Fillable Form 2015: CHAR500 Open to Public Inspection NYS (CharitiesNYS.com)

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Form 2015: CHAR500 Open to Public Inspection NYS (CharitiesNYS.com)

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2015
Open to Public
Inspection
CHAR500
NYS Annual Filing for Charitable Organizations
www.CharitiesNYS.com
Send with fee and attachments to:
NYS Office of the Attorney General
Charities Bureau Registration Section
28 Liberty Street
New York, NY 10005
1. General Information
For Fiscal Year Beginning (mm/dd/yyyy) _______/_______/ 2015 and Ending (mm/dd/yyyy) _______/_______/_____________
Check if Applicable:
Address Change
Name Change
Initial Filing
Final Filing
Amended Filing
Reg ID Pending
Name of Organization:
Mailing Address:
City / State / Zip:
Employer Identification Number (EIN):
NY Registration Number:
Telephone:
Email:
Website:
We certify under penalties of perjury that we reviewed this report, including all attachments, and to the best of our knowledge and belief,
they are true, correct and complete in accordance with the laws of the State of New York applicable to this report.
President or Authorized Officer: ____________________________________________________________________________________________
Chief Financial Officer or Treasurer: ____________________________________________________________________________________________
1. General Information
2. Certification
Signature Print Name and Title Date
Signature Print Name and Title Date
3. Annual Reporting Exemption
7A only EPTL only DUAL (7A & EPTL) EXEMPT
3a. 7A filing exemption: Total contributions from NY State including residents, foundations, government agencies, etc. did not exceed $25,000
and the organization did not engage a professional fund raiser (PFR) or fund raising counsel (FRC) to solicit contributions during the fiscal year.
Or the organization qualifies for another 7A exemption (see instructions).
3b. EPTL filing exemption: Gross receipts did not exceed $25,000 and the market value of assets did not exceed $25,000 at any time during the
fiscal year.
4. Schedules and Attachments
5. Fee
Check the exemption(s) that apply to your filing. If your organization is claiming an exemption under one category (7A or EPTL only filers) or both
categories (DUAL filers) that apply to your registration, complete only parts 1, 2, and 3, and submit the certified Char500. No fee, schedules, or additional
attachments are required. If you cannot claim an exemption or are a DUAL filer that claims only one exemption, you must file applicable schedules and
attachments and pay applicable fees.
4a. Did your organization use a professional fund raiser, fund raising counsel or commercial co-venturer for
fund raising activity in NY State? If yes, complete Schedule 4a.
Yes No
Yes No
4b. Did the organization receive government grants? If yes, complete Schedule 4b.
See the checklist on the
next page to calculate your
fee(s). Indicate fee(s) you
are submitting here:
7A filing fee: EPTL filing fee: Total fee:
$______ $______ $______
Make a single check or money order
payable to:
"Department of Law"
See the following page
for a checklist of
schedules and
attachments to
complete your filing.
See instructions for certification requirements. Improper certification is a violation of law that may be subject to penalties.
Check your organization's
registration category:
- -
Confirm your Registration Category in the
Charities Registry at www.CharitiesNYS.com.
CHAR500 Annual Filing for Charitable Organizations (Updated December 2015) Page 1
CHAR500
Annual Filing Checklist
Checklist of Schedules and Attachments
Simply submit the certified CHAR500 with no fee, schedule, or additional attachments IF:
- Your organization is registered as 7A only and you marked the 7A filing exemption in Part 3.
- Your organization is registered as EPTL only and you marked the EPTL filing exemption in Part 3.
- Your organization is registered as DUAL and you marked both the 7A and EPTL filing exemption in Part 3.
Our organization was eligible for and filed an IRS 990-N e-postcard. We have included an IRS Form 990-EZ for state purposes only.
IRS Form 990, 990-EZ, or 990-PF, and 990-T if applicable
If you answered "yes" in Part 4b, submit Schedule 4b: Government Grants
If you answered "yes" in Part 4a, submit Schedule 4a: Professional Fund Raisers (PFR), Fund Raising Counsel (FRC), Commercial Co-Venturers (CCV)
Check the schedules you must submit with your CHAR500 as described in Part 4:
Check the financial attachments you must submit with your CHAR500:
All additional IRS Form 990 Schedules, including Schedule B (Schedule of Contributors).
Audit Report if you received total revenue and support greater than $500,000
Review Report if you received total revenue and support greater than $250,000 and up to $500,000.
