Fillable STATE OF MINNESOTA CHARITABLE ORGANIZATION ANNUAL REPORT FORM (Minnesota Department of Revenue)

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STATE OF MINNESOTA CHARITABLE ORGANIZATION ANNUAL REPORT FORM (Minnesota Department of Revenue)

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Mail To:
Minnesota Attorney General’s Office
Charities Division
445 Minnesota Street, Suite 1200
St. Paul, MN 55101-2130
Website Address:
www.ag.state.mn.us/charity
STATE OF MINNESOTA
CHARITABLE ORGANIZATION
ANNUAL REPORT FORM
INSTRUCTIONS
(Pursuant to Minn. Stat. ch. 309)
WHO SHOULD FILE
• A charitable organization registered to solicit contributions in Minnesota must file an annual report with the
Attorney General’s Office.
• A charitable organization is a person who engages in or purports to engage in solicitation for a charitable
purpose. See Minn. Stat. 309.50, subd. 5. “Solicit” and “solicitation” have the meanings set forth in Minn.
Stat. § 309.50, subd. 10 and include oral or written requests.
• Please refer to the definitions set forth in Minn. Stat. § 309.50 when completing registration and report
forms.
WHEN TO FILE
• An organization’s annual report must be postmarked by the 15
th
day of the seventh month after its fiscal
year-end. If the due date falls on a Saturday, Sunday, or federal holiday, the report must be postmarked by
the next business day.
• An organization may request a four-month extension. Extension requests must be submitted on or before the
due date. If an organization fails to file its annual report or request an extension by the due date, a
$50 late fee is assessed. Visit www.ag.state.mn.us/Charity/ExtensionRequest.aspx to request an extension.
Fiscal Year-End
Due Date
Extended Due Date
January 31
August 15
December 15
February 28
September 15
January 15
March 31
October 15
February 15
April 30
November 15
March 15
May 31
December 15
April 15
June 30
January 15
May 15
July 31
February 15
June 15
August 31
March 15
July 15
September 30
April 15
August 15
October 31
May 15
September 15
November 30
June 15
October 15
December 31
July 15
November 15
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WHAT TO FILE
If submitting these forms via mail, please do not use staples.
Charitable Organization Annual Report Form.
IRS Form 990, 990-EZ, 990-PF, or 990-N plus all schedules and attachments.
IRS Form 990-T (if the organization files one).
A full list of the organization’s board of directors, including names, addresses, and total compensation paid
to each.
An audit prepared in accordance with generally accepted accounting principles by an independent CPA or
LPA if the organization has total revenue of more than $750,000. The value of donated food to a nonprofit
food shelf may be excluded from the total revenue if the food is donated for subsequent distribution at no
charge and is not resold.
$25 registration fee.
$50 late fee, if the organization failed to request an extension or submit its complete report by the due date.
HOW TO FILE
This form may be submitted via email and the fee may be paid electronically.
• The form and all attachments should be emailed to charity.registration@ag.state.mn.us. The email and
attachments can be no larger than 25 MB. The subject line of the email must contain the organization’s
name. If the materials you are submitting are more than 25 MB, submit the attachments in separate emails
properly labeled in the subject line (e.g., email 1 of 3).
• Documents must be in PDF format and named in an identifying manner (e.g., Charity Annual Report).
• You will receive an automatically generated confirmation email. Receipt of the email confirms only that
this Office received your submission and is not an attestation regarding the validity or completeness of the
submitted materials.
• You may pay the $25 registration fee and/or $50 late fee via credit card at
www.ag.state.mn.us/Charity/CharFees.aspx, or you may submit a check via U.S. mail. If paying by check,
make the check payable to "State of Minnesota."
CHARITABLE ORGANIZATION ANNUAL REPORT FORM INSTRUCTIONS
(Continued)
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PLEASE NOTE
• Some organizations may be exempt from registration and reporting. See Minn. Stat. § 309.515 for more
information.
• An organization may submit the Unified Registration Statement, but it must also file the Minnesota
Supplement.
