Articles of Incorporation of Professional Fund Raiser.

 

8.       Certificate of Authority to Transact Business in Illinois.  This must be filed by out of state corporations only.

 

9.       List of all business locations used for fund raising. (Attach a schedule indicating street address, city, state).

 

Direct the above registration materials, including all required fees payable to the "Illinois Charity Bureau Fund" to:

 

Office of the Attorney General

Charitable Compliance Section

100 West Randolph Street, 3rd Floor

Chicago, Illinois  60601

(312) 814-2595

 

Note:  Registrations and contracts not filed timely must by law pay a late filing fee of $1,000.00 for each contract that is not on file with this office.

 

(Source:  Added at 24 Ill. Reg. 14684, effective September 21, 2000)

Section 400.APPENDIX B   Professional Fund Raiser Forms

 

Section 400.ILLUSTRATION B   List of Charities and Contracts

 

FORM PFR-06

PROFESSIONAL FUND RAISER (PFR)

JIM RYAN

 

LIST OF CHARITIES & CONTRACTS

ATTORNEY GENERAL

Attachment

For Whom Fund Raising Services Are to be Provided

 

 

 

 

PFR NAME __________________________________________________________PFR # 02-________________

MANAGEMENT PERSON(S) WHO PREPARE THIS FORM. _________________________________________

 

SUBMIT A COPY OF EACH CONTRACT WITH REGISTRATION.

LIST CHARITIES FOR WHOM FUNDRAISTNG SERVICES ARE TO BE PROVIDED.

PROVIDE the following BANK ACCOUNT INFORMATION FOR ALL ACCOUNTS USED TO DEPOSIT FUNDS SOLICITED FOR OR ON BEHALF OF EACH CHARITY LISTED:

 

Contract Info:

Charity Name, City, State:

Contract

Contract Date:   ___/___/___

CO#

 

Terms:

Beginning:         ___/___/___

01- ________ _________

 

 

Ending:             ___/___/___

Bank Account

Name of Bank:

Signatory Control of Bank Acct:

Information:

Address of Bank:

 PFR  Charity  Escrow/Caging

 

Acct. #

 Other describe:__________________

Contract Info:

Charity Name, City, State:

Contract

Contract Date:   ___/___/___

CO#

 

Terms

Beginning:         ___/___/___

01-________ _________

 

 

Ending:             ___/___/___

Bank Account

Name of Bank:

Signatory Control of Bank Acct:

Information:

Address of Bank:

 PFR  Charity  Escrow/Caging

 

Acct. #

 Other Describe:_________________

Contract Info:

Charity Name, City, State:

Contract

Contract Date:    ___/___/___

CO#

 

Terms:

Beginning:         ___/___/___

01-________ _________

 

 

Ending:             ___/___/___

Bank Account

Name of Bank:

Signatory Control of Bank Acct:

Information:

Address of Bank:

 PFR  Charity  Escrow/Caging

 

Acct. #

 Other Describe:_________________

Contract Info:

Charity Name, City, State:

Contract

Contract Date:   ___/___/___

CO#

 

Terms:

Beginning:         ___/___/___

01-________ _________

 

 

Ending:             ___/___/___

Bank Account

Name of Bank:

Signatory Control of Bank Acct:

Information:

Address of Bank:

 PFR  Charity  Escrow/Caging

 

Acct. #

 Other Describe:_________________

Contract Info:

Charity Name, City, State:

Contract

Contract Date:    ___/___/___

CO#

 

Terms:

Beginning          ___/___/___

01-________ _________

 

 

Ending:             ___/___/___ 

Bank Account

Name of Bank:

Signatory Control of Bank Acct:

Information:

Address of Bank:

 PFR  Charity  Escrow/Caging

 

Acct. #

 Other Describe:_________________

 

 

 

COMPLETE AS MANY COPIES OF FORM PFR-06 AS NEEDED TO LIST ALL CHARITIES FOR WHICH FUND RAISING SERVICES ARE TO BE PROVIDED. A COMPLETED COPY OF THIS FORM MUST BE SUBMITTED WITH EACH NEW CONTRACT FILED.