If you are a 7A only or DUAL filer, submit the applicable independent Certified Public Accountant's Review or Audit Report:
Calculate Your Fee
For 7A and DUAL filers, calculate the 7A fee:
$0, if you checked the 7A exemption in Part 3a
$25, if you did not check the 7A exemption in Part 3a
$25, if the NET WORTH is less than $50,000
$0, if you checked the EPTL exemption in Part 3b
For EPTL and DUAL filers, calculate the EPTL fee:
$50, if the NET WORTH is $50,000 or more but less than $250,000
$250, if the NET WORTH is $1,000,000 or more but less than $10,000,000
$100, if the NET WORTH is $250,000 or more but less than $1,000,000
$750, if the NET WORTH is $10,000,000 or more but less than $50,000,000
$1500, if the NET WORTH is $50,000,000 or more
Where do I find my organization's NET WORTH?
NET WORTH for fee purposes is calculated on:
- IRS From 990 Part I, line 22
- IRS Form 990 EZ Part I line 21
- IRS Form 990 PF, calculate the difference between
Total Assets at Fair Market Value (Part II, line 16(c)) and
Total Liabilities (Part II, line 23(b)).
Send Your Filing
Send your CHAR500, all schedules and attachments, and total fee to:
NYS Office of the Attorney General
Charities Bureau Registration Section
28 Liberty Street
New York, NY 10005
Is my Registration Category 7A, EPTL, DUAL or EXEMPT?
Organizations are assigned a Registration Category upon
registration with the NY Charities Bureau:
7A filers are registered to solicit contributions in New York
under Article 7-A of the Executive Law ("7A")
EPTL filers are registered under the Estates, Powers & Trusts
Law ("EPTL") because they hold assets and/or conduct
activites for charitable purposes in NY.
DUAL filers are registered under both 7A and EPTL.
EXEMPT filers have registered with the NY Charities Bureau
and meet conditions in Schedule E - Registration
Exemption for Charitable Organizations. These
organizations are not required to file annual financial reports
but may do so voluntarily.
Confirm your Registration Category and learn more about NY
law at www.CharitiesNYS.com.
No Review Report or Audit Report is required because total revenue and support is less than $250,000
CHAR500 Annual Filing for Charitable Organizations (Updated December 2015) Page 2
We are a DUAL filer and checked box 3a, no Review Report or Audit Report is required
2015
Open to Public
Inspection
Need Assistance?
Visit: www.CharitiesNYS.com
Call: (212) 416-8401
Email: Charities.Bureau@ag.ny.gov
CHAR500
Instructions for Completing Your NY Annual Filing
www.CharitiesNYS.com
Before You Begin
Visit www.CharitiesNYS.com and search the Charities Registry to find your organization's NY State Registration Number (##-##-##) and Registration
Category (7A, EPTL, DUAL, or EXEMPT). Knowing your organization's Registration Category will help you respond to Sections 1 and 3, determine the
required attachments to the CHAR500 and calculate your filing fee. If your organization is not registered with the Charities Bureau, please complete
CHAR410 "Registration Statement for Charitable Organizations".
1. General Information
Enter the accounting period covered by the report. Provide the best contact information for your organization. This information will be publicly
available in the Charities Registry and will be used for communication to your organization. If your organization is registered and this is your regular
annual filing, check Initial Filing. If your contact information needs to be updated, check Address Change and/or Name Change. Check Amended Filing if
you are making a change to a previous filing. If you have submitted a CHAR410 - Registration Statement for Charitable Organizations - but do not yet
have a NY State Registration Number, check NY Reg Pending. If this is a final filing and the organization is seeking dissolution or ceasing operations, check
Final Filing and submit all applicable IRS schedules and attachments. If your organization is a NY corporation, visit www.CharitiesNYS.com for information
on how to dissolve. Check the Charities Bureau Registration Category of your organization (7A, EPTL, DUAL, or EXEMPT). EXEMPT organizations are those
that have registered with the NY Charities Bureau and meet conditions in Schedule E - Registration Exemption for Charitable Organizations - but have
registered and file voluntarily.
When you have completed the form, sign and print the name, title and date. For 7A and DUAL filers, the CHAR500 must be signed by both the president
or another authorized officer and the chief financial officer or treasurer. These must be different individuals. EPTL filers have the option of a single
signature if the certification is by a banking institution or a trustee of a trust. Clearly state the title of the representative (e.g. "President," "CEO",
Treasurer," "CFO," "Bank Vice President" or "Trustee").
2. Certification
You may claim an exemption from the reporting and fee requirements if you meet the filing exemptions applicable to your organization. If claiming an
exemption under one statute (7A and EPTL only filers) or both statutes (DUAL filers) that apply to your registration, complete only parts 1, 2, and 3, and
submit the certified Char500. No fee, schedule, or additional attachments are required. Otherwise, file all required schedules and attachments and pay
applicable fees.
Note: A 7A or DUAL filer with contributions over $25,000 that did not contract with a professional fund raiser may check the 7A filing exemption in Part 3
if it (i) received all or substantially all of its contributions from a single government agency to which it submitted an annual report similar to that required
by Executive Law Article 7A, or (ii) it received an allocation from a federated fund, United Way or incorporated community appeal and contributions from
all other sources did not exceed $25,000.
