Section 480.EXHIBIT C Annual Report and Instructions
For Office Use Only
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ILLINOIS CHARITABLE
ORGANIZATION ANNUAL REPORT
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Form AG990-IL
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Attorney General LISA
MADIGAN State of Illinois
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PMT#
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Charitable Trust
Bureau, 100 West Randolph
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CO #
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3rd Floor,
Chicago, Illinois 60601
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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
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AMT
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Report for the Fiscal
Period:
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Makes
Checks Payable to the Illinois Charity Bureau Fund
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INT
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Beginning
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&
Ending
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MO
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DAY
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YR
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Federal
ID #
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MO
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DAY
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YR
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Are
contributions to the organization tax deductible?
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Yes
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No
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Date
Organization was created
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/ /
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LEGAL
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Year-end
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NAME
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amounts
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MAIL
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A)
ASSETS
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A) $
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ADDRESS
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B)
LIABILITIES
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B) $
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CITY, STATE
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C)
NET ASSETS
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C) $
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ZIP CODE
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I.
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SUMMARY
OF ALL REVENUE ITEMS DURING THE YEAR:
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PERCENTAGE
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AMOUNT
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D. PUBLIC SUPPORT
CONTRIBUTIONS & PROGRAM SERVICE REV. (GROSS AMTS.)
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%
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D) $
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E. GOVERNMENT GRANTS
& MEMBERSHIP DUES
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%
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E) $
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F. OTHER REVENUES
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%
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F) $
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G. TOTAL REVENUE,
INCOME AND CONTRIBUTIONS RECEIVED (ADD D, E, & F)
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100%
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G) $
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II.
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SUMMARY
OF ALL EXPENDITURES DURING THE YEAR:
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H. OPERATING
CHARITABLE PROGRAM EXPENSE
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%
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H) $
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I. EDUCATION PROGRAM
SERVICE EXPENSE
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%
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I) $
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J. TOTAL CHARITABLE
PROGRAM SERVICE EXPENSE (ADD H & I)
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%
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J) $
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J1. JOINT COSTS
ALLOCATED TO PROGRAM SERVICES (INCLUDED IN J)
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$
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K. GRANTS TO OTHER
CHARITABLE ORGANIZATIONS
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%
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K) $
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L. TOTAL CHARITABLE
PROGRAM SERVICE EXPENDITURE (ADD J & K)
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%
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L) $
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M. MANAGEMENT AND
GENERAL EXPENSE
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%
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M) $
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N. FUNDRAISING
EXPENSE
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%
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N) $
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O. TOTAL
EXPENDITURES THIS PERIOD (ADD L, M, & N)
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100%
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O) $
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III.
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SUMMARY
OF ALL PAID FUNDRAISER AND CONSULTANT ACTIVITIES:
(Attach
Attorney General Report of Individual Fundraising Campaign Form IFC. One for
each PFR.)
PROFESSIONAL
FUNDRAISERS:
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P. TOTAL AMOUNT
RAISED BY PAID PROFESSIONAL FUNDRAISERS
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100%
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P) $
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Q. TOTAL FUNDRAISERS
FEES AND EXPENSES
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%
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Q) $
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R. NET RECEIVED BY
THE CHARITY (P MINUS Q = R)
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%
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R) $
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PROFESSIONAL
FUNDRAISING CONSULTANTS:
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S. TOTAL AMOUNT PAID
TO PROFESSIONAL FUNDRAISING CONSULTANTS
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S) $
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IV.
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COMPENSATION
TO THE 3 HIGHEST PAID PERSONS DURING THE YEAR:
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T. NAME, TITLE
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T) $
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U. NAME, TITLE
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U) $
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V. NAME, TITLE
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V) $
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V.
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CHARITABLE
PROGRAM DESCRIPTION:
CHARITABLE
PROGRAM (3 HIGHEST BY $ EXPENDED) CODE CATEGORIES
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List on back side of
instructions
CODE
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W. DESCRIPTION
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W) #
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X. DESCRIPTION
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X) #
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Y. DESCRIPTION
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Y) #
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IF THE ANSWER TO ANY OF
THE FOLLOWING IS YES, ATTACH A DETAILED EXPLANATION:
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YES
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NO
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1.
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WAS THE ORGANIZATION THE
SUBJECT OF ANY COURT ACTION, FINE, PENALTY OR JUDGMENT?..................................
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1.
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2.
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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?.........................................................................................................................................................................................................................................................
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2.
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3.
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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?.........................................................................................................................................................................................................................................................
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3.
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4.
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HAS THE ORGANIZATION
INVESTED IN ANY CORPORATE STOCK IN WHICH ANY OFFICER, DIRECTOR OR TRUSTEE
OWNS MORE THAN 10% OF THE OUTSTANDING SHARES?.........................................................................................................................................................................................................................................................
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4.
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5.
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IS ANY PROPERTY OF THE ORGANIZATION
HELD IN THE NAME OF OR COMMINGLED WITH THE PROPERTY OF ANY OTHER PERSON OR
ORGANIZATION?.........................................................................................................................................................................................................................................................
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5.
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6.
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DID THE ORGANIZATION USE THE
SERVICES OF A PROFESSIONAL FUNDRAISER? (ATTACH FORM IFC).........................................................................................................................................................................................................................................................
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6.
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7a.
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DID THE ORGANIZATION
ALLOCATE THE COST OF ANY SOLICITATION MAILING, ADVERTISEMENT OR LITERATURE
COSTS BETWEEN PROGRAM SERVICE AND FUNDRAISING EXPENSES?.........................................................................................................................................................................................................................................................
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7.
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7b.
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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 $
.
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8.