• Include all required attachments. Registration statements and reports that fail to include all required
attachments will be considered deficient and will not be effective until all required materials are received by
the Minnesota Attorney General’s Office. You will be informed of your registration status by letter from
the Minnesota Attorney General’s Office.
• Failure to maintain registration while soliciting may result in the imposition of civil penalties up to $25,000
for each violation of Minn. Stat. ch. 309.
• NOTICE: All information and documentation provided as part of registration and reporting shall be
public records.
CHARITABLE ORGANIZATION ANNUAL REPORT FORM INSTRUCTIONS
(Continued)
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Mail To:
Minnesota Attorney General’s Office
Charities Division
445 Minnesota Street, Suite 1200
St. Paul, MN 55101-2130
Website Address:
www.ag.state.mn.us/charity
STATE OF MINNESOTA
CHARITABLE ORGANIZATION
ANNUAL REPORT FORM
(Pursuant to Minn. Stat. ch. 309)
SECTION A: Organization Information
Legal Name of Organization _______________________________________________________________
Federal EIN:______________________________ Fiscal Year-End: ______________________________
mm/dd/yyyy
Did the organization’s fiscal year-end change? Yes No
____________________________________________________
Contact Person
____________________________________________________
Street Address
____________________________________________________
City, State, and Zip Code
____________________________________________________
Phone Number
____________________________________________________
Physical Address:
_____________________________________________________
Contact Person
_____________________________________________________
Street Address
_____________________________________________________
City, State, and Zip Code
_____________________________________________________
Phone Number
_____________________________________________________
Email Address
1. Organization’s website:__________________________________________________________________
2. List all of the organization’s alternate and former names (attach list if more space is needed).
________________________________________________________________ Alternate Former
________________________________________________________________ Alternate Former
3. List all names under which the organization solicits contributions (attach list if more space is needed).
_____________________________________________________________________________________
_____________________________________________________________________________________
4. Is the organization incorporated pursuant to Minn. Stat. ch. 317A? Yes No
5. Total amount of contributions the organization received from Minnesota donors: $___________________
6. Has the organization’s tax-exempt status with the IRS changed?
Yes No If yes, attach explanation.
7. Has the organization significantly changed its purpose(s) or program(s)?
Yes No If yes, attach explanation.
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8. Has the organization been denied the right to solicit contributions by any court or government agency?
Yes No If yes, attach explanation.
9. Does the organization use the services of a professional fundraiser (outside solicitor or consultant) to
solicit contributions in Minnesota? Yes No
If yes, provide the following information for each (attach list if more space is needed):
____________________________________________________________________________________
Name of Professional Fundraiser Compensation
____________________________________________________________________________________
Street Address City, State, and Zip Code
10. Is the organization a food shelf? Yes No
If yes, is the organization required to file an audit? Yes, audit attached No
Note: An organization that has total revenue of more than $750,000 is required to file an audit prepared in
accordance with generally accepted accounting principles by an independent CPA or LPA. The value of
donated food to a nonprofit food shelf may be excluded from the total revenue if the food is donated for
subsequent distribution at no charge and is not resold.
11. Do any directors, officers, or employees of the organization or its related organization(s) receive total
compensation* of more than $100,000?
Yes No
If yes, provide the following information for the five highest paid individuals:
Name and title
Compensation*
Other compensation
*Compensation is defined as the total amount reported on Form W-2 (Box 5) or Form 1099-MISC (Box 7)
issued by the organization and its related organizations to the individual. See Minn. Stat. § 309.53, subd.
3(i) and Minn. Stat. § 317A.011 for definitions.
CHARITABLE ORGANIZATION ANNUAL REPORT FORM
(Continued)
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SECTION B: Financial Information
This section must be completed by organizations that file an IRS Form 990-EZ, 990-PF, or 990-N.
Organizations that file an IRS Form 990 may skip Section B and go directly to Section C.
