The annual registration form for a NFP on the Minnesota Attorney General?s Website is attached.

Chapter 16 (B1) - Smithville Softball League For this exercise please use the following accounts Cash Field Improvements Salary & Wage Expense Utility Expense Concession Stand Food Costs Field Maintenance (Program Costs) Management & general (Support Costs) Fund-Raising (Support Costs) Contributions - Unrestricted Contributions - Temporarily Restricted Contributions - In-kind unrestricted Concession Stand Revenue Net Assets Unrestricted Net Assets Temporarily Restricted Net Assets - Released - Temporarily Restricted Net Assets - Released - Unrestricted Record the following transactions for Smithville Softball Association: 1) Rec'd $15,000 in cash contribution at a local fund-raising event 2) Paid the field manager $5,000 3) Paid the electric bills totaling $1,500 4) The local JC's chamber contributed $2,000 to the association 5) Smithville Rental contributed a lawnmower for the season, to help with lawn care. The fair market value of the lawnmower rental is $1,800 (Debit: Field Maintenance) 6) Revenues made at the concession stand amounted to $7,500 7) The value of the labor that people contributed to work the concession stand is valued at $3,000 8) A contribution $1,100 was received by a player's family which the donor requested that it be used for future field expansion. 9) The cost of the food sold at the concession stand was $2,500. 10)Skid steer work donated for the field expansion was valued at $2,200. (Debit: Field Improvements) 11) Dirt and sod placed for the field expansion costs $900 and a check was written. (Debit: Field Improvements) 12)Release $900 from transaction #8 for satisfaction of contribution. 13)Allocate the field manager's salary: 90% Program costs - Field Maintenance 5% Support Costs - Management and general 5% Support Costs - Fund-raising 14)Allocate the utility bill: 95% Program Costs - Field Maintenance 5% Support Costs - Management & general 15)Close the nominal accounts. GENERAL JOURNAL Debits 1. 2. 3. 4. 5. 6. 7. 8. 9. 10. 11. 12. 13. Credits 14. Close the Contributions - Temporarily Restricted to Net Assets-Temporarily Restricted 15. Close two the Net Assets - Released to their respective Net Assets Accounts 15. Close the Expenses, Revenues and the two Contributions Unrestricted accounts to Net Assets Unrestricted 15. Cash Field Improvements Salary & Wage Expense Utility Expense Concession Stand Food Costs Field Maintenance Costs Management & General Costs Fund-Raising Costs Concession Stand Revenue Contributions Unrestricted Net Assets - Released - Temporarily Restricted Net Assets - Released Unrestricted Contributions - Temporarily Restricted Contributions - Inkind - Unrestricted Net Assets Unrestricted Net Assets Temporarily Restricted Chapter 16 - Smithville Softball League Activity Assignment Based the transactions you recorded completed the financial statements to present at the annual meeting. The shaded areas are for your numbers. Smithville Softball League Statement of Activities FYE December 31, 2014 Concessio n Stand Unrestricted Temporarily Restricted Total Revenue & Other Support: Concession Stand Contributions - Cash Contributions - In-Kind New Assets Released Total Revenue & Other Support Expenses: Concession Stand Food Field Maintenance Management & General Fund-Raising Total Expenses Increase in Net Assets Beginning Net Assets Ending Net Assets c. 0 0 SOLVE STATEMENT OF FINANCIAL POSITION DECEMBER 31, 2014 Assets: Cash Field Improvements Total Assets Liabilities: Total Liabilities Net Assets: Unrestricted Temporarily Restricted Total Net Assets Total Liabilities & Net Assets 0 0 Smithville Softball League - Minnesota Annual Report http://www.ag.state.mn.us/Charities/CharityForms.asp Pull up the annual registration form for a NFP on the Minnesota Attorney General's Website and as the treasurer you are required to complete the report for the Smithville Softball League. Use the financial statements that you prepared for your chapter 13 quiz. I have provided additional information to help you complete the form. Complete Section A, C & D Tax Id #: 123456789 NFP's Registered Name: Smithville Softball League Company. This has always been the NFP's name. Mailing & Physical address: 123 Accounting Lane, Funtown, MN 55000 Contact Person: Use your name EMail, Tel. No & Fax No: You may leave blank or be creative with the information Professional fundraiser: None Accounting Year: December. No change in the accounting year. Filing Fees, and attachments: Included Change in Tax Status: None Individuals paid over $100,000: None List of Board of Directors: Assume attached 990N: Assume attached Chair: Joan Smith The Section D Document was executed by the Board of Directors on June 1, 2015 STATE OF MINNESOTA CHARITABLE ORGANIZATION INITIAL REGISTRATION & ANNUAL REPORT FORM ATTORNEY GENERAL LORI SWANSON Annual Reporting SUITE 1200, BREMER TOWER 445 MINNESOTA STREET ST. PAUL, MN 55101-2130 (651) 757-1311 (651) 296-1410 (TTY) www.ag.state.mn.us Initial Registration FEDERAL EIN NUMBER: FOR YEAR ENDING: SECTION A: REQUIRED INFORMATION FOR INITIAL REGISTRATION & ANNUAL REPORTING 1. Legal Name of Organization: __________________________________________________________ If annual reporting, is this a new name since the organization's last filing? Yes No If so, please state former name: __________________________________________________________ 2. List all names under which the organization solicits contributions: ___________________________________________________________________________________ ___________________________________________________________________________________ Mailing Address of Organization (required) Physical Address of Organization (required) _______________________________________ ________________________________________ _______________________________________ ________________________________________ _______________________________________ ________________________________________ 3. 