Fillable Form AG990-IL: ILLINOIS CHARITABLE ORGANIZATION ANNUAL REPORT

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Form AG990-IL: ILLINOIS CHARITABLE ORGANIZATION ANNUAL REPORT

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ILLINOIS CHARITABLE ORGANIZATION ANNUAL REPORT
Form AG990-IL
Revised 1/19
Yes No
LEGAL
NAME
MAIL
A) ASSETS
A) $
ADDRESS
B) LIABILITIES
B) $
CITY, STATE
C) NET ASSETS
ZIP CODE
C) $
PERCENTAGE
AMOUNT
%
D) $
%
E) $
%
F) $
100%
G) $
I. SUMMARY OF ALL REVENUE ITEMS DURING THE YEAR:
F) OTHER REVENUES
G) TOTAL REVENUE, INCOME AND CONTRIBUTIONS RECEIVED (ADD D,E, & F)
II. SUMMARY OF ALL EXPENDITURES DURING THE YEAR:
K) GRANTS TO OTHER CHARITABLE ORGANIZATIONS
N) FUNDRAIS
ING EXPENSE
O) TOTAL EXPENDITURES THIS PERIOD (ADD L, M, & N)
D) PUBLIC SUPPORT, CONTRIBUTIONS & PROGRAM SERVICE REV.
(GROSS AMTS.)
E) GOV
ERNMENT GRANTS & MEMBERSHIP DUES
H) OPERATING CHARITABLE PROGRAM EXPENSE
I) E
DUCATION PROGRAM SERVICE EXPENSE
L) TOTAL CHARITABLE PROGRAM SERVICE EXPENDITURE (ADD J & K
)
M) MANAG
EMENT AND GENERAL EXPENSE
100 %
P) $
%
Q) $
%
R) $
III. SUMMARY OF ALL PAID FUNDRAISER AND CONSULTANT ACTIVITIES:
(Attach Attorney General Report of Individual Fundraising Campaign- Form IFC. One for each PFR.)
P) TO
TAL AMOUNT RAISED BY PAID PROFESSIONAL FUNDRAISERS
Q) TOTAL FUNDRAISERS FEES AND EXPENSES
R) NET RECEIVED BY THE CHARITY (P MINUS Q=R)
T) $
IV. COMPENSATION TO THE (3) HIGHEST PAID PERSONS DURING THE YEAR:
T) NAME, TITLE:
U) $
V) NAME, TITLE:
V) $
CODE
W) #
V. CHARITABLE PROGRAM DESCRIPTION:
X) DESCRIPTION:
X) #
Y
) DESCRIPTION:
Y) #
CO
Attorney General KWAME RAOUL State of Illinois
Charitable Trust Bureau, 100 West Randolph
11th Floor, Chicago, Illinois 60601
Year-end
amounts
Check all items attached:
For Office Use Only
W) DESCRIPTION:
CHARITABLE PROGRAM (3 HIGHEST BY $ EXPENDED) CODE CATEGORIES
List on back side of instructions
S) TOTAL AM
OUNT PAID TO PROFESSIONAL FUNDRAISING CONSULTANTS
/
/
/
/
N) $
O) $
L) $
M) $
10
0 %
%
%
%
K) $
%
H) $
S) $
Make Checks
Payable to
the Illinois
Charity
Bureau Fund
MO DAY YR
MO DAY YR
Are contributions to the organization tax deductible?
Copy of IRS Return
Audited Financial Statements
Copy of Form IFC
$15.00 Annual Report Filing Fee
$100.00 Late Report Filing Fee
Report for the Fiscal Period:
Beginning
Federal ID #
& Ending
/
/
Date Organization was created:
U) NAME, TITLE:
PMT #
AMT
INIT
%
I) $
J) TOTAL CHARITABLE PROGRAM SERVICE EXPENSE (ADD H & I)
J
1
) JOINT COSTS ALLOCATED TO PROGRAM SERVICES (INCLUDED IN J): $
%
J) $
%
PROFESSIONAL FUNDRAISERS:
PROFESSIONAL FUNDRAISING CONSULTANTS:
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:
PRESIDENT or TRUSTEE (PRINT NAME)
SIGNATURE
DATE
1.) REPORTS ARE DUE WITHIN SIX
MONTHS OF YOUR FISCAL YEAR END.
2.) FOR FEES DUE SEE INSTRUCTIONS.
TREASURER or TRUSTEE (PRINT NAME)
SIGNATURE
DATE
3.) REPORTS THAT ARE LATE OR
INCOMPLETE ARE SUBJECT TO A
$100.00 PENALTY.
PREPARER (PRINT NAME)
SIGNATURE
DATE
( ATTACH FORM IFC )
6. DID THE ORGANIZATION USE THE SERVICES OF A PROFESSIONAL FUNDRAISER?
7a. DID THE ORGANIZATION ALLOCATE THE COST OF ANY SOLICITATION, MAILING, ADVERTISEMENT OR
LITERATURE COSTS BETWEEN PROGRAM SERVICE AND FUNDRAISING EXPENSES?
8.
9.
SUSPENDED OR REVOKED BY ANY GOVERNMENTAL AGENCY?
10.
IF THE ANSWER TO ANY OF THE FOLLOWING IS YES, ATTACH A DETAILED EXPLANATION:
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 CONTRIBTION 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.
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?
9. HAS THE ORGANIZATION EVER BEEN REFUSED REGISTRATION OR HAD ITS REGISTRATION OR TAX EXEMPTION
10. WAS THERE OR DO YOU HAVE ANY KNOWLEDGE OF ANY KICKBACK, BRIBE, OR ANY THEFT, DEFALCATION,
MISAPPROPRIATION, COMMINGLING OR MISUSE OF ORGANIZATIONAL FUNDS?
11. LIST THE NAME AND ADDRESS OF THE FINANCIAL INSTITUTIONS WHERE THE ORGANIZATION MAINTAINS ITS
THREE LARGEST ACCOUNTS:
12. NAME AND TELEPHONE NUMBER OF CONTACT PERSON:
NO
YES
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Form AG990-IL: ILLINOIS CHARITABLE ORGANIZATION ANNUAL REPORT

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Completed 2 February 2022

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