 

 

Contract Info:

Charity Name, City, State:

Contract

Contract Date:    ___/___/___

CO#

 

Terms:

Beginning:         ___/___/___

01-________ _________

 

 

Ending:              ___/___/___

Bank Account:

Name of Bank:

Signatory Control of Bank Acct:

Information:

Address of Bank:

 PFR  Charity  Escrow/Caging

 

Acct #

 Other Describe:

Contract Info:

Charity Name, City, State:

Contract

Contract Date:    ___/___/___

CO#

 

Terms:

Beginning:         ___/___/___

01-________ _________

 

 

Ending:              ___/___/___

Bank Account:

Name of Bank:

Signatory Control of Bank Acct:

Information:

Address of Bank:

 PFR  Charity  Escrow/Caging

 

Acct #

 Other Describe:

Contract Info:

Charity Name, City, State:

Contract

Contract Date:    ___/___/___

CO#

 

Terms:

Beginning:         ___/___/___

01-________ _________

 

 

Ending:              ___/___/___

Bank Account

Name of Bank:

Signatory Control of Bank Acct:

Information:

Address of Bank:

 PFR  Charity  Escrow/Caging

 

Acct #

 Other Describe:

Contract Info:

Charity Name, City, State:

Contract

Contract Date:    ___/___/___

CO#

 

Terms:

Beginning:          ___/___/___

01-________ _________

 

 

Ending:              ___/___/___

Bank Account

Name of Bank:

Signatory Control of Bank Acct:

Information:

Address of Bank:

 PFR  Charity  Escrow/Caging

 

Acct #

 Other Describe:

Contract Info:

Charity Name, City, State:

Contract

Contract Date:    ___/___/___

CO#

 

Terms:

Beginning:         ___/___/___

01-________ _________

 

 

Ending:              ___/___/___

Bank Account

Name of Bank:

Signatory Control of Bank Acct:

Information:

Address of Bank:

 PFR  Charity  Escrow/Caging

 

Acct #

 Other Describe:

Contract Info:

Charity Name, City, State:

Contract

Contract Date:    ___/___/___

CO#

 

Terms:

Beginning:         ___/___/___

01-________ _________

 

 

Ending:              ___/___/___

Bank Account

Name of Bank:

Signatory Control of Bank Acct:

Information:

Address of Bank:

 PFR  Charity  Escrow/Caging

 

Acct #

 Other Describe:

Contract Info:

Charity Name, City, State:

Contract

Contract Date:    ___/___/___

CO#

 

Terms:

Beginning:         ___/___/___

01-________ _________

 

 

Ending:              ___/___/___

Bank Account

Name of Bank:

Signatory Control of Bank Acct:

Information:

Address of Bank:

 PFR  Charity  Escrow/Caging

 

Acct #

 Other Describe:

 

(Source:  Added at 24 Ill. Reg. 14684, effective September 21, 2000)

Section 400.APPENDIX B   Professional Fund Raiser Forms

 

Section 400.ILLUSTRATION C   Bond

 

Form CS-6

JIM RYAN

ATTORNEY GENERAL

Professional Fund Raiser's Bond

PLEASE TYPE or PRINT IN INK

KNOW ALL MEN BY THESE PRESENTS

That we,

 

 

of

 

 

as Principal and

 

 

as surety, are held and firmly bound unto the Attorney General of the State of Illinois, for the use of the State of Illinois, and to any person who may have a cause of action against the Principal for any malfeasance or misfeasance in the conduct of solicitation by the Principal as a Professional Fund Raiser, in the sum of TEN THOUSAND DOLLARS ($10,000), lawful money of the United States of America to be paid to the Attorney General of the State of Illinois for the use of the State of Illinois, and for charitable purposes, and to any persons who may have a cause of action against the Principal for any malfeasance or  misfeasance in the conduct of solicitation by the Principal as a Professional Fund Raiser, as their interests may appear, not exceeding in the aggregate and said sum of TEN THOUSAND DOLLARS ($10,000), for  which payment well and truly to be made we bind ourselves, our heirs, executors, administrators, successors and assigns, jointly and severally by these presents.

 

WHEREAS, the above bounden Principal has applied to the Attorney General of the State of Illinois for registration as a Professional Fund Raiser for the purpose of acting as a Professional Fund Raiser for a charitable organization required to register with the Attorney General of the State of Illinois pursuant to Section 6 of "An Act to Regulate Solicitation and Collection of Funds for Charitable Purposes" of the Sate of Illinois and the acts amendatory thereof and supplemental thereto.

 

NOW, the condition of this obligation is such,

 

That if the Attorney General of the State of Illinois does register the above bounden Principal as such Professional Fund Raiser and said Principal faithfully and honestly acts as such Professional Fund Raiser in accordance with law, and fully complies with the provisions of "An Act to Regulate Solicitation and Collection of Funds for Charitable Purposes" of the Sate of Illinois and the acts amendatory thereof and supplemental thereto, and the Principal shall fully indemnify and save harmless from loss of the State of Illinois and any person who may have a cause of action against the Principal for any malfeasance or misfeasance in the conduct of solicitation as such Professional Fund Raiser, then this obligation to be void, otherwise to remain in full force and virtue.

 

 

 

 

This bond shall not become void upon the first recovery thereon but may be sued upon from time to time until the full amount shall have been exhausted.