3. Annual Reporting Exemption
4. Schedules and Attachments
If you do not qualify for the reporting exemptions as described in Part 3, review the checklist of schedules and attachments required to complete your
filing. If your organization qualified for and submitted an IRS 990-N "e-Postcard", you must complete and submit an IRS Form 990-EZ to the NY Charities
Bureau for reporting purposes. The NY Charities Bureau will not accept an IRS 990-N "e-postcard" because it does not contain sufficient financial
information.
Your total fee is based on your registration category (7A, EPTL or DUAL). 7A or EPTL filers only pay the fee that applies to the statute under which they
have registered unless they have claimed an exemption in Part 3. DUAL filers must pay both fees, unless they have claimed an exemption in Part 3.
Consult the CHAR500 to calculate your fee or contact the NY Charities Bureau if you have additional questions.
5. Fee
7A and DUAL filers: postmarked within 4 1/2 months after the organization's accounting period ends. For example, fiscal year end December 31 reports
are due by May 15th of the following year. EPTL filers: postmarked within 6 months after the organization's accounting period ends. An additional 180
day extension is automatically granted. Information regarding extensions is available at www.CharitiesNYS.com.
When to Submit Your Filing
Payment must be made to the "Department of Law". Send the complete filing with payment to:
NYS Office of the Attorney General, Charities Bureau Registration Section, 28 Liberty Street, New York, NY 10005.
Where to Submit Your Filing
The Attorney General may cancel the registration of or seek civil penalties from an organization that fails to comply with the filing requirements.
Penalties
CHAR500 Instructions for Completing Your NY Annual Filing (Updated December 2015) Page 1
CHAR500
Schedule 4a: Professional Fund Raisers, Fund Raising Counsels, Commercial Co-Venturers
www.CharitiesNYS.com
2015
Open to Public
Inspection
NY Registration Number:
Name of Organization:
If you checked the box in question 4a in Part 4 on the CHAR500 Annual Filing for Charitable Organizations, complete this schedule for EACH Professional
Fund Raiser (PFR), Fund Raising Counsel (FRC) or Commercial Co-Venturer (CCV) that the organization engaged for fund raising activity in NY State. The
PFR or FRC should provide its NY Registration Number to you. Include this schedule with your certified CHAR500 NYS Annual Filing for Charitable
Organizations and use additional pages if necessary.
1. Organization Information
2. Professional Fund Raiser, Fund Raising Counsel, Commercial Co-Venturer Information
Commercial Co-Venturer
Fund Raising Counsel
Professional Fund Raiser
Fund Raising Professional type:
Telephone:
NY Registration Number:
City / State / Zip:
Mailing Address:
Name of FRP:
4. Description of Services
Services provided by FRP:
5. Description of Compensation
Compensation arrangement with FRP:
Amount Paid to FRP:
3. Contract Information
Contract Start Date: Contract End Date:
6. Commercial Co-Venturer (CCV) Report
If services were provided by a CCV, did the CCV provide the charitable organization with the interim or closing report(s) required by
Section 173(a) part 3 of the Executive Law Article 7A?
NoYes
A Professional Fund Raiser (PFR), in addition to other activities, conducts solicitation of contributions and/or handles the donations (Article 7A, 171-a.4).
A Fund Raising Counsel (FRC) does not solicit or handle contributions but limits activities to advising or assisting a charitable organization to perform
such functions for itself (Article 7A, 171-a.9).
A Commercial Co-Venturer (CCV) is an individual or for-profit company that is regularly and primarily engaged in trade or commerce other than raising
funds for a charitable organization and who advertises that the purchase or use of goods, services, entertainment or any other thing of value will benefit a
charitable organization (Article 7A, 171-a.6).
Definitions
--
--
CHAR500 Schedule 4a: Professional Fund Raisers, Fund Raising Counsels, Commercial Co-Venturers (Updated December 2015) Page 1
CHAR500
Schedule 4b: Government Grants
www.CharitiesNYS.com
2015
Open to Public
Inspection
NY Registration Number:Name of Organization:
If you checked the box in question 4b in Part 4 on the CHAR500 Annual Filing for Charitable Organizations, complete this schedule and list EACH
government grant. Use additional pages if necessary. Include this schedule with your certified CHAR500 NYS Annual Filing for Charitable Organizations.
1. Organization Information
2. Government Grants
Name of Government Agency Amount of Grant
1. 1.
2. 2.
3. 3.
4. 4.
5. 5.
6. 6.
7. 7.
8. 8.
9. 9.
10. 10.
11. 11.
12. 12.
13. 13.
14. 14.
15. 15.
Total Government Grants: Total:
--
CHAR500 Schedule 4b: Government Grants (Updated December 2015) Page 1
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