Fill - Free fillable CT-12S Oregon Department of Justice (Columbia Gorge Community College) PDF form

Form

CT-12S

For Split-Interest Trusts

Charitable Activities Section

Oregon Department of Justice

100 SW Market Street VOICE (971) 673-1880

Portland, OR 97201-5702 TTY (800) 735-2900

Email: charitable@doj.state.or.us FAX (971) 673-1882

Website: https://www.doj.state.or.us

For Accounting Periods

Beginning in:

2019

Section I. General Information

Cross Through Incorrect Items and Correct Here:

(See instructions for change of name or accounting period.)

Registration #:

rganization Name:

ddress:

ty, State, Zip:

hone: Fax: Amended

Email: Report?

Period Beginning: / / Period Ending: / /

Has the trust or any of its officers, directors, trustees, or key employees ever signed a voluntary agreement with any

government agency or been a party to legal action in any court or administrative agency regarding charitable solicitation,

administration, management, or fiduciary practices? If yes, attach explanation of each such agreement or action. See

instructions.

Yes No

3. During this reporting period, did the trust amend any trust documents OR did the trust receive a determination or revocation

letter from the Internal Revenue Service relating to its tax-exempt status? If yes, attach a copy of the amended document or

letter.

Yes No

Is the trust ceasing operations and is this the final report? (If yes, see instructions on how to close your registration.)

Yes No

5. Provide contact information for the person responsible for retaining the trust’s records.

Name

Position

Phone

Mailing Address & Email Address

6. List of Officers, Directors, Trustees and Key Employees – List each person who held one of these positions at any time during the year even if they

did not receive compensation. Attach additional sheets if necessary. If an attached IRS form includes substantially the same compensation

information, the phrase “See IRS Form” may be entered in lieu of completing that section.

(A) Name, mailing address, daytime phone number

and email address

(B) Title &

average

weekly hours

devoted to

position

(C)

Compensation

(enter $0 if

position unpaid)

Name:

_ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _

(_ _ _)_ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _

Address:

Phone:

Email:

Name:

_ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _

(_ _ _)_ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _

Address:

Phone:

Email:

Name:

_ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _

(_ _ _)_ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _

Address:

Phone:

Email:

Form Continued on Reverse Side

Reset

Section II. Fee Calculation

Charitable Distribution ..............................................................................................................

(If no charitable distributions were made during the report year write $0. Otherwise, write the total of Lines 31 a, b and c

plus Line 36 from Form 5227, or the total of Line 18 plus Line 24 from Form 1041-A)

Charitable Distribution Fee ................................................................................................................................

.....................

(See chart below. Minimum fee is $20.)

Amount on Line 8 Charitable Distribution Fee

$0 - $24,999 $20

$25,000 - $49,999 $50

$50,000 - $99,999 $90

$100,000 - $249,999 $150

$250,000 - $499,999 $200

$500,000 - $999,999 $300

$1,000,000 or more $400

Net Assets at the End of the Reporting Period ..........................................................................

(Line 59b on Form 5227 or Line 45b on Form 1041-A)

10.

Net Assets Fee ................................................................................................................................................................

.......

(Line 9 multiplied by .0001. If the fee is less than $5, write $0. Not to exceed $2,000. Round cents to the nearest whole dollar.)

10.

11.

Are you filing this report late? Yes No ................................................................................................

.................

(If yes, the late fee is a minimum of $20. You may owe more depending on how late the report is. See Instruction 12 for additional information or contact the

Charitable Activities Section at (971) 673-1880 to obtain late fee amount.)

11.

12.

Total Amount Due ................................................................................................................................................................

(Add Lines 8, 10, and 11. Make check payable to the Oregon Department of Justice.)

12.

13.

Attach a copy of the trust’s federal returns and all supporting schedules and attachments.

Please

Sign

Here

Under penalties of perjury, I declare that I have examined this return, including all accompanying forms, schedules, and attachments,

and to the best of my knowledge and belief, it is true, correct, and complete.