 

THIS BOND IS A SEPARATE BOND AND NOT A CONTINUATION OF A PREVIOUSLY ISSUED BOND.

 

 

This bond is to cover all claims arising on account of the solicitation activities of the Principal and his acting as such Professional Fund Raiser

for the full term here beginning on

 

,  19

 

and expiring on the 30th day of the next June.

In Witness Whereof we have hereunto set our hands and seals this

 

day of

 

 ,  19

 

 

 

(SEAL)

Principal

 

Surety

BY:

 

 

ACKNOWLEDGMENT OF INDIVIDUAL

 

STATE OF

 

)

SS

COUNTY OF

 

)

On this

 

day of

 

,      19

 

before me personally came

 

,  to me known and known to me to be the individual described in

and who executed the foregoing instrument, and he acknowledged to me that he executed the same.

 

 

 

Notary

 

ACKNOWLEDGEMENT OF PARTNERSHIP

 

STATE OF

 

)

SS

COUNTY OF

 

)

On this

 

day of

 

,     19

 

before me personally came

 

, to me known and known to me to be a partner in the partnership of

 

and the person described in and who executed the foregoing instrument in the

partnership name of

 

, and he duly acknowledged to me that

he executed the same as and for  the act and deed of said partnership.

 

 

 

Notary

 

ACKNOWLEDGEMENT OF CORPORATON

 

STATE OF

 

)

SS

COUNTY OF

 

)

On this

 

day of

 

, 19

 

before me personally came

 

, to me known, who being by me duly sworn, did depose and say that

he resides in

 

, that he is the

 

of the corporation:

that seal affixed of said instrument  in such corporate seal; that it was affixed  by order of the Board of Directors of said corporation

and that he signed his name thereto by like order.

 

 

 

Notary

NOTE:  If acknowledgment is made outside the State of Illinois, a certificate of the County Clerk or other proper official, showing authority of the notary public or other official before whom acknowledgment is made, should be attached.

 

(Source:  Added at 24 Ill. Reg. 14684, effective September 21, 2000)

Section 400.APPENDIX B   Professional Fund Raiser Forms

 

Section 400.ILLUSTRATION D   Annual Financial Report

 

Form PFR-02

PROFESSIONAL FUND RAISER ANNUAL FINANCIAL REPORT

JIM RYAN

ATTORNEY GENERAL

 

THIS MUST BE FILED BY

 

 

FILE AT:  Office of the Attorney General, Charitable Trust and Solicitations Bureau, 100 West Randolph Street, Chicago, Illinois 60601

GENERAL INSTRUCTIONS (FURTHER INSTRUCTIONS AT END OF FORM)

PLEASE TYPE OR PRINT IN BLACK INK

A.

RESPOND TO ALL ITEMS ON THIS FORM.

B.

CHANGES OF OR ADDITIONS TO THE INFORMATION IN THIS STATEMENT MUST BE SUBMITTED IN THIS FORMAT.

C.

ANNUAL REPORT (CHECK ONE):

 

 

PREPARED ON ACCRUAL BASIS 

PREPARED ON A CASH BASIS 

OR PREPARED BY ANOTHER METHOD 

 

IF PREPARED BY ANOTHER METHOD EXPLAIN:

 

 

 

LEGAL NAME

 

REGISTERED FOR FISCAL YEAR

MAIL ADDRESS

 

ENDED JUNE 30,

 

AS

CITY

 

PFR# 02-

 

 

STATE, ZIP CODE

 

FEDERAL ID NUMBER

 

PHONE NUMBER

(             )

 

 

 

 

 

 

 

REPORT IS FOR PERIOD BEGINNING JANUARY 1,

 

AND ENDING

 

 

CHARITIES FOR WHOM FUNDS WERE RAISED

(A)

AMOUNT TO

CHARITY

(B)

SOLICITATION

EXPENSES

(C))

TOTAL AMOUNT RAISED

(D)

% = A/C

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

TOTAL FOR ALL CHARITABLE FUNDRAISING BY PFR:

 

 

 

 

TOTAL NUMBER OF CHARITIES BEING REPORTED

 

 

 

Note:  Verification must be by the Corporate President, a General Partner or the Sole Proprietor

STATE OF

 

}

SS

AFFIDAVIT

COUNTY OF

 

 

I,

 

, under penalty of perjury and being sworn on oath that I am (circle one) the

corporate president, a general partner or the sole proprietor of the registered professional fundraiser.

(Name of PFR)________________________________

, have read this annual report including all attachments and personally

know the contents thereof to be true, and such is stated herein and filed with the Illinois Attorney General for the purpose of having the people of the State of Illinois rely thereupon.  I hereby further authorize and agree to submit myself and the registrant hereby to be jurisdiction of the State of Illinois.