4. Contact Person___________________________ Tel. No. _________________________________ E-mail ________________________________ Fax No.________________________________ 5. Does the organization use the services of a professional fund-raiser (outside solicitor or consultant)? Yes No If so, provide name and address of any outside professional fund-raiser employed by the organization and state the total amount of compensation each outside fund-raiser received from the filing organization during the year. Attach schedule if more than one. Name ______________________________________________________________________________ Address ____________________________________________________________________________ City________________State______ Zip ________ Compensation _____________________________ 6. a) Does this professional fund-raiser solicit or consult in Minnesota? Yes b) Is this professional fund-raiser registered to solicit or consult in Minnesota? No Yes No 7. Month and day accounting year ends: _____________________________________________________ 8. Has the organization included the filing fee, late fee (if any) and all attachments required by the instructions? Yes No Office Use Only: 01/13 ARF $25 $50 N(e-Postcard) 990 EZ PF FES SIG BD SAL Audit Upon request this material can be made available in alternate formats. 9. This Section A(9) must be completed by organizations filing a 990-N (e-Postcard) or organizations whose filing does not contain the information requested below. This includes organizations that: 1) do not file an IRS Form 990, 2) file an IRS Form 990-EZ or 990-PF, or 3) organizations that file a group return that does not include the filing organization's individual financial information. INCOME Contributions from the public Government Grants Other revenue TOTAL REVENUE EXCESS or DEFICIT TOTAL Assets TOTAL Liabilities $__________________ $__________________ $__________________ 0.00 $__________________ $_______________ $_______________ $_______________ END OF YEAR FUND BALANCE/NET WORTH (Assets minus Liabilities) $_________________ 2 SECTION B: REQUIRED FOR INITIAL REGISTRATION ONLY 1. Address of registered agent in the State of Minnesota or the address of the person who has custody of the organization's books and records if not kept at the organization's office. Name ______________________________________________________________________________ Street and Number ____________________________________________________________________ City________________ State_______ Zip ________ Telephone # ____________________________ 2. Type of legal entity (Attach the creating document): Nonprofit corporation Trust Unincorporated association Other ______________ 3. Place and date the organization was incorporated: ___________________________________________ (state) (date) 4. Is the organization exempt from federal income taxes? Yes (Attach a copy of the IRS determination letter) Status: 501(c)(_____) No Date organization submitted Form 1023 to the IRS ____________________________________ 5. If the organization is not exempt from federal income taxes and uses a fiscal agent, state the fiscal agent's name, address and federal EIN: ____________________________________________________ ___________________________________________________________________________________ 6. Has the organization been denied the right to solicit contributions? a. By any government agency? Yes No If yes, attach explanation. b. By any court? Yes No If yes, attach explanation. 7. Explain in detail the charitable purposes of the organization, including major program activities. ___________________________________________________________________________________ ___________________________________________________________________________________ ___________________________________________________________________________________ 8. Please mark all items that describe the organization's charitable mission: Arts & Culture Human Services Civic/Lobbying International Health Environment Mental Health Education Religious Other _______________ Or: List the NTEE code(s) that describe the organization's purpose: ___________________________ 9. Which of the above two best describes the organization's primary purpose(s)? 