⇒

_______________________________________ _____________________ _________________________

Signature of officer Date Title

_______________________________________ _______________________________________________________

Officer’s name (printed) Address

_______________________________________________________

Phone

Paid

Preparer’s

Use Only

⇒

_______________________________________ _____________________ _________________________

Preparer’s signature Date Phone

_______________________________________ _______________________________________________________

Preparer’s name (printed) Address

Line-by-line instructions for completing the annual report form can be found at https://www.doj.state.or.us/charitable-

activities/annual-reporting-for-charities/file-your-annual-report. If you click the appropriate link for this year’s form, the

instructions are included in that document. If you would like us to send a copy of the instructions, please call us at 971-673-

1880 or send an email to charitable@doj.state.or.us.

Charitable Activities Section, Oregon Department of Justice

2019 Form CT-12S Instructions

General

Instructions

Purpose

Oregon law charges the Attorney General with

the duty and responsibility to represent the

public’s interest in charitable organizations and

assets held or received for charitable purposes.

The Attorney General carries out this

responsibility by requiring charitable

organizations to register and file periodic

financial reports.

Once submitted, this Form and all attachments

become a part of the public record excluding

social security numbers and similar confidential

information. Any interested person may examine

or obtain a copy of an annual report of a

charitable organization by contacting the

Charitable Activities Section.

Who Must File

All organizations registered with the Charitable

Activities Section of the Oregon Department of

Justice must annually file Form CT-12, CT-12F,

or CT-12S unless the Attorney General has

specifically exempted the organization from the

reporting requirements.

What Form to File

File Form CT-12 if the organization is

incorporated, organized, or headquartered in

Oregon.

File Form CT-12F if the organization is based

or headquartered outside of Oregon. The

Charitable Activities Section does not accept

multi-state annual report forms in lieu of a

completed Form CT-12F.

File Form CT-12S if the organization is a split-

interest trust that holds assets for the benefit of

both charitable and non-charitable beneficiaries.

If the organization does not fit within any of the

above categories, file Form CT-12.

The Form year should match the starting

year of the fiscal period covered by the

report.

Due Date

The Form, all required attachments and

schedules, and payment of fees are due in the

Charitable Activities Section’s office no later

than 4 months and 15 days after the end of the

organization’s fiscal year. If the due date falls on

a weekend or legal holiday, the due date is the

next business day.

The Charitable Activities Section does not use

the postmark date to determine whether an

organization has filed timely. Instead, filings are

considered timely if they are physically received

within 5 business days after the due date. All

filings received more than 5 business days after

the due date will be assessed a late charge. See

Instruction 11 Late Fees.

Extensions for Filing

A trust may apply for an extension of time to

file. Extension requests must be received on or

before the due date of the report to avoid a late

fee. The maximum available extension period is

180 days. An extension to file is also an

extension to pay any associated fees. Therefore,

estimated payments should not be included with

extension requests.

Please do not submit an incomplete CT-12/CT-

12F/CT-12S if you intend to later supplement or

amend your report with a copy of your IRS

return. Instead, file an extension request so that

you can submit a complete report by the

extended due date with a copy of the appropriate

IRS form attached.

Extensions may be requested through the

Department of Justice website at

https://justice.oregon.gov/Charities/Extensions.

Follow the instructions carefully to ensure that

we receive your request. Please contact our

office if you have any questions or difficulties

with your online request.

You should print and retain a copy of the online

Confirmation of Extension Request. You should

also expect to receive a confirmation of receipt

of your online request.

You may also submit a written request or a copy

of the trust’s federal extension request (IRS

Form 8868) so long as the Charitable

Activities Section receives the request or copy

before the due date of the report. The trust’s

4 or 5-digit registration number should be noted

on the top of all extension requests. If you

would like acknowledgement that your extension

request has been received, you should enclose an

additional copy of the request and a self-

addressed, stamped envelope.

In the event your request is denied, to avoid a

late fee, the annual report must be submitted by

the later of the due date or within 10 days after

the trust receives notice of denial of the

requested extension.

