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CHAR500 - 2012
Form CHAR500
Annual Filing for Charitable Organizations
New York State Department of Law (Office of the Attorney General)
Charities Bureau - Registration Section
28 Liberty Street
New York, NY 10005
www.charitiesnys.com
2012
This form used for
Article 7-A, EPTL and dual filers
(replaces forms CHAR 497, CHAR
010 and CHAR 006)
Open to Public
Inspection
1. General Information
a. For the fiscal year beginning (mm/dd/yyyy) / 2 0 1 2 and ending (mm/dd/yyyy)
b. Check if applicable for NYS:
G Address change
G Name change
G Initial filing
G Final filing
G Amended filing
G NY registration pending
c. Nam e of organization d. Fed. employer ID no. (EIN ) (##-#######)
e. NY State registration no. (##-##-##)
Number and street (or P.O. box if mail not delivered to street address) Room/suite f. Telephone number
City or town, state or country and zip + 4 g. Email
2. Certification - Two Signatures Required
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.
Signature Printed Name Title Date
Signature Printed Name Title Date
3. Annual Report Exemption Information
a. Article 7-A annual report exemption (Article 7-A registrants and dual registrants)
Check - if total contributions from NY State (including residents, foundations, corporations, 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 this fiscal year.
NOTE: An organization may claim this exemption if no PFR or FRC was used and either: 1) it received an allocation from a federated fund,
United Way or incorporated community appeal and contributions from other sources did not exceed $25,000 or 2) it received all or
substantially all of its contributions from one government agency to which it submitted an annual report similar to that required by Article 7-A.
b. EPTL annual report exemption (EPTL registrants and dual registrants)
Check - if gross receipts did not exceed $25,000 and assets (market value) did not exceed $25,000 at any time during this fiscal year.
For EPTL or Article-7A registrants claiming the annual report exemption under the one law under which they are registered and for dual registrants claiming the annual report
exemptions under both laws, simply complete part 1 (General Information), part 2 (Certification) and part 3 (Annual Report Exemption Information) above.
Do not submit a fee, do not complete the following schedules and do not submit any attachments to this form.
4. Article 7-A Schedules
If you did not check the Article 7-A annual report exemption above, complete the following for this fiscal year:
a. Did the organization use a professional fund raiser, fund raising counsel or commercial co-venturer for fund raising activity in NY State? . . G Yes* G No
* If “Yes”, complete Schedule 4a.
b. Did the organization receive government contributions (grants)? . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . G Yes* G No
* If “Yes”, complete Schedule 4b.
5. Fee Submitted: See last page for summary of fee requirements.
Indicate the filing fee(s) you are submitting along with this form:
a. Article 7-A filing fee ................................................ $ ________
b. EPTL filing fee .................................................... $ ________
c. Total fee ........................................................ $ ________
Submit only one check or money order for the
total fee, payable to “NYS Department of Law”
6. Attachments - For organizations that are not claiming annual report exemptions under both laws, see last page for required attachments ººº
a. President or Authorized Officer
b. Chief Financial Officer or Treas.
