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Form Name:   AG990-IL
Tags:   illinois charitable organization annual report
Posted By:  
Date:   3/7/2010
Size:   215KB
Type:   .PDF
     
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#ILLINOIS CHARITABLE ORGANIZATION ANNUAL REPORT Form AG990-ILRevised 3/05YesNoLEGALNAMEMAILA) ASSETSA) $ADDRESSB) LIABILITIESB) $CITY, STATEC) NET ASSETSZIP CODEC) $PERCENTAGEAMOUNT%D) $%E) $%F) $100%G) $I. SUMMARY OF ALL REVENUE ITEMS DURING THE YEAR:F) OTHER REVENUESG) TOTAL REVENUE, INCOME AND CONTRIBUTIONS RECEIVED (ADD D,E, & F)II. SUMMARY OF ALL EXPENDITURES DURING THE YEAR: K) GRANTS TO OTHER CHARITABLE ORGANIZATIONSN) FUNDRAISING EXPENSEO) TOTAL EXPENDITURES THIS PERIOD (ADD L, M, & N)D) PUBLIC SUPPORT, CONTRIBUTIONS & PROGRAM SERVICE REV. (GROSS AMTS.)E) GOVERNMENT GRANTS & MEMBERSHIP DUESH) OPERATING CHARITABLE PROGRAM EXPENSE I) EDUCATION PROGRAM SERVICE EXPENSEL) TOTAL CHARITABLE PROGRAM SERVICE EXPENDITURE (ADD J & K)M) MANAGEMENT AND GENERAL EXPENSE100 %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) TOTAL AMOUNT RAISED BY PAID PROFESSIONAL FUNDRAISERSQ) TOTAL FUNDRAISERS FEES AND EXPENSESR) 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) $CODEW) #V. CHARITABLE PROGRAM DESCRIPTION:X) DESCRIPTION:X) #Y) DESCRIPTION:Y) #COAttorney GeneralLISA MADIGANState of IllinoisCharitable Trust Bureau, 100 West Randolph11th Floor, Chicago, Illinois 60601Year-end amountsCheck all items attached:For Office Use OnlyW) DESCRIPTION:CHARITABLE PROGRAM (3 HIGHEST BY $ EXPENDED) CODE CATEGORIESList on back side of instructionsS) TOTAL AMOUNT PAID TO PROFESSIONAL FUNDRAISING CONSULTANTS / / / /N) $O) $L) $M) $100 %%%% K) $%H) $S) $Make Checks Payable to the Illinois Charity Bureau FundMO DAY YRMO DAY YRAre contributions to the organization tax deductible?Copy of IRS ReturnAudited Financial StatementsCopy of Form IFC$15.00 Annual Report Filing Fee$100.00 Late Report Filing FeeReport for the Fiscal Period:BeginningFederal ID #& Ending / /Date Organization was created:U) NAME, TITLE:PMT #AMTINIT% I) $ J) TOTAL CHARITABLE PROGRAM SERVICE EXPENSE (ADD H & I)J1) JOINT COSTS ALLOCATED TO PROGRAM SERVICES (INCLUDED IN J): $% J) $%PROFESSIONAL FUNDRAISERS:PROFESSIONAL FUNDRAISING CONSULTANTS:YESNOIF THE ANSWER TO ANY OF THE FOLLOWING IS YES, ATTACH A DETAILED EXPLANATION:1.1. WAS THE ORGANIZATION THE SUBJECT OF ANY COURT ACTION, FINE, PENALTY OR JUDGMENT?2.MISAPPROPRIATION OF FUNDS OR ANY FELONY?3. DID THE ORGANIZATION MAKE A GRANT AWARD OR CONTRIBUTION TO ANY ORGANIZATION IN WHICHANY 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 OR4.TRUSTEE OWNS MORE THAN 10% OF THE OUTSTANDING SHARES?IS ANY PROPERTY OF THE ORGANIZATION HELD IN THE NAME OF OR COMMINGLED WITH THE5.PROPERTY OF ANY OTHER PERSON OR ORGANIZATION?5.7a. DID THE ORGANIZATION ALLOCATE THE COST OF ANY SOLICITATION, MAILING, ADVERTISEMENT ORLITERATURE COSTS BETWEEN PROGRAM SERVICE AND FUNDRAISING EXPENSES?6.8. DID THE ORGANIZATION EXPEND ITS RESTRICTED FUNDS FOR PURPOSES OTHER THAN RESTRICTED7.PURPOSES?2. HAS THE ORGANIZATION OR A CURRENT DIRECTOR, TRUSTEE, OFFICER OR EMPLOYEE THEREOF,EVER BEEN CONVICTED BY ANY COURT OF ANY MIDSDEMEANOR INVOLVING THE MISUSE ORANY OF ITS OFFICERS, DIRECTORS OR TRUSTEES OWNS AN INTEREST; OR WAS IT A PARTY TO ANY TRANSACTIONIN WHICH ANY OF ITS OFFICERS, DIRECTORS OR TRUSTEES HAS A MATERIAL FINANCIAL INTEREST; OR DID9. HAS THE ORGANIZATION EVER BEEN REFUSED REGISTRATION OR HAD ITS REGISTRATION OR TAX EXEMPTION8.SUSPENDED OR REVOKED BY ANY GOVERNMENTAL AGENCY?6. DID THE ORGANIZATION USE THE SERVICES OF A PROFESSIONAL FUNDRAISER?9.10.11. 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:UNDER PENALTY OF PERJURY, I (WE) THE UNDERSIGNED DECLARE AND CERTIFY THAT I (WE) HAVE EXAMINED THIS ANNUAL REPORTAND THE ATTACHED DOCUMENTS, INCLUDING ALL THE SCHEDULES AND STATEMENTS AND THE FACTS THEREIN STATED ARETRUE AND COMPLETE AND FILED WITH THE ILLINOIS ATTORNEY GENERAL FOR THE PURPOSE OF HAVING THE PEOPLE OF THESTATE OF ILLINOIS RELY THEREUPON. I HEREBY FURTHER AUTHORIZE AND AGREE TO SUBMIT MYSELF AND THE REGISTRANTHEREBY TO THE JURISDICTION OF THE STATE OF ILLINOIS.PRESIDENT or TRUSTEE (PRINT NAME)SIGNATUREDATETREASURER or TRUSTEE (PRINT NAME)SIGNATUREDATESIGNATUREDATE7b. IF "YES", ENTER (i) THE AGGREGATE AMOUNT OF THESE JOINT COSTS $;(ii) THE AMOUNTALLOCATED TO PROGRAM SERVICES $; (iii) THE AMOUNT ALLOCATED TO MANAGEMENTAND GENERAL $; AND (iv) THE AMOUNT ALLOCATED TO FUNDRAISING $( ATTACH FORM IFC )10. WAS THERE OR DO YOU HAVE ANY KNOWLEDGE OF ANY KICKBACK, BRIBE, OR ANY THEFT, DEFALCATIONMISAPPROPRIATION, COMMINGLING OR MISUSE OF ORGANIZATIONAL FUNDS?BE SURE TO INCLUDE ALL FEES DUE:1.) REPORTS ARE DUE WITHIN SIX MONTHS OF YOUR FISCAL YEAR END.2.) FOR FEES DUE SEE INSTRUCTIONS.3.) REPORTS THAT ARE LATE OR INCOMPLETE ARE SUBJECT TO A $100.00 PENALTY.PREPARER (PRINT NAME)ALL ATTACHMENTS MUST ACCOMPANY THIS REPORT - SEE INSTRUCTIONS