Subscribed and sworn to

before me, this

 

 

 

 

(Signature)

day of

 

19

 

.

 

 

NOTARY PUBLIC

 

 

 

(Source:  Added at 24 Ill. Reg. 14684, effective September 21, 2000)

Section 400.APPENDIX B   Professional Fund Raiser Forms

 

Section 400.ILLUSTRATION E   Report of Individual Fundraising Campaign

 

Form IFC

REPORT OF INDIVIDUAL

JIM RYAN

 

FUNDRAISING CAMPAIGN

ATTORNEY GENERAL

CHARITY:

Name

Campaign Beginning

and Ending

Mailing Address

 

CO# 01-

 

City, State, Zip Code

 

Phone #

Contact Person

 

Title

Phone #

PROFESSIONAL FUND RAISER (PFR):

 

 

Name

 

PFR #02-

NATURE OF FUNDRAISING ACTIVTY:

 

 

 

 

 

A.

Amount received by the charitable organization .......................................................... A.

$

 

 

 

PAID BY:

 

B.

Expenses:

PFR

Charity

 

 

1.

Professional Fundraiser Fee................. 1.

 

 

 

 

2.

Solicitor Compensation....................... 2.

 

 

 

 

3.

Salaries.............................................. 3.

 

 

 

 

4.

Printing.............................................. 4.

 

 

 

 

5.

Postage.............................................. 5.

 

 

 

 

6.

Telephone.......................................... 6.

 

 

 

 

7.

Rent & Utilities.................................. 7.

 

 

 

 

8.

Supplies............................................. 8.

 

 

 

 

9.

Travel................................................ 9.

 

 

 

 

10.

 

10.

 

 

 

 

11.

 

11.

 

 

 

 

12.

 

12.

 

 

 

 

13.

TOTAL EXPENSES (PFR + Charity)............. 13.

 

 

         B.

$

C.

Total Amount Raised.................................................................................................. C.

$

D.

Percentage of funds received by charity (Line A divided by Line C)................................ D.

%

E.

Bank and account number where funds are deposited?

 

F.

Who (charity or PFR) has signature control of the account(s) listed above?

 

F.

Attach a schedule explaining, in detail, how expenses are allocated between fundraising campaigns.

We, the undersigned, declare and certify under perjury that we have examined this report, including all the schedules, and statements, and the facts therein stated are true and complete and filed with the Illinois Attorney General for the purpose of having the people of the State of Illinois rely thereupon.

PFR CAMPGAIN

MANAGER (Print Name)

TITLE

SIGNATURE

DATE

OFFICER, DIRECTOR

OF CHARITY (Print Name)

TITLE

SIGNATURE

 

DATE

 

 

(Source:  Added at 24 Ill. Reg. 14684, effective September 21, 2000)

Section 400.APPENDIX B   Professional Fund Raiser Forms

 

Section 400.ILLUSTRATION F   Professional Solicitor Compensation Report

 

Form PFR-04

PROFESSIONAL SOLICITOR

JIM RYAN

 

 

COMPENSATION REPORT

 

ATTORNEY GENERAL

 

 

 

 

 

 

FOR THE PERIOD ENDING

 

 

PFR NAME:

 

 

 

PFR #02-

 

 

CHANGES OF OR ADDITIONS TO THE INFORMATION IN THIS STATEMENT MUST BE SUBMITTED IN THIS FORMAT.

1.

LIST ALL SOLICITORS EMPLOYED BY YOU DURING THE PERIOD COVERED BY YOUR ANNUAL FINANCIAL REPORT:

PROFESSIONAL SOLICITOR NAME  & ADDRESS

SOCIAL SECURITY #

AREA CODE/

TELEPHONE #

AMOUNT PAID

HOURS

WORKED

ADDRESS:

 

 

 

 

 

 

 

 

 

 

 

ADDRESS

 

 

 

 

 

 

 

 

 

 

 

ADDRESS

 

 

 

 

 

 

 

 

 

 

 

ADDRESS

 

 

 

 

 

 

 

 

 

 

 

ADDRESS

 

 

 

 

 

 

 

 

 

 

 

ADDRESS

 

 

 

 

 

 

 

 

 

 

 

ADDRESS

 

 

 

 

 

 

 

 

 

 

 

ADDRESS

 

 

 

 

 

 

 

 

 

 

 

ADDRESS

 

 

 

 

 

2.

TOTAL NUMBER OF SOLICITORS EMPLOYED:

 

 

3.

TOTAL AMOUNT PAID TO ALL SOLICITORS EMPLOYED DURING THIS PERIOD:

$

 

 

4.

