Annual Financial Report Form

North Carolina Department of the Secretary of State Charitable Solicitation Licensing Division Annual Financial Report Form for charitable or sponsor organizations CSL Contact Information: Agency Internet Site: www.sosnc.gov Electronic Mail: csl@sosnc.gov Telephone: (919) 814 - 5400 - Toll free for NC residents: 1 - 888 - 830 - 4989 Facsimile: (919) 807 - 2220 Mailing Address: P.O. Box 29622, Ralei gh, NC 27626 - 0622 Annual Financial Report Form Form Revision: February 2, 2018 Effective Date: July 24, 2012 Page 1 of 3 1. Organization Name: 2. For Fiscal Year Ending: Section 1. Balance Sheet Concise Statement of Financial Position A. Assets and liabilities: Amount 3. Unrestricted Assets: 4. Restricted Assets: 5. Fixed Assets: 6. Total Current Assets: 7. Total Current Liabilities: 8. Total Net Assets: B. Fund balance: 9. Unrestricted net assets at beginning of fiscal year: 10. Unrestricted net assets at end of fiscal year: 11. Total Change in unrestricted net assets: Sections 2 and 3: Statement of Activities for Reporting Period Section 2. Support and revenues: Amount 12. Government grants and contracts: 13. 247131F - 2(18) qualifying organization grants: 14. 247131F - 2(5) qualifying bona fide membership fees 15. Program service revenues not exceeding service or good fair market value: 16. Program service revenues over and above service or good fair market value: 17. Corporate or business grants: 18. Contributions designated or received through third party channels (e.g., via parent group, federated fundraising group) : 19. 247131F - 2(5) non - qualifying donation - based membership fees: - 21. Restricted direct contributions (e.g., endowment giving, charitable gift annuities, unrealized bequests): 22. Unrestricted direct contributions: 23. Total G.S. 247131F - (add items 16 through 22 and enter total here) : 24. Total Support and Revenue (add items 12 through 22 and enter total here) : American LegalNet, Inc. www.FormsWorkFlow.com North Carolina Department of the Secretary of State Charitable Solicitation Licensing Annual Financial Report Form for charitable or sponsor organizations CSL Contact Information: Agency Internet Site: www.sosnc.gov Electronic Mail: csl@sosnc.gov Telephone: (919) 814 - 5400 - Toll free for NC residents: 1 - 888 - 830 - 4989 Facsimile: (919) 807 - 2220 Mailing Address: P.O. Box 29622, Raleigh, NC 27626 - 0622 Annual Financial Report Form Form Revision: February 2, 2018 Effective Date: July 24, 2012 Page 2 of 3 Section 3. Functional Expense Statement: Functional Expenses (A) TOTAL (B) Program Services (C) Management and General (D) Fund raising 25. Grants and allocations 26. Specific assistance to individuals 27. Benefits paid to or from members 28. Compensation of officers, directors, etc. 29. Other salaries and wages 30. Pension plan contributions 31. Other employee benefits 32. Payroll taxes 33. Professional fundraising fees 34. Accounting fees 35. Legal fees 36. Supplies 37. Telephone 38. Postage and shipping 39. Occupancy 40. Equipment rental and maintenance 41. Printing and publications 42. Travel 43. Conferences, conventions and meetings 44. Interest 45. Depreciation, depletion, etc. 46. Other expenses not covered above Total Expense Amounts: Total: Program Services: Management and General: Fundraising: 47. TOTAL EXPENSES: American LegalNet, Inc. www.FormsWorkFlow.com North Carolina Department of the Secretary of State Charitable Solicitation Licensing Annual Financial Report Form for charitable or sponsor organizations CSL Contact Information: Agency Internet Site: www.sosnc.gov Electronic Mail: csl@sosnc.gov Telephone: (919) 814 - 5400 - Toll free for NC residents: 1 - 888 - 830 - 4989 Facsimile: (919) 807 - 2220 Mailing Address: P.O. Box 29622, Raleigh, NC 27626 - 0622 Annual Financial Report Form Form Revision: February 2, 2018 Effective Date: July 24, 2012 Page 3 of 3 Joint cost allocations: 48. Are any joint costs from a combined educational campaign and fundraising solicitation reported in the expense totals for Section 3 (B) Program Services? YES NO Amount 49. Aggregate (total) amount of joint costs: 50. Amount allocated to Program Services: 51. Amount allocated to Management and General: 52. Amount allocated to Fundraising: Optional Attachments: 53. You may submit additional explanatory or descriptive information as attachments. YES NO 54. FINANCIAL REPORT CERTIFICATION MUST HAVE THREE (3) SIGNATURES ( 18 NCAC 11 . 0506 (a) ) We, as members of the audit and/or finance committee or as members of the board of directors of the organization identified above, do hereby certify that the information in this report and any attachments is true and correct to the best of our individual and collective knowledge. Name: Signature Title: Name: Signature Title: Name: Signature Title 55. Report Completion and Signature Date: American LegalNet, Inc. www.FormsWorkFlow.com