§480.EXHIBIT C. Annual Report and Instructions


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    ILLINOIS CHARITABLE ORGANIZATION ANNUAL REPORT

    Form AG990-IL

     

     

    Attorney General LISA MADIGAN State of Illinois

     

     

    PMT#

     

     

    Charitable Trust Bureau, 100 West Randolph

    CO #

     

     

    3rd 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

             /         /

     

    MO

    DAY

    YR

     

     

    Federal ID #

     

     

    MO

    DAY

    YR

    Are contributions to the organization tax deductible?

    Yes

    No

    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

     

     

     

    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 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) $

     

    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, 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.

     

     

    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

     

     

    112

    Neighborhood and Community Development

     

     

    RELIGIOUS ACTIVITIES

    113

    Nursing Services (i.e., Home Care)

     

    020

    Church, Synagogue, etc.

    114

    Programs for Minority Advocacy

     

    021

    Missionary Activities

    115

    Programs for Needy Children

     

     

     

    116

    Rescue and Emergency Service

     

     

    CULTURAL AND HISTORICAL

    117

    Services for the Aged

     

    030

    Performing Arts (Ballet, Symphony, Theatre)

    118

    Services for Alcohol or Drug Abuse

     

    031

    Art and/or Literature

    119

    Services for Blind Adults

     

    032

    Museum

    120

    Services for Blind Children

     

    033

    Library

    121

    Services for Developmentally Disabled Adults

     

    034

    Historical Societies

    122

    Services for Developmentally Disabled Children

     

     

     

    123

    Services for Handicapped Adults

     

     

    RECREATIONAL & SOCIAL ACTIVITIES

    124

    Services for Handicapped Children

     

    040

    Youth

    125

    Services for the Hearing Impaired

     

    041

    Adult

    126

    Services for the Poor

     

    042

    Music Groups & Youth Bands

    127

    Services for Veterans

     

    043

    Youth Clubs (i.e., Boy Scouts, Girl Scouts, 4-H, Boys Club, etc.)

     

    044

    Community Recreational Facilities

     

    HOUSING

     

     

     

    130

    Housing for Youth

     

     

    RESEARCH

    131

    Housing for the Poor

     

    050

    Scientific Research

    132

    Housing for the Aged

     

    051

    Heart Disease Research

    133

    Women Shelter

     

    052

    Cancer Research

    134

    Housing for the Disabled

     

    053

    Other Medical and Disease Research

     

     

     

     

     

    BENEFITTING PUBLIC SAFETY EMPLOYEES & FAMILY

     

    HEALTH FACILITIES

    140

    Firemen & Families

     

    060

    Hospitals

    141

    Law Enforcement Personnel & Families

     

    061

    Nursing Homes

     

    062

    Health Clinics

     

    ACTIVITIES INVOLVING OTHER ORGANIZATIONS

     

    063

    HMO

    150

    Grants to Other Charitable Organizations

     

    064

    Hospice

    151

    Furnished Services or Facilities to Other Organizations

     

     

     

    152

    Umbrella/Parent Organization

     

     

    ANIMAL WELFARE

     

     

     

    070

    Animal Shelter, Humane Society and/or Anti-cruelty Society

     

    OTHER PROGRAM SERVICES

     

    071

    Wildlife Preservation & Shelter for Wildlife

    200

    Scholarships and Student loans

     

     

     

     

     

     

     

    ENVIRONMENT

     

    MISCELLANEOUS PROGRAM SERVICES

     

    080

    Preservation/Conservation of Natural Resources

    300

    (Write in Description)

     

    081

    Prevention of Pollution

     

     

     

     

     

    CIVIC ACTIVITIES

     

    090

    Legal Services and Legal Aid

     

    091

    Civil Rights Activities

     

     

    (Source:  Amended at 29 Ill. Reg. 11788, effective July 15, 2005)