TOTAL NUMBER OF MAN HOURS WORKED BY PROFESSIONAL SOLICITORS DURING THIS PERIOD:

 

 

5.    DESCRIBE IN DETAIL HOW SOLICITORS ARE PAID. PROVIDE INFORMATION DESCRIBING THE SALARY STRUCTURE OF ALL PROFESSIONAL SOLICITORS EMPLOYED BY YOU DURING THIS PERIOD (I.E. HOURLY RATE, COMMISSION, SALARY, OTHER):

 

 

 

 

 

 

 

 

 

 

 

6.    WERE ALL PROFESSIONAL SOLICITORS FURNISHED A 1099 OR A W2 LAST YEAR?  YES     NO

IF NO, EXPLAIN IN DETAIL:

 

 

 

7.    WERE ALL PROFESSIONAL SOLICITORS EMPLOYED BY YOU REGISTERED WITH THE ILLINOIS ATTORNEY GENERAL:

 

YES 

NO 

IF NO, EXPLAIN:

 

 

 

 

PAGE _____ OF _____ PAGES

 

(Source:  Added at 24 Ill. Reg. 14684, effective September 21, 2000)

Section 400.APPENDIX B   Professional Fund Raiser Forms

 

Section 400.ILLUSTRATION G   Explanation of Professional Fundraising Fees

 

Form PFR-05

EXPLANATION OF

JIM RYAN

 

PROFESSIONAL FUNDRAISING FEES

ATTORNEY GENERAL

 

FOR THE PERIOD ENDING

 

 

PFR NAME:

PFR #02

 

1.             GIVE DETAILED DESCRIPTION OF THE SERVICES RENDERED FOR CAMPAIGN, DRIVE, OR EVENT HELD OR ORGANIZED BY YOUR ORGANIZATION FOR THE PURPOSE OF RAISING FUNDS FOR A CHARITABLE ORGANZATION:

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

2.             GIVE A DETAILED DESCRIPTION OF THE BASIS USED TO DETERMINE YOUR OWN ORGANIZATION'S COMPENSATION FOR SERVICES RENDERED ON EACH FUNDRAISING CAMPAIGN HELD OR ORGANIZED BY YOUR ORGANIZATION (I.E. PERCENTAGE OF FUNDS RAISED, TIME SPENT, RESOURCES USED, ETC.) (SEE CONTRACT IS NOT ACCEPTABLE):

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

(Source:  Added at 24 Ill. Reg. 14684, effective September 21, 2000)

Section 400.APPENDIX C   Professional Solicitor Forms

 

Section 400.ILLUSTRATION A   Registration Statement

 

Form PS-01

PROFESSIONAL  SOLICITOR

-REGISTRATION  STATEMENT-

JIM RYAN

ATTORNEY GENERAL

PLEASE TYPE OR PRINT IN BLACK INK.  Respond to all items. If unable to answer in space provided attach a schedule in the same format.  Changes of or additions to the information in this statement are to be submitted in this format.  Due to the  large volume of reports and registrations handled by this division, we will not consider a partial registration.  This form must be complete and accompanied by any supporting documents.  A copy of this form must be retained by the Professional Fund Raiser who intends to employ this party.  One copy of this Registration Statement and attachments are to be filed with the Attorney General's Office, Charitable Trust and Solicitations Bureau,  100 West Randolph Street, Chicago, Illinois 60601.

1.

THIS IS A (CHECK ONE and DATE):

 

 

NEW REGISTRATION    REREGISTRATION    CHANGE    ADDITION , AS OF

          /       /             

 

2.

LEGAL NAME

REGISTRATION/REREGISTRATION

 

 

For Fiscal Year Ending June 30,  ______

3.

MAIL ADDRESS

PFR NUMBER

 

 

02-

 

CITY, STATE, ZIP CODE

PHONE NUMBER

SOCIAL SECURITY NUMBER

 

 

 

4.

This PROFESSIONAL SOLICITOR intends to be employed by (PFR)

 

 

 

(NAME OF PFR)

5.

A STREET ADDRESS (if different than above)

 

 

 

 

6.

BIRTH DATE

      /        /      

DRIVER'S LICENSE NO.

 

STATE OF ISSUE

 

7.

IF THE ADDRESS ABOVE IS NOT IN ILLINOIS, LIST PRINCIPAL ILLINOIS ADDRESS, IF ANY, A STREET ADDRESS ONLY (NOT A P.O. BOX)

 

 

8.

LIST NAME AND DAYTIME TELEPHONE NUMBER OF A FAMILY MEMBER OR ANOTHER PERSON WHO CAN CONTACT YOU IN THE EVENT YOU ARE NO LONGER AT THE ABOVE ADDRESS.