INCOME
1. Contributions Received $______________________1
2. Government Grants $______________________2
3. Program Service Revenue $______________________3
4. Other Revenue $______________________4
5. TOTAL INCOME $______________________5
EXPENSES
6. Program Expenses $______________________6
7. Management & General Expenses $______________________7
8. Fund-raising Expenses $______________________8
9. TOTAL EXPENSES $______________________9
10. EXCESS or DEFICIT $______________________10
(Line 5 minus Line 9)
ASSETS
11. Cash $______________________11
12. Land, Buildings & Equipment $______________________12
13. Other Assets $______________________13
14. TOTAL ASSETS $______________________14
LIABILITIES
15. Accounts Payable $______________________15
16. Grants Payable $______________________16
17. Other Liabilities $______________________17
18. TOTAL LIABILITIES $______________________18
FUND BALANCE/NET WORTH $______________________
(Line 14 minus Line 18)
CHARITABLE ORGANIZATION ANNUAL REPORT FORM
(Continued)
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Section B (continued): Statement of Functional Expenses
This expense statement must be prepared in accordance with generally accepted accounting principles. Each
column must be completed, and Columns B, C, and D must equal Column A. The amount on Line 25,
Column A must match Line 17 of IRS Form 990-EZ or Line 26 of IRS Form 990-PF.
(A)
Total expenses
(B)
Program service
expenses
(C)
Management and
general expenses
(D)
Fundraising
expenses
1. Grants and other assistance to governments and organizations in the U.S.
2. Grants and other assistance to individuals in the U.S.
3. Grants and other assistance to governments, organizations, and individuals
outside the U.S.
4. Benefits paid to or for members
5. Compensation of current officers, directors, trustees, and key employees
6. Compensation not included above, to disqualified persons (as defined under
section 4958(f)(1) and persons described in section 4958(c)(3)(B)
7. Other salaries and wages
8. Pension plan contributions (include section 401(k) and section 403(b)
employer contributions)
9. Other employee benefits
10. Payroll taxes
11. Fees for services (non-employees):
a. Management
b. Legal
c. Accounting
d. Lobbying
e. Professional fundraising services
f. Investment management fees
g. Other
12. Advertising and promotion
13. Office expenses
14. Information technology
15. Royalties
16. Occupancy
17. Travel
18. Payments of travel or entertainment expenses for any federal, state, or
local public officials
19. Conferences, conventions, and meetings
20. Interest
21. Payments to affiliates
22. Depreciation, depletion, and amortization
23. Insurance
24. Other expenses. Itemize expenses not covered above. Expenses labeled
miscellaneous may not exceed 5% of total expenses (Line 25).
a._____________________________________________________
b._____________________________________________________
c._____________________________________________________
d._____________________________________________________
25. Total functional expenses. Add lines 1 through 24d.
26. Joint costs. Check here ► if following SOP 98-2. Complete this line
only if the organization reported in Column B joint costs from a combined
educational campaign and fundraising solicitation
CHARITABLE ORGANIZATION ANNUAL REPORT FORM
(Continued)
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Section C: Board of Directors Signatures and Acknowledgment
The form must be executed pursuant to a resolution of the board of directors, trustees, or managing group and
must be signed by two officers of the organization. See Minn. Stat. § 309.52, subd. 3.
We, the undersigned, state and acknowledge that we are duly constituted officers of this organization,
being the ________________________(Title) and _________________________(Title) respectively, and that
we execute this document on behalf of the organization pursuant to the resolution of the
_____________________________(Board of Directors, Trustees, or Managing Group) adopted on the _____
day of ___________________, 20____, approving the contents of the document, and do hereby certify that the
________________________________(Board of Directors, Trustees or Managing Group) has assumed, and
will continue to assume, responsibility for determining matters of policy, and have supervised, and will continue
to supervise, the operations and finances of the organization. We further state that the information supplied is
true, correct and complete to the best of our knowledge.
_________________________________________ __________________________________________
Name (Print) Name (Print)
_________________________________________ __________________________________________
Signature Signature
_________________________________________ __________________________________________
Title Title
_________________________________________ __________________________________________
Date Date
CHARITABLE ORGANIZATION ANNUAL REPORT FORM
(Continued)
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STATE OF MINNESOTA CHARITABLE ORGANIZATION ANNUAL REPORT FORM (Minnesota Department of Revenue)

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Completed 22 February 2021

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