Oregon Department of Justice Fundraising Firm Solicitation
Campaign Financial Report PF-12
(Instructions on reverse)
Official Use Only
1. Name of professional/commercial fundraising firm:
OR Registration #:
Ongoing campaign?
yes no
2. Name of nonprofit beneficiary:
Campaign Start Date:
Campaign End Date:
/ /
/ /
3. Financial Report:
+ A. Gross Oregon Campaign Revenue .................................................................... $ ____________
B(1) Was this campaign part of larger national or regional campaign? yes no
B(2) If yes, please indicate whether the dollar amounts reported in Items C through F below reflect:
National or Regional amounts Oregon only.
If you are reporting national or regional amounts below, please also provide corresponding gross
national or regional campaign revenue at B(3).
or + B(3) Gross National or Regional Campaign Revenue………………………………….$____________
C(1).Cost of Goods or Services Sold, (if applicable)
Itemize: Item Cost:
$_________
$_________
$_________
$_________
- C(2). Total Cost of Goods or Services Sold ................................................................. $ ____________
D(1). Other Costs of Solicitation
Itemize: Item Cost:
$_________
$_________
$_________
$_________
- D(2). Total Other Costs of Solicitation........................................................................ $ ____________
- E. Amount Retained by Fundraising Firm (management salaries and profit) ........... $ ____________
= F. Amount Paid to Beneficiary .............................................................................. $ ____________
NOTE: Item A or Item B(3) minus items C(2), D(2) and E must equal the amount in Item F, Amount Paid to Beneficiary.
I hereby declare that the foregoing information is true and correct to the best of my knowledge and belief and that
I understand it is made for use as evidence in court or administrative proceeding and is subj
ect to penalty for
perjury.
______________________________________ ________________________________________
Signature of Declarant for Fundraising Firm Signature of declarant for Nonprofit Beneficiary
______________________________________ ________________________________________
(Print Name and Title of Declarant) (Print Name and Title of Declarant)
______________________________________ ________________________________________
(Date) (Date)
Rev 4/20/20
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Charitable Activities Section, Oregon Department of Justice
Fundraising Firm Solicitation Campaign Financial Report PF-12
General Instructions
Pursuant to ORS 128.812 and 128.841, professional and commercial
fundraising firms must file a solicitation campaign financial report
within 90 days after completion of the solicitation campaign unless
funds are collected directly by the nonprofit beneficiary without the
use of a caging company or similar intermediary. Generally, a
campaign is completed when solicitation of new contributors has
ceased. Firms must file interim financial reports annually for each
campaign lasting greater than one year.
The financial report must be completed and signed by a responsible
party with the professional/commercial fundraising firm and an
official from each nonprofit beneficiary. A responsible party
includes a sole proprietor, partner (partnership), or officer
(corporation). The term “beneficiary” refers to each nonprofit
organization that is to receive a portion of the funds raised and
whose name is used in the course of the solicitation campaign.
Line Instructions
1. Firm Name/Registration Number
Enter the full name of the professional/commercial fundraising firm
and the Oregon registration number issued to the firm by the
Department of Justice. Check Yes if this report is for a solicitation
campaign still in progress.
2. Beneficiary Name/Campaign Dates
Enter the full name of the nonprofit beneficiary and the start and end
dates of the campaign. The term “beneficiary” refers to each
nonprofit organization that is to receive a portion of the funds raised
and whose name is used in the course of the solicitation campaign.
3. Financial Report Information
A. Enter the gross campaign revenue.
B. Please indicate whether the Oregon solicitations were
part of a national or regional campaign at B(1). If yes, please
indicate whether the dollar amounts reported in Items C through F
reflect national or regional amounts or expenditures only for Oregon.
If you are reporting national or regional amounts, please also provide
the corresponding gross national or regional campaign revenues at
B(3).
C. If the campaign involves the sale of goods or services,
itemize the costs directly associated with the provision of those
goods or service in C(1). For example, if the campaign involves the
sale of cookies or magazines, itemize the cost of those items in C(1).
Similarly, if the campaign involves the sale of services such as ticket
sales to a concert or similar event, itemize costs directly related to
the production of the event, such as rental costs for the facility and
fees paid to performers in C(1). Total the itemized costs in C(2). If
the campaign only involves a request for donations and does not
involve the sale of goods or services, then you may have no costs to
itemize in Item C and campaign costs should be itemized at Item D.
If you do report costs in response to Item C, please itemize
significant expenses in general, but descriptive categories. Please
limit the use of a miscellaneous or other” category to no more
than ten (10) percent of gross campaign revenues. Attach additional
sheets if necessary but enter the total costs listed in C(1) on the form
at (C)(2).
D. In D(1), itemize the other costs of the solicitation
campaign not included in C(1), but, excluding salaries or other
compensation paid to managers, which should be listed in response
to Item E. Please itemize significant expenses in general, but
descriptive categories. Please limit the use of a miscellaneousor
“othercategory to no more than ten (10) percent of gross campaign
revenues. Potential categories include compensation of
solicitors/office staff, printing costs, postage costs, telephone
equipment cost/rental, and rental of the solicitation facilities. Attach
additional sheets if necessary but enter the total costs listed in D(1)
on the form at D(2).
E. Enter the total amount retained by the
professional/commercial fundraising firm for management salaries
and profit.
F. Enter the total dollar amount paid to the nonprofit
beneficiary. If this campaign had more than one beneficiary, enter
the name and amount paid to each organization. Attach additional
sheets if necessary but enter the total on the form. This amount must
equal item A or B(3) minus the total of the amounts listed under
items C, D and E.
Important Note Reports submitted with incorrectly calculated
totals or other discrepancies will be returned for correction.
Signature
An authorized officer for both the fundraising firm and the nonprofit
beneficiary must sign in the spaces provided.
Amended Reports
A financial report will be due no later than 90 days after the
campaign ending date as submitted on the solicitation campaign
notice regardless of donations received after the ending date. If
significant donations are received after the reported period, the
professional/commercial fundraising firm must submit an amended
report. Contact the Professional Fundraising Registrar at (971) 673-
1880 for additional forms.
Where to File
Submit the completed solicitation campaign financial report form to
the following address:
Professional Fundraising Registrar
Charitable Activities Section
100 SW Market Street
Portland, Oregon 97201-5702
Alternatively, the completed and signed report can be emailed to
charitable@doj.state.or.us
Additional Information
For information regarding the additional responsibilities of
professional/commercial fundraising firms, see Oregon’s Charitable
Solicitations Act (Oregon Revised Statues 128.801 to 128.898).
Rev. 4/20/20