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Charitable Organization Annual Report AG990-IL - Illinois

Charitable Organization Annual Report Form. This is a Illinois form and can be used in Charitable Trusts Office Of The Attorney General Statewide .
 Fillable pdf Last Modified 5/3/2005
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For Office Use Only Form AG990-IL ILLINOIS CHARITABLE ORG ANIZATION ANNUAL REPORT PMT # Revised 3/05 Attorney GeneralLISA MADIGAN State of Illinois Charitable Trust Bureau, 100 West Randolph AMT 11th Floor, Chicago, Illinois 60601 CO # Check all items attached: Report for the Fiscal Period: Copy of IRS Return Make Checks Audited Financial Statements Beginning / / Payable to Copy of Form IFC INIT the Illinois Charity $15.00 Annual Report Filing Fee / / Bureau Fund $100.00 Late Report Filing Fee & Ending MO DAY YR Federal ID # MO DAY YR Are contributions to the organization tax deductible? Yes No Date Organization was created: / / Year-end LEGAL amounts NAME A) ASSETS A) $ MAIL 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 RECE IVED (ADD D,E, & F) 100% G) $ II. SUMMARY OF ALL EXPENDITURES DURING THE YEAR: % H) $ H) OPERATING CHARITABLE PROGRAM EXPENSE 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) HIGHES T PAID PERSONS DURING THE YEAR: T) NAME, TITLE: T) $ U) $ U) NAME, TITLE: V) $ V) NAME, TITLE: List on back side of instructions V. CHARITABLE PROGRAM DESCRIPTION: CHARITABLE PROGRAM (3 HIGHEST BY $ EXPENDED) CODE CATEGORIES CODE W) DESCRIPTION: W) # X) DESCRIPTION: X) # Y) DESCRIPTION: Y) # American LegalNet, Inc. www.USCourtForms.com<<<<<<<<<********>>>>>>>>>>>>> 2 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 MIDSDEMEANOR 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 TRUS TEES HAS A MATERIAL FINANCIAL INTEREST; OR DID ANY OFFICER, DIRECTOR OR TRUSTEE RECEIVE ANYT HING OF VALUE NOT REPORTED AS COMPENSATION? 3. 4 HAS THE ORGANIZATION INVESTED IN ANY CO RPORATE 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 PE RSON OR ORGANIZATION? 5. 6. DID THE ORGANIZATION USE TH E SERVICES OF A PROFESSIONAL FUNDRAISER? ( ATTACH FORM IFC ) 6. 7a. DID THE ORGANIZATION ALLOCATE THE COST OF ANY SOLICITATION, MAILING, ADVERTISEMENT OR 7. LITERATURE COSTS BETWEEN PROGRAM SERVICE AND FUNDRAISING EXPENSES? 7b. IF "YES", ENTER (i) THE AGGREG ATE 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 RESTRI CTED FUNDS FOR PURPOSES OTHER THAN RESTRICTED PURPOSES? 8. 9. HAS THE ORGANIZATION EVER BEEN REFUSED RE GISTRATION 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 MI SUSE OF ORGANIZATIONAL FUNDS? 10. 11. LIST THE NAME AND ADDRESS 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 SCHEDULE S 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: PRESIDENT or TRUSTEE (PRINT NAME) SIGNATURE DATE 1.) REPORTS ARE DUE WITHIN SIX MONTHS OF YOUR FISCAL YEAR END. 2.) FOR FEES DUE SEE INSTRUCTIONS. 3.) REPORTS THAT ARE LATE OR TREASURER or TRUSTEE (PRINT NAME) SIGNATURE DATE INCOMPLETE ARE SUBJECT TO A $100.00 PENALTY. PREPARER (PRINT NAME) SIGNATURE DATE American LegalNet, Inc. www.USCourtForms.com
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