 

 

RELATIONSHIP

 

 

9.

LIST ALL PAST, PRESENT AND ANTICIPATED EMPLOYMENT AS A PROFESSIONAL SOLICITOR.  THROUGH THE END OF THE FISCAL YEAR INDICATE ALL TERMS OF COMPENSATION. BE SPECIFIC: INDICATE ACTUAL RATE PER HOUR, % OF FUNDS or OTHER ARRANGEMENT.

 

NAME and ADDRESS of PROFESSIONAL FUND RAISER

TERMS of COMPENSATION

FROM and To Dates (Month/Day/Year)

 

 

 

 

 

 

10.

ARE YOU LICENSED, REGISTERED OR HAVE A PERMIT FROM ANY OTHER STATE OR GOVERNMENTAL BODY FOR SOLICITING

 

FUNDS FOR CHARITABLE ORGANIZATIONS?   YES    NO  IF "YES" COMPLETE THE FOLLOWING:

 

NAME and ADDRESS of STATE or GOVERNMENT

DATE of AUTHORIZATION

 

 

11.

ARE YOU TO RECEIVE, FOR TAX PURPOSES, A W-2 OR 1099 FROM PFR?    YES    NO 

12.

HAS ANY LICENSE OR PERMIT BEEN DENIED, CANCELED OR REVOKED, OR HAS ANY ACTION BEEN TAKEN

 

AGAINST YOU IN CONNECTION WITH SOLICITATION OF FUNDS FOR CHARITABLE PURPOSES?    YES    NO

 

IF "YES"  COMPLETE THE FOLLOWING:

 

NAME and ADDRESS of GOVERNMENTAL AGENCY

NATURE and DATE of ACTION

 

 

13

ARE YOU AN EMPLOYEE OF OR INDEPENDENT CONTRACTOR WITH THE PER?

 

14.

HAVE YOU EVER BEEN CONVICTED OF A CRIME INVOLVING THE MISUSE OR THEFT OF MONEY?    YES    NO

 

AFFIDAVIT OF INDIVIDUAL

 

STATE OF

 

)

SS

 

COUNTY OF

 

)

 

 

 

, BEING DULY SWORN

DEPOSES AND SAYS THAT S/HE IS THE INDIVIDUAL WHO HAS MADE THE FOREGOING PROFESSIONAL SOLICITOR'S REGISTRATION STATEMENT, AS REQUIRED BY SECTION 8 OF "AN ACT TO REGULATE THE SOLICITATION AND COLLECTION OF FUNDS FOR CHARITABLE PURPOSES"; THAT S/HE HAS READ THE FOREGOING REGISTRATION STATEMENT AND KNOWS THE CONTENTS THEREOF; THAT S/HE IS AUTHORIZED TO VERIFY THIS REGISTRATION STATEMENT; THAT THE SAME IS TRUE TO HER/HIS OWN KNOWLEDGE; AND THAT THE STATEMENT WAS MADE FOR THE PURPOSE OF COMPLYING WITH THE REQUIREMENTS OF SECTION 8 OF SAID ACT.

 

Subscribed and sworn to before me,

this

 

day of

 

, 19

 

 

 

 

 

 

(Signature)

NOTARY PUBLIC

 

 

NOTE:

If sworn to outside the State of Illinois, a certificate of the County Clerk or other proper official, showing authority of the notary public or other official before whom the oath is administered, shall be attached.

 

 

 

 

AFFIDAVIT BY PROFESSIONAL FUND RAISER

 

STATE OF

 

)

SS

COUNTY OF

 

)

 

 

 

, BEING DULY SWORN

DEPOSES AND SAYS THAT S/HE IS THE (Title of Office)

 

OF THE (Name of Corporation)

 

OR MEMBER OF THE FIRMS OF (Partner or Association)

 

OR THE INDIVIDUAL WHO OR WHICH HAS or INTENDS TO EMPLOY THE FOREGOING PROFESSIONAL SOLICITATOR WHO IS REGISTERING, AS REQUIRED BY SECTION 8 OF "AN ACT TO REGULATE THE SOLICITATION AND COLLECTION OF FUNDS FOR CHARITABLE PURPOSES"; THAT S/HE HAS READ THE FOREGOING REGISTRATION STATEMENT AND KNOWS THE CONTENTS THEREOF; THAT S/HE IS AUTHORIZED TO VERIFY INFORMATION IN THIS REGISTRATION STATEMENT IS THE SAME AS IN THE EMPLOYMENT RECORDS OF THE PROFESSIONAL FUND RAISER; AND THAT THE STATEMENT WAS MADE FOR THE PURPOSE OF COMPLYING WITH THE REQUIREMENTS OF SECTION 8 OF SAID ACT.