Important Note—An extension request filed

with the IRS or the Oregon Department of

Revenue does NOT act as an extension with

the Charitable Activities Section unless a copy

is submitted to the Charitable Activities

Section by the due date.

Record Keeping

Please retain a copy of this report and all

supporting documentation for at least five years

after the due date.

Rounding and Blank Lines

Round all amounts on the report to the nearest

whole dollar. Drop amounts under 50 cents and

increase amounts from 50 to 99 cents to the next

whole dollar. If the amount is zero write “$0.”

Do not leave any line blank. Your report may

be treated as incomplete if you leave blank lines.

Important Reminders

Important information regarding Social

Security numbers (SSNs) – Forms submitted

to this office become a public record. To

protect the privacy of named individuals, you

should redact any SSNs (if used) from copies

of any IRS forms submitted. Although we

endeavor to redact SSNs from any forms we

receive, we request your assistance in

safeguarding this information by not

including it in your submission.

How to Contact the

Charitable Activities

Section

To obtain blank forms, mailed instructions,

technical assistance or information about a

charitable organization, contact the Charitable

Activities Section or visit our website at:

Charitable Activities Section

Oregon Department of Justice

100 SW Market Street

Portland, OR 97201-5702

Phone: (971)673-1880

TTY: (800)735-2900

Fax: (971)673-1882

Email: charitable@doj.state.or.us

Website: https://www.doj.state.or.us

Where to File

Send completed forms and any corresponding

payment of fees to the above address. The

Charitable Activities Section does not accept

CT-12S reports by Fax, Email, or electronic

submission at this time.

Line Instructions

Section I.

General Information

1. Missing or Incorrect

Information

The Charitable Activities Section sends a form

preprinted with name, address contact

information and registration number to all

registered trusts. If the organization is returning

one of these preprinted forms, provide the

requested information in this section.

Name Changes

If applicable, write the trust’s new legal name.

Attach a copy of the trust document that changed

the trust’s name.

Address, Email, and Phone

Number Changes

If applicable, write the new address where mail

for the trust should be directed in the future. If

applicable, write the new daytime phone

number, fax number and email address for the

trust.

Accounting Year Changes

If applicable, write the trust’s new or short

reporting period. Preprinted forms are based

upon the accounting period we have on record

for the trust. If the trust has changed its fiscal

year or is filing a final report for a period less

than 12 months, the shortened period covered by

the report must be noted here. If the trust is

filing a final report, see the instructions for line 5

for closing requirements.

Short Year Report—If the trust is filing a

shortened report due to a change in fiscal year,

see the instructions for line 9 for calculation of

prorated Net Assets fee.

Amended Reports

If amending previously submitted information

for the same accounting period, check the

amended report box. Either complete a blank

form that includes the amended information or

provide a copy of the previously submitted form

that clearly shows what information is being

amended. Submit any additional fee due with the

amended report.

2. Disclosure of Legal Action

Check yes if the trust or any of its officers,

directors, trustees or key employees ever signed

a voluntary agreement with any government

agency, such as a state attorney general,

secretary of state, or local district attorney, or

been a party to legal action in any court or

administrative agency regarding charitable

solicitation, administration, management, or

fiduciary practices. This includes assurances of

voluntary compliance or discontinuance

involving the trust or any other proceeding in

which the trust or any current officer, director,

trustee, or key employee is subject to any

injunction, order, or pending action relating to

the solicitation of contributions, or

administration of charitable assets. Attach a

written explanation of each such action or

agreement, including the agency involved and

the allegations. Also, attach a copy of any

agreements or actions that occurred in the

current reporting period.

3. Amendments to Trust

Documents

Check yes if during the reporting period the trust

amended the documents that created the trust or

if the IRS issued a tax-exempt status ruling for

the trust.

Important Note—Attach signed and dated

copies of amended trust documents and/or IRS

determination letters.

4. Final Report

Check yes if this is the final report for the trust.

The trust should contact the Charitable Activities

Section for specific instructions and

requirements relating to closing procedures.

