Section 480.EXHIBIT C Annual Report and Instructions

For Office Use Only

ILLINOIS CHARITABLE ORGANIZATION ANNUAL REPORT

Form AG990-IL

Attorney General LISA MADIGAN State of Illinois

PMT#

Charitable Trust Bureau, 100 West Randolph

CO #

3^rd Floor, Chicago, Illinois 60601

Check all items attached:

Copy of IRS Return

Audited Financial Statements

Copy of Form IFC

$15 Annual Report Filing Fee

$100 Late Report Filing Fee

AMT

Report for the Fiscal Period:

Makes Checks Payable to the Illinois Charity Bureau Fund

INT

Beginning

/ /

& Ending

/ /

DAY

Federal ID #

DAY

Are contributions to the organization tax deductible?

Yes

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

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) $

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, 3^rd FLOOR

CHICAGO, ILLINOIS 60601-3175

(312)814-2595

Section1(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