Fillable STATE OF MINNESOTA CHARITABLE ORGANIZATION INITIAL REGISTRATION FORM (Minnesota Department of Revenue)

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STATE OF MINNESOTA CHARITABLE ORGANIZATION INITIAL REGISTRATION FORM (Minnesota Department of Revenue)

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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
INITIAL REGISTRATION FORM
INSTRUCTIONS
(Pursuant to Minn. Stat. ch. 309)
WHO SHOULD FILE
A charitable organization must file a registration statement if any of the following are true:
• The organization receives or plans to receive more than $25,000 in total contributions from the
public during an accounting year.
• The organization’s functions and activities are not performed wholly by volunteers (i.e. it pays staff,
independent contractors, officers, etc.).
• The organization employs a professional fundraiser.
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 must register before it solicits contributions. Solicitation prior to registration may result in the
imposition of civil penalties up to $25,000 for each violation of Minn. Stat. ch. 309.
WHAT TO FILE
If submitting these forms via mail, please do not use staples.
Charitable Organization Initial Registration Form.
A copy of the organization’s Articles of Incorporation.
A copy of the IRS letter notifying the organization of its tax-exempt status (if applicable).
A full list of the organization’s board of directors, including names, addresses, and total compensation paid
to each.
IRS Form 990, 990-EZ, 990-PF, or 990-N (plus all schedules and attachments, EXCLUDING any
schedules of contributors to the organization (Schedule B)) or financial statement (Section B of registration
form) for the organization’s most recent fiscal year-end.
$25 registration fee.
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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 Initial Registration).
• 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 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.”
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. Required attachments do NOT include any schedules of contributors to the
organization (Schedule B). 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 INITIAL REGISTRATION FORM
INSTRUCTIONS
(Continued)
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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
INITIAL REGISTRATION FORM
(Pursuant to Minn. Stat. ch. 309)
SECTION A: Organization Information
Legal Name of Organization _______________________________________________________________
Federal EIN:________________________ Most Recent Fiscal Year-End: ________________________
mm/dd/yyyy
Mailing Address:
____________________________________________________
Contact Person
____________________________________________________
Street Address
____________________________________________________
City, State, and Zip Code
____________________________________________________
Phone Number
____________________________________________________
Email Address
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. Type of legal entity:
Corporation
Sole Proprietorship
Limited Liability Company
Partnership
Unincorporated Association
Other: _____________________
5. Is the organization incorporated pursuant to Minn. Stat. ch. 317A? Yes No
6. Place and date of organization/incorporation:__________________________________________________
State Date
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7. What is the organization’s tax-exempt status? 501(c)_______ Status Pending Not Tax-Exempt
If the organization’s tax-exempt status is pending, identify the date the organization submitted Form 1023
to the Internal Revenue Service: __________________________________
8. Does the organization use a fiscal agent? Yes No
If yes, identify fiscal agent’s name, address, and Federal EIN:____________________________________
______________________________________________________________________________________
9. Address of principal office in Minnesota, or, if none, the name and address of the person who has custody
of books and records:
______________________________________________________________________________________
Contact Person Phone Number Email Address
______________________________________________________________________________________________________
Street Address City, State, and Zip Code
10. Explain in detail the organization’s charitable purpose(s) (attach explanation if more space is needed):
_______________________________________________________________________________________________________
_______________________________________________________________________________________________________
_______________________________________________________________________________________________________
11. What methods of solicitation does the organization anticipate using? Check all that apply.
Telemarketing Publication/Magazine Show/Concert/Event
Direct Mail Email Discount Coupons
Door-to-Door Solicitation Website Radio
Thrift Store Social Media Vehicle Donations
Other (describe): ________________________________________________
12. Total amount of contributions the organization anticipates receiving from Minnesota donors: $_________
13. Has the organization been denied the right to solicit contributions by any court or government agency?
Yes No If yes, attach explanation.
14. 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
CHARITABLE ORGANIZATION INITIAL REGISTRATION FORM
(Continued)
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SECTION B: Financial Information
An organization may submit a copy of its IRS Form 990, 990-EZ, or 990-PF in lieu of completing Section B.
If an organization has not yet filed an IRS return, it must provide preliminary financials for its most recent
fiscal year-end.
• Is an IRS Form 990, 990-EZ, or 990-PF attached? Yes No If no, provide the following information:
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 INITIAL REGISTRATION 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 INITIAL REGISTRATION FORM
(Continued)
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STATE OF MINNESOTA CHARITABLE ORGANIZATION INITIAL REGISTRATION FORM (Minnesota Department of Revenue)

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Completed 28 September 2021

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