A final report must reflect the financial

transactions of the trust from the day after the

close of its last accounting period to the date of

the disposition of all remaining assets.

5. Who Keeps the Books?

Indicate the person to be contacted if the trust's

books need to be accessed for information or

review. Either a business or personal phone

number email, and mailing address are

acceptable. If the person does not have an email

address, please note that on the form.

6. Officers, Directors,

Trustees, and Other Key

Employees

List each person who was an officer, director,

trustee, or key employee (defined below) of the

trust at any time during the year even if they are

a volunteer and do not receive any compensation

from the organization. Give the daytime phone

number and preferred mailing address at which

officers, etc., want the Charitable Activities

Section to contact them. Use an attachment if

there are more persons to list than there are lines

available.

A failure to fully complete this part can subject

the trust to late fees or civil penalties for filing

an incomplete Form.

Officers include those officers required by

applicable state law, such as president, secretary,

or treasurer, and also includes the person(s)

elected or appointed to implement the decisions

of the governing body or for supervising the

management, administration, or operation of the

organization, regardless of title or the amount of

compensation received. The CEO or Executive

Director is an officer for purposes of this form.

The top financial official may also be an officer

if they are responsible for managing the

organization’s finances.

Column (C)

If an IRS form is attached that includes complete

and accurate compensation information, the

phrase “See IRS Form” may be entered in lieu of

completing this section.

Otherwise, for each person listed, report the total

amount of compensation paid or deferred for

payment to a later date, including salary, fees,

bonuses, benefits, taxable allowances or

reimbursements, the value of noncash

compensation, and severance payments.

Enter a zero in column (C) if the person was a

volunteer and was not paid or did not accrue any

compensation during the reporting year.

The trust may provide an attachment to explain

the entire compensation package for any person

listed in this part, including whether the

compensation includes the payment of amounts

previously deferred.

Section II.

Fee Calculation

7. Charitable Distribution

The charitable distribution represents the total

amount paid to charitable organizations. For

Charitable Remainder trusts there will generally

be no charitable distributions until the final year

when the trust terminates. If no charitable

distributions were made during the report year,

enter zero on line 8. Otherwise, if IRS Form

5227 was filed, add the amounts on lines 31 a, b

and c and 36. If IRS Form 1041-A was filed,

add the amounts on lines 18 and 24.

8. Charitable Distribution Fee

Use the charitable distribution figure from line 8

to calculate the charitable distribution fee

according to the following schedule.

Charitable Distribution Fee Schedule

Amount on Line 8

Charitable

Distribution Fee

$ 0

$ 24,999

$ 20

25,000

49,999

50,000

99,999

100,000

249,999

150

250,000

499,999

200

500,000

999,999

300

1,000,000

400

The maximum amount subject to the charitable

distribution fee is $1,000,000. The maximum

charitable distribution fee is $400. The minimum

charitable distribution fee is $20.

9. Net Assets at the End of

the Reporting Period

The Charitable Activities Section has adopted

the definition for “Net Assets” used by the

Internal Revenue Service. If the trust completed

one of the following IRS Forms for this

reporting period, the Net Assets figure should

come from the line number listed:

• IRS Form 1041-A, Part IV, line 45b

• IRS Form 5227, Part IV, line 59b

If the trust was not required to complete one of

these IRS Forms, a summary of what constitutes

Net Assets is provided within these instructions.

A more detailed definition can be found in the

IRS instructions for forms listed above.

Net Assets refer to the trust’s assets minus

liabilities.

“Assets” are items of value to the trust, such as

cash, receivables less any allowance for doubtful

accounts, inventory, prepaid expenses,

investments, land, buildings & equipment less

any accumulated depreciation if the trust records

depreciation.

“Liabilities” are the amount of debts and

obligations owed by the trust, such as accounts

payable, accrued expenses, deferred revenue,

loans, and mortgages.

Important Note— If the trust disposed of all or

substantially all of the trust’s assets during this

reporting period, attach a letter listing a

description of the asset and the name, address,

phone number, and contact person of each entity

which received the trust’s assets.