 

Subscribed and sworn to before me,

this

 

day of

 

, 19

 

 

 

 

 

(Signature)

NOTARY PUBLIC

 

NOTE:

If sworn to outside the State of Illinois, a certificate of the County Clerk or other proper official, showing authority of the notary public or other official before whom the oath is administered, shall be attached.

 

 

 

(Source:  Added at 24 Ill. Reg. 14684, effective September 21, 2000)

Section 400.APPENDIX D   Professional Fund Raising Consultant Forms

 

Section 400.ILLUSTRATION A   Registration Statement

 

 

Form PFC-01

PROFESSIONAL FUNDRAISING CONSULTANT

– REGISTRATION STATEMENT –

Jim Ryan

Attorney General

 

PLEASE TYPE OR PRINT IN BLACK INK.  Respond to all items. If unable to answer in space provided attach a schedule in the same format.  Changes of or additions to the information in this statement are to be submitted in this format. All consultants must attach an affidavit attesting that the professional fund raising consultant has not or will not at any time have custody or control of charitable contributions.  Copies of all fund raising contracts must be submitted to this Office within ten (10) days of signing. If any of the information in this statement changes, this Office must be notified in writing within 10 days of the changes. All contracts between professional fund raising consultants and charitable organizations must be in writing and filed by the PFR with the Attorney General within ten (10) days of execution. Contracts shall contain the charity's legal name, their registration number, a street address, a contact party and that party's daytime telephone number. Changes or additions to the information in this statement must be submitted on this form.  One copy of this Registration Statement and attachments are to be filed with the Office of the Attorney General, Charitable Trust and Solicitations Bureau, 100 West Randolph Street, Chicago, Illinois 60601.

 

1.

THIS IS A (CHECK ONE and DATE):

 

 

 

NEW REGISTRATION (  )  REREGISTRATION (  )  CHANGE (  ) ADDITON (  ) AS OF  

      /        /     

 

2.

LEGAL NAME

REGISTRATION/REREGISTRATION

For Two (2) Years Upon Filing with the Attorney General

 

 

 

3.

MAIL ADDRESS

PFR NUMBER

11-

 

 

 

 

 

CITY, STATE, ZIP CODE

PHONE NUMBER

FEDERAL ID NUMBER

 

 

 

 

 

 

 

 

4.

TYPE OF FIRM (Individual, Partnership or Corporation)

 

 

 

5.

WHERE and WHEN ORGANIZED (Corporations must ATTACH Charter & Articles)

 

 

 

 

6.

NAME OF MANAGEMENT PERSON & PRESIDENT

 

TITLE

 

 

 

7.

A STREET ADDRESS (if different than above)

 

 

 

8.

NAME OF ILLINOIS REGISTERED AGENT

 

 

 

9.

AGENT'S MAIL ADDRESS (if P.O. BOX also a street address)

 

 

 

 

10.

GIVE PRINCIPAL ILLINOIS ADDRESS, IF ANY, AT WHICH RECORDS ARE KEPT AND NAME OF CUSTODIAN (NOT A P.O. BOX)

 

 

 

 

11.

LIST ALL BUSINESS LOCATIONS, OTHER THAN ABOVE, USED FOR FUNDRAISING.  (ATTACH SCHEDULE INDICATING ACTIVITY DESCRIPTION, STREET ADDRESS, CITY, STATE and if temporary location BEGINNING and ENDING USE DATES.)

 

 

 

 

12.

IF NAME IN ABOVE IS NOT THE CORPORATE or ONLY NAME USED BY THE REGISTRANT ATTACH SCHEDULE AND DOCUMENTS TO SUPPORT LEGAL USE OF OTHER NAMES (e.g., REGISTRATION UNDER THE ASSUMED NAME ACT)

 

 

 

 

13.

ILLINOIS SECRETARY OF STATE'S CORPORATE FILE NO.

 

 

 

IF A FOREIGN CORPORATION ATTACH A COPY OF AUTHORIZATION.

 

 

14.

LIST ALL PRINCIPAL PARTIES, OFFICERS, DIRECTORS, EXECUTIVE PERSONNEL, AND OWNERS OF TEN PERCENT OR MORE OF THE CAPITAL STOCK.  (ATTACH SCHEDULE IF NECESSARY)

 

 

 

NAME     STREET ADDRESS      TITLE     % OF INTEREST     BIRTH DATE     DRIVERS LICENSE #     STATE OF ISSUE

 

 

 

 

 

 

 

 

 

 

15.

