Ohio > Statewide > Attorney General Office > Business Services
Solicitation Campaign Financial Report - Ohio
| Solicitation Campaign Financial Report Form. This is a Ohio form and can be used in Business Services Attorney General Office Statewide . |
|
||||||
 Get this form for FREE as a print-only pdf |
|||||||
|
Charitable Law Section 150 E. Gay St., 23rd Fl. Columbus, OH 43215 Telephone: (614) 466-3181 Facsimile: (614) 466-9788 www.ag.state.oh.us FOR OFFICIAL USE ONLY PS #________________________________ REG # ______________________________ CAMPAIGN # ________________________ CAMPAIGN COMPLETE _____Y _____N SOLICITATION CAMPAIGN FINANCIAL REPORT (Sections 1716.05 and 1716.07, Ohio Revised Code) This financial report is to be completed by Fund-raising Counsel that at any time have custody of contributions, and Professional Solicitors for each solicitation campaign conducted on behalf of a charitable organization. Fund-raising Counsel and Professional Solicitors must file with the charity a financial report of the solicitation campaign on the anniversary of the commencement of a campaign lasting more than year and within 90 days after the campaign has been completed. Professional Solicitors must also file their reports with the Attorney General. Fund-raising Counsel must file their reports with the Attorney General within seven days after filing with the charity. PLEASE DO NOT LEAVE ANY FIELDS BLANK. IF NOT APPLICABLE, INDICATE "N/A". PLEASE PRINT OR TYPE. 1. ________________________________________________________________________________________________ (Name of Professional Solicitor or Fund-raising Counsel) (EIN) ________________________________________________________________________________________________ (Street Address of Principal Place of Business) ________________________________________________________________________________________________ (City) (State) (Zip) (Telephone Numbe r) 2. ________________________________________________________________________________________________ (Name of Charitable Organization as Filed with the Attorney General's Office) ________________________________________________________________________________________________ (Charity EIN) (Ohio AG Registration #) ________________________________________________________________________________________________ (Street Address of Principal Place of Business) ________________________________________________________________________________________________ (City) (State) (Zip) (Telephone Num ber) 3. Provide the dates of the solicitation campaign as previously filed on the Solicitation Notice: Start Date:______________________________________End Date:_______________________________ (MM/DD/YY) (MM/DD/YY) (MM/DD/YY) 4. 5. Provide the date the contract was signed by the Professional Solicitor:__________________________________ Is the campaign still ongoing? _____Yes _____No (MM/DD/YY) If no, please provide the date the solicitation campaign was completed: _____________________________ 6. Please check each of the applicable fund-raising methods used in the solicitation campaign. ___ telephone solicitation ___ mail solicitation ___ door-to-door solicitation ___ Internet solicitation ___ sell advertising ___ sell other items ___ sell coupon books ___ show or performance ___ special events PLEASE DO NOT LEAVE ANY FIELDS BLANK American LegalNet, Inc. www.FormsWorkflow.com Solicitation Campaign Financial Report Type of Report: Interim Final/Closing Amended For the solicitation period beginning (mm/dd/yy): _____________________ and ending (mm/dd/yy): _________________________ If this is an interim report, provide the date (mm/dd/yy) solicitation began in Ohio: ________________________________________ PROVIDE EXACT NUMBERS DO NOT ROUND AMOUNTS UP OR DOWN Total Campaign Ohio* 1. Gross Revenue (Do not include pledges not yet received.) 2. Expenses: (do not attach separate list of expenses) Professional solicitor fees Salaries, wages, commissions Contract service fees Show or performance fees Cost of goods sold to contributors Printing Postage/Shipping Telephone Rent/Utilities Advertising/Marketing Insurance Supplies/Equipment Licenses/Permits/Registration fees Professional/Legal/Accounting Fees Other (describe): Other (describe): Other (describe): Other (describe): Other (describe): Other (describe): Other (describe): Other (describe): Other (describe): Other (describe): Other (describe): Other (describe): Other (describe): 3. Total Expenses: 4. Net Proceeds (Gross Revenue minus Total Expenses): 5. Amount of Net Proceeds Retained by the Charitable Organization: 6. Amount of Net Proceeds Retained by the Professional Solicitor: 7. Percentage of Gross Revenue Retained by the Charitable Organization: (Amount retained by the Charitable Organization divided by gross revenue) 8. Percentage of Gross Revenue to be Retained by the Charitable Organization as Written in the Contract and Solicitation Notice: PROVIDE EXACT NUMBERS DO NOT ROUND AMOUNTS UP OR DOWN * A breakdown of gross receipts and expenses generated in Ohio must be provided if the contract between the professional solicitor and the charitable organization provides for a percentage of gross revenue to be received by the charitable organization that differs from state to state. PLEASE DO NOT LEAVE ANY FIELDS BLANK American LegalNet, Inc. www.FormsWorkflow.com PLEASE DO NOT LEAVE ANY FIELDS BLANK AFFIDAVIT STATE OF _________________________: SS: COUNTY OF _______________________: I, ________________________________________________________________, being first duly sworn (Typed or Printed Name) say that I am the ______________________________________________________________________ (Title or Office) of _________________________________________________________________________________ (Name of Professional Solicitor or Fund-raising Counsel) and further state as follows: 1. 2. 3. 4. I am the individual who has completed the foregoing Solicitation Campaign Financial Report Form; I have read the foregoing Report and know the contents thereof; The same is true to the best of my knowledge and belief; and This Report is made for the purpose of complying with the provisions of Chapter 1716 of the Ohio Revised Code. In accordance with Ohio Revised Code Section 1716.07(E), a copy of this report was provided to ___________________________on____________ (Charitable Organization) (Date) (Enclosed is a confirmation of receipt, copy of cover letter, or other proof of mailing, etc.) 5. _____________________________________________ (Signature) Sworn to and subscribed before me this _________ day of ______________________________ 20____. _____________________________________________ (Notary Public Signature) Seal _____________________________________________ (Printed Name) PLEASE D
|
|||||||