10. Net Assets Fee

Multiply the amount subject to a Net Assets fee

from line 10 by .0001 and enter this figure on

line 11. Round to the nearest whole dollar. If the

result is less than $5 enter $0. If the result is

more than $2,000 enter $2,000.

Important Note—If the trust is filing a short

report of less than one year due to a change in

accounting periods, the amount entered on line

11 should be prorated by the number of months

covered by the report. To determine the prorated

amount, divide the amount determined above by

12 and multiply by the number of months

covered by the short report. No similar proration

should be made if the short report is due to the

initial or final reporting period.

11. Late Fees

If the report is not filed or the fee is not paid by

the due date (or the extended due date), an initial

late fee of $20 will be due. If the report or

payment remains outstanding more than 13

months past the end of the fiscal year covered by

the report, the late fee will increase to $50. If

the delinquency is not corrected within 16

months of the end of the fiscal year covered by

the report, the late fee increases to $100.

Late Fee Schedule

Fiscal

Year End

Dates

Late

Report

Receive

d Before

This

Date

Late

Report

Received

Between

These

Dates

Late

Report

Received

After This

Date

Late

Fee:

$20 $50 $100

12/31/19

2/1/21

2/1/21-

4/30/21

1/31/20

3/1/21

5/31/21

2/28/20

4/1/21

4/1/21-

6/30/21

3/31/20

5/1/21

5/1/21-

7/31/21

4/30/20

6/1/21

6/1/21-

8/31/21

5/31/20

7/1/21

7/1/21-

9/30/21

6/30/20

8/1/21

8/1/21-

10/31/21

7/31/20

9/1/21

9/1/21-

11/30/21

8/31/20

10/1/21

10/1/21-

12/31/21

9/30/20

11/1/21

11/1/21-

1/31/22

10/31/20

12/1/21

12/1/21-

2/28/22

11/30/20

1/1/22

1/1/22-

3/31/22

The above late fees apply automatically and

cannot be waived. The Department has the

authority to obtain additional civil penalties

against the organization and its officers and

directors or take other administrative action in

connection with the failure to file timely reports.

12. Total Amount Due

Add lines 9, 11, and 12. This is the total amount

due. Make check or money order payable to the

“Oregon Department of Justice”. The

Department does not accept payment by credit

card. Do not send cash.

Mail payment together with the report to:

Charitable Activities Section

Oregon Department of Justice

100 SW Market Street

Portland, Oregon 97201-5702

Important Note—Indicate on the check the

trust’s 4 or 5-digit Oregon Department of Justice

registration number. The registration number is

located on line 1 of the preprinted Form CT-12S

or can be obtained by contacting the Charitable

Activities Section.

13. IRS Forms, Schedules,

and Attachments

All trusts must attach a complete copy of all

forms, supporting schedules, and attachments

filed with the IRS. This may include IRS Form

1041-A and/or IRS Form 5227.

Important Note for CPAs/Paid

Preparers/Beneficiaries— Forms submitted

to this office become a public record. To protect

the privacy of named individuals, you should

redact Social Security Numbers (if used) from

the copy of the IRS Form 990/990-EZ/990-

PF/5227/1041-A (Schedule K) submitted to this

office. Although we endeavor to redact social

security numbers from any forms we receive, we

request your assistance in safeguarding this

information by not including it in your

submission.

Signature Block

To make the return complete, a trustee, receiver

or assignee must sign any return he or she files

for the trust. Signature stamps and labels are not

acceptable.

In the paid preparer’s information section,

include the name, daytime phone number, and

address of any person who was paid by the trust

to complete this report. Power of Attorney

signature is not accepted.