LIST THE INTEREST OF ALL PRINCIPAL PARTIES, OFFICERS, DIRECTORS, EXECUTIVE PERSONNEL, OWNERS OF REGISTRANT AND THEIR FAMILY MEMBERS HAVING ANY OWNERSHIP INTEREST IN ANY OTHER FIRMS PROVIDING GOODS OR SERVICES USED IN FUNDRAISING

 

 

 

NATURE OF BUSINESS

NAME of PARTY

% INTEREST

NAME and STREET ADDRESS OF BUSINESS

 

 

 

 

 

 

 

 

 

 

 

 

16.

LIST THE INFORMATION REQUESTED BELOW FOR ALL CHARITABLE ORGANIZATIONS HAVING CONTRACTS WITH THIS FIRM FOR THE PERIOD OF THIS REGISTRATION OR CURRENTLY IN EFFECT INVOLVING THE RAISING OF FUNDS IN ILLINOIS AND ATTACH COPIES OF THE CONTRACTS.

 

 

 

 

 

ILLINOIS CO #

LEGAL NAME and STREET ADDRESS of CHARITABLE ORGANIZATION

FROM and TO DATES (Month/Day/Year)

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

17.

IS THE REGISTRANT LICENSED BY, REGISTERED WITH OR HAVE A PERMIT FROM ANY OTHER GOVERNMENTAL AGENCY FOR THE PURPOSE OF PROVIDING FUNDRAISING COUNSEL FOR CHARITABLE ORGANIZATIONS          YES         NO

 

IF "YES" LIST THE FOLLOWING INFORMATION:

 

NAME and ADDRESS of GOVERNMENTAL AGENCY

DATE of AUTHORIZATION (Month/Day/Year)

 

 

 

 

 

 

18.

HAS THE REGISTRANT EVER HAD ANY LICENSE, REGISTRATION OR PERMIT DENIED, CANCELED OR REVOKED, OR IS ANY SUCH ACTION PENDING?       YES       NO  IF "YES" ATTACH A SCHEDULE INDICATING NAME and ADDRESS of GOVERNMENTAL AGENCY, NATURE of ACTION, DATE of ACTION

 

 

 

19.

HAS ANY GOVERNMENTAL ACTION, OTHER THAN LISTED IN 20 ABOVE, BEEN TAKEN AGAINST THE BUSINESS OR ANY OF ITS PRINCIPAL PARTIES, EMPLOYEES, OFFICERS, DIRECTORS, EXECUTIVE PERSONNEL, OWNERS OF TEN PERCENT OR MORE OF THE CAPITAL STOCK OR THEIR RELATIONS IN CONNECTION WITH ANY FUNDRAISING ACTIVITY?        YES         NO

 

IF "YES" ATTACH A SCHEDULE INDICATING NAME and ADDRESS of GOVERNMENTAL AGENCY, AGAINST WHOM ACTION WAS TAKEN, NATURE of ACTION, DATE of ACTION.

 

 

 

 

20.

HAS ANY OF THE FIRM'S PRINCIPAL PARTIES, EMPLOYEES, OFFICERS, DIRECTORS, EXECUTIVE PERSONNEL, OWNERS OF TEN PERCENT OR MORE OF THE CAPITAL STOCK OR THEIR RELATIONS EVER BEEN CONVICTED OF A MISDEMEANOR INVOLVING THE MISAPPROPRIATION OR MISUSE OF MONEY OF ANOTHER, OR OF ANY FELONY?        YES        NO

 

IF "YES" ATTACH A SCHEDULE INDICATING NAME and ADDRESS of COURT, WHO WAS CONVICTED, NATURE of OFFENSE, DATE of CONVICTION.

 

NOTE:  VERIFICATION MUST BE BY THE CORPORATE PRESIDENT, A GENERAL PARTNER OR THE SOLE PROPRIETOR.

 

 

STATE OF

 

)

SS

AFFIDAVIT

 

COUNTY OF

 

)

 

 

 

I,

 

, under penalty of perjury and being sworn on oath state

that I am (strike out) the CORPORATE PRESIDENT, a GENERAL PARTNER or the SOLE PROPRIETOR of the registrant professional fund raiser.

 

 

(Name of PFC)

 

, that I have read the foregoing registration statement and personally

know the contents thereof to be true, and such is stated and filed with the Illinois Attorney General for the purpose of having the people of the State of Illinois rely thereupon.  I hereby further authorize and agree to submit myself and the registrant hereby to the jurisdiction of the State of Illinois.

 

 

Subscribed and sworn to before me

 

 

this

 

day of

 

,

19

 

 

 

 

 

 

 

 

 

 

 

 

(Signature)

 

 

 

 

 

NOTARY PUBLIC

 

 

 

(Source:  Added at 24 Ill. Reg. 14684, effective September 21, 2000)