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.activities@doj.state.or.us FAX (971) 673-1882
Website: http://www.doj.state.or.us
For Accounting Periods
Beginning in:
2018
Section I. General Information
1.
Cross Through Incorrect Items and Correct Here:
(See instructions for change of name or accounting period.)
Registration #:
Organization Name:
Address:
City, State, Zip:
Phone: Fax: Amended
Email: Report?
Period Beginning: / / Period Ending: / /
2.
Has 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? 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
4.
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:
Print
Reset
Form Continued on Reverse Side
Section II. Fee Calculation
7.
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)
7.
8.
Charitable Distribution Fee ................................................................................................................................
.....................
(See chart below. Minimum fee is $20.)
8.
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
9.
Net Assets at the End of the Reporting Period ..........................................................................
(Line 59b on Form 5227 or Line 45b on Form 1041-A)
9.
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.activities@doj.state.or.us.
Charitable Activities Section, Oregon Department of Justice
2018 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 connection with assets held
for charitable purposes. The Attorney General
carries out this responsibility by requiring
organizations holding such assets 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. Reports can also
be viewed on our website at
https://justice.oregon.gov/Charities.
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 or organized in Oregon.
File Form CT-12F if the organization is
incorporated or organized 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.
Extensions may be requested through the
Department of Justice website at
https://justice.oregon.gov/Charities/Extensions.
Follow the instructions carefully to ensure that
the Charitable Activities Section receives your
request. Please contact our office if you have
any questions about the online extension process
or are experiencing difficulties with your online
request.
The trust 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.
The Charitable Activities Section will not
provide formal notice that the trust’s extension
request has been approved. Instead, the trust
should assume that its extension request has
been granted unless you hear otherwise from our
office. 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 NoteAn 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.
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 social security numbers
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, 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.activities@doj.state.or.us
Website: http://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 trust has received one of
these preprinted forms, provide any missing or
corrected information. If the organization is
completing a blank form, provide 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 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 ReportIf 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 NoteAttach 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 and mailing address are acceptable.
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 penalties for filing an incomplete
Form.
A "key employee" is any person having
responsibilities or powers similar to those of
officers, directors, or trustees. The term includes
the chief management and administrative
officials of a trust (such as executive director)
but does not include the heads of separate
departments or smaller units within a trust.
A chief financial officer and the officer in charge
of administration or program operations are both
key employees if they have the authority to
control the trust’s activities, its finances, or both.
The "heads of separate departments" reference
applies to persons such as the head of the
radiology department or coronary care unit of a
hospital or the head of the chemistry or history
or English department at a college. These
persons are managers within their specific areas
but not for the trust as a whole and, therefore, are
not key employees.
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
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
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 NoteIf 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 NoteIf 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
12/31/18
2/1/20
2/1/20-
4/30/20
4/30/20
1/31/19
3/1/20
3/1/20
5/31/20
5/31/20
2/28/19
4/1/20
4/1/20-
6/30/20
6/30/20
3/31/19
5/1/20
5/1/20-
7/31/20
7/31/20
4/30/19
6/1/20
6/1/20-
8/31/20
8/31/20
5/31/19
7/1/20
7/1/20-
9/30/20
9/30/20
6/30/19
8/1/20
8/1/20-
10/31/20
10/31/20
7/31/19
9/1/20
9/1/20-
11/30/20
11/30/20
8/31/19
10/1/20
10/1/20-
12/31/20
12/31/2
9/30/19
11/1/20
11/1/20-
1/31/21
1/31/21
10/31/19
12/1/20
12/1/20-
2/28/21
2/28/21
11/30/19
1/1/21
1/1/21-
3/31/21
3/31/21
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 NoteIndicate 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.activities@doj.state.or.us
Website: http://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: http://www.irs.gov
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
Veterans’ Services
If you are or know a veteran and would like
more information about benefits, please see DOJ
Veterans Resources available through the
Department of Justice’s website at:
http://www.doj.state.or.us
Secretary of State
Corporation Division
Public Service Building
255 Capitol Street NE, Suite 151
Salem, OR 97310-1327
Phone: (503)986-2200
Website:
http://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: http://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: http://www.oregon.gov
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