Contact the Following Agencies for Assistance

Charitable Activities

Section

Oregon Department of Justice

100 SW Market Street

Portland, Oregon 97201-5702

Phone: (971)673-1880

TTY: (800)735-2900

Fax: (971)673-1882

Email: charitable@doj.state.or.us

Website: https://www.doj.state.or.us

Issues

• Questions about annual reports for

charitable organizations-Forms CT-12,

CT-12F, and CT-12S

• Registration of charitable organizations

and trusts

• Merging nonprofit organizations

• Dissolving nonprofit organizations

• Reporting illegal activity by nonprofit

organizations

• Serving as a board member of a

nonprofit organization

• Information about charitable

organizations and copies of annual

reports

• Questions about raffles and other

charitable gaming

Forms

• RF-C, Registration Form for Charitable

Organizations

• RF-T, Registration Form for Trusts

• CT-12, Annual Report Form for

Oregon Charities

• CT-12F, Annual Report Form for

Foreign Charities

• CT-12S, Annual Report Form for Split-

Interest Trusts

• Closing Form

Publications

• Oregon Wise Giving Guide

• A Guide to Non-Profit Board Service in

Oregon

Oregon Revised Statutes

• Chapter #65, Nonprofit Corporations

• Chapter #128, Trusts; Charitable

Activities

• Chapter #130, Uniform Trust Code

• Chapter #464, Charitable Gaming

• Chapter #646, Trade Practices &

Antitrust Regulations

Oregon Administrative Rules

• Chapter #137-010-0005 et seq.

Internal Revenue Service

Phone: (877)829-5500

Website: https://www.irs.gov/charities-and-

nonprofits

Issues

• Obtaining federal tax identification

number or federal tax-exempt status

• Completing federal tax forms

Forms

• 990, Return of Organization Exempt

From Income Tax

• 990-EZ, Short Form - Return of

Organization Exempt From Income Tax

• 990-PF, Return of Private Foundation

• 990-T, Exempt Organization Business

Income Tax Return

• 1023/1023-EZ, Application for

Recognition of Exemption Under

§501(c)(3)

• 1024, Application for Recognition of

Exemption Under §501(a)

• 1041, U.S. Income Tax Return for

Estates and Trusts

• 1041-A, U.S. Information Return -

Trust Accumulation of Charitable

Amounts

• 1128, Application to Adopt, Change, or

Retain a Tax Year

• 4720, Return of Certain Excise Taxes

on Charities and Other Persons

• 5227, Split-Interest Trust Return

• 5768, Election/Revocation of Election

by an Eligible Section 501(c)(3)

Organization to Make Expenditures to

Influence Legislation

• 8822, Change of Address

• 8868, Application for Extension of

Time to File an Exempt Organization

Return

• 8976, Notice of Intent to Operate Under

Section 501(c)(4)

Publications

• Pub. 526, Charitable Contributions

• Pub. 538, Accounting Periods and

Methods

• Pub. 557, Tax-Exempt Status for Your

Organization

• Pub. 583, Starting a Business and

Keeping Records

• Pub. 598, Tax on Unrelated Business

Income of Exempt Organizations

• Pub. 3079, Gaming Publication for

Tax-Exempt Organizations

• Pub. 4220, Applying for 501(c)(3) Tax-

Exempt Status

• Pub. 4221, Compliance Guide for

501(c)(3) Organizations

Secretary of State

Corporation Division

Public Service Building

255 Capitol Street NE, Suite 151

Salem, OR 97310-1327

Phone: (503)986-2200

Website:

https://sos.oregon.gov/business/Pages/

default.aspx

Issues

• Forming a new corporation

• Merging nonprofit corporations

• Dissolving nonprofit corporations

• Amending articles of incorporation

• Obtaining copies of filed articles of

incorporation and amendments

Forms

• Articles of Incorporation

• Assumed Business Name Registration

• Articles of Amendment

• Restated Articles

• Articles of Dissolution

• Revocation of Dissolution

Publications

• Oregon Business Guide

Oregon Department

of Revenue

Revenue Building

955 Center St. NE

Salem, OR 97301-2555

Phone: (503)378-4988 and (800)356-4222

Website: https://www.oregon.gov/DOR

Issues

• State taxation and filing requirements

Forms

• 20, Oregon Corporation Excise Tax

Return

• 41, Oregon Fiduciary Income Tax

Return

State of Oregon

Website: https://www.oregon.gov

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