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DID THE ORGANIZATION EXPEND
ITS RESTRICTED FUNDS FOR PURPOSES OTHER THAN RESTRICTED PURPOSES?.........................................................................................................................................................................................................................................................
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8.
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9.
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HAS THE ORGANIZATION EVER
BEEN REFUSED REGISTRATION OR HAD ITS REGISTRATION OR TAX EXEMPTION SUSPENDED
OR REVOKED BY ANY GOVERNMENTAL AGENCY?.........................................................................................................................................................................................................................................................
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9.
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10.
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WAS THERE OR DO YOU HAVE ANY
KNOWLEDGE OF ANY KICKBACK, BRIBE, OR ANY THEFT, DEFALCATION, MISAPPROPRIATION,
COMMINGLING OR MISUSE OF ORGANIZATIONAL FUNDS?.........................................................................................................................................................................................................................................................
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10.
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11.
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LIST THE NAME, ADDRESS AND
THE ACCOUNT # OF THE FINANCIAL INSTITUTIONS WHERE THE ORGANIZATION MAINTAINS
ITS THREE LARGEST ACCOUNTS:
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12.
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NAME AND TELEPHONE NUMBER OF
CONTACT PERSON:
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ALL ATTACHMENTS MUST ACCOMPANY
THIS REPORT − SEE INSTRUCTIONS
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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.
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BE SURE TO INCLUDE ALL
FEES DUE:
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1)
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REPORTS ARE DUE WITHIN SIX
MONTHS OF YOUR FISCAL YEAR END.
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PRESIDENT or TRUSTEE (PRINT NAME)
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SIGNATURE
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DATE
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2)
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FOR FEES DUE, SEE
INSTRUCTIONS.
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TREASURER or TRUSTEE (PRINT NAME)
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SIGNATURE
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DATE
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3)
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REPORTS THAT ARE LATE OR INCOMPLETE
ARE SUBJECT TO A $100 PENALTY.
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PREPARER (PRINT
NAME)
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SIGNATURE
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DATE
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Form AG990-IL INS
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ILLINOIS
CHARITABLE ORGANIZATION
– FORM AG990-IL
FILING INSTRUCTIONS –
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LISA MADIGAN
ATTORNEY GENERAL
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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
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.
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SCHOOLS
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PUBLIC POLICY
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001
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Pre-School
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100
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Legislative
and Political Activities
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002
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Elementary or High Schools
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101
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Lobbying
& Advocacy
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003
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College & Universities
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102
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Consumer
Interest Group (non-education)
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004
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Trade Schools, Vocational
Schools & Job Training
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103
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Peace
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104
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Other
Public Policy
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PUBLIC EDUCATION OTHER
THAN SCHOOLS
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010
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Public Education by Mail
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HUMAN SERVICES
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011
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Seminars and Conferences
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110
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Day Care Centers
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012
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Other Educational Materials
for the Public
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111
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Family and Individual
Services
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112
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Neighborhood and Community
Development
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RELIGIOUS ACTIVITIES
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113
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Nursing Services (i.e., Home
Care)
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020
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Church, Synagogue, etc.
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114
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Programs for Minority
Advocacy
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021
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Missionary Activities
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115
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Programs for Needy Children
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116
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Rescue and Emergency Service
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CULTURAL AND HISTORICAL
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117
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Services for the Aged
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030
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Performing Arts (Ballet,
Symphony, Theatre)
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118
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Services for Alcohol or Drug
Abuse
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031
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Art and/or Literature
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119
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Services for Blind Adults
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032
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Museum
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120
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Services for Blind Children
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033
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Library
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121
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Services for Developmentally
Disabled Adults
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034
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Historical Societies
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122
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Services for Developmentally
Disabled Children
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123
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Services for Handicapped
Adults
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RECREATIONAL & SOCIAL
ACTIVITIES
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124
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Services for Handicapped
Children
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040
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Youth
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125
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Services for the Hearing
Impaired
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041
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Adult
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126
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Services for the Poor
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042
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Music Groups & Youth
Bands
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127
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Services for Veterans
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043
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Youth Clubs (i.e., Boy
Scouts, Girl Scouts, 4-H, Boys Club, etc.)
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044
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Community Recreational
Facilities
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HOUSING
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130
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Housing for Youth
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RESEARCH
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131
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Housing for the Poor
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050
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Scientific Research
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132
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Housing for the Aged
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051
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Heart Disease Research
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133
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Women Shelter
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052
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Cancer Research
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134
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Housing for the Disabled
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053
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Other Medical and Disease
Research
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BENEFITTING PUBLIC SAFETY
EMPLOYEES & FAMILY
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HEALTH FACILITIES
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140
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Firemen & Families
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060
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Hospitals
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141
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Law Enforcement Personnel
& Families
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061
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Nursing Homes
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062
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Health Clinics
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ACTIVITIES INVOLVING
OTHER ORGANIZATIONS
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063
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HMO
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150
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Grants to Other Charitable
Organizations
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064
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Hospice
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151
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Furnished Services or
Facilities to Other Organizations
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152
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Umbrella/Parent Organization
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ANIMAL WELFARE
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070
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Animal Shelter, Humane
Society and/or Anti-cruelty Society
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OTHER PROGRAM SERVICES
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071
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Wildlife Preservation &
Shelter for Wildlife
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200
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Scholarships and Student
loans
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ENVIRONMENT
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MISCELLANEOUS PROGRAM SERVICES
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080
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Preservation/Conservation of
Natural Resources
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300
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(Write in Description)
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081
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Prevention of Pollution
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CIVIC ACTIVITIES
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090
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Legal Services and Legal Aid
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091
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Civil Rights Activities
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(Source: Amended at 29 Ill.
Reg. 11788, effective July 15, 2005)