1._______________________________________ 2. ______________________________________ 10. Check one or more methods of solicitation the organization anticipates using: Telephone appeals Grant writing Sweepstakes Other _________________ Direct mail Internet Media 11. State the total contributions the organization received during the accounting year last ended: $_________________________________ 12. Attach a list of organization's officers, directors, trustees, and chief executive officer, including their titles, addresses, and total annual compensation paid to each. Attached 3 SECTION C: REQUIRED FOR ANNUAL REPORTING ONLY ALL Annual Report filers MUST complete questions 1-6 . Has the organization's accounting year changed since the last report was filed? If yes, provide the new year-end date:__________________________ 1. Yes No 2. Attach an explanation if there has been any change in the organization's tax status with the Internal Revenue Service; a significant change in the purposes of the organization; or if the organization's right to solicit funds has been denied, suspended, revoked or enjoined by any state agency or court in any state, or if there are proceedings pending. None Attached 3. List of the five highest paid directors, officers, and employees of the organization and its related organizations, as that term is defined by section 317A.011, subdivision 18, that receive total compensation of more than $100,000, together with the compensation paid to each. For purposes of this subdivision, "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. The value of fringe benefits and deferred compensation paid by the charitable organization and all related organizations as that term is defined by section 317A.011, subdivision 18, shall also be reported as a separate item for each person whose compensation is required to be reported pursuant to this subdivision. Name/Title Compensation Deferred Compensation Fringe Benefits 1 2 3 4 5 4. Attach a list of organization's board of directors. Attached Included in IRS Return 5. Attach a GAAP audit if total revenue exceeds $750,000. Attached Audit not included under the Food Shelf Exemption (excluding from total revenue the value of food donated to a nonprofit food shelf for redistribution at no cost). Audit not required 6. Minnesota law requires that an organization file a copy of all tax or informational returns filed with the IRS, including IRS Form 990-N (e-Postcard), 990, 990-EZ, or 990-PF, including all schedules and amendments. Has the organization included with this annual report a copy of all tax or informational returns, including IRS Form 990-N (e-Postcard), 990, 990-EZ or 990-PF that it filed with the IRS (excluding Schedule B or any other donor list)? Yes No (Not required to file a return with IRS or files a group return). NOTE: By answering YES to the above question, you are attesting that the IRS informational return filed with this office is an exact copy, including all schedules and attachments, of the IRS informational return filed with the IRS (excluding Schedule B or any other donor list the IRS may require). 4 7. This Section C(7) must be completed by organizations that: 1) do not file an informational return with the IRS; 2) file a 990-N (ePostcard), 990-EZ, or 990-PF; 3) file a group return that does not include the filing organization's functional expense information; or 4) file an IRS Form 990 that does not contain a completed functional expenses statement within the IRS Form 990. Statement of Functional Expenses (A) Total expenses 1 2 3 4 5 6 7 8 9 10 11 a b (B) Program service expenses (C) Management and general expenses (D) Fundraising expenses $ 0.00 $ 0.00 $ 0.00 $ 0.00 Grants and other assistance to governments and organizations in the U.S. Grants and other assistance to individuals in the U.S. Grants and other assistance to governments, organizations, and individuals outside the U.S. Benefits paid to or for members Compensation of current officers, directors, trustees, and key employees Compensation not included above, to disqualified persons (as defined under section 4958(f)(1) and persons described in section 4958(c)(3)(B) Other salaries and wages Pension plan contributions (include section 401(k) and section 403(b) employer contributions) Other employee benefits Payroll taxes Fees for services (non-employees): Management Legal c Accounting d Lobbying e Professional fundraising services f g 12 13 14 15 16 17 18 19 20 21 22 23 24 Investment management fees Other Advertising and promotion Office expenses Information technology Royalties Occupancy Travel Payments of travel or entertainment expenses for any federal, state, or local public officials Conferences, conventions, and meetings Interest Payments to affiliates Depreciation, depletion, and amortization Insurance Other expenses. Itemize expenses not covered above. (Expenses grouped together and labeled miscellaneous may not exceed 5% of total expenses shown on line 25 below.) a ......................................................................... b ......................................................................... c d 25 26 ......................................................................... All other expenses Total functional expenses. Add lines 1 through 24d 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 Must be prepared in accordance with generally accepted accounting principles. For 990-EZ filers: Column A, Line 25 should equal line 17 IRS Form 990-EZ For 990-PF filers: Column A, Line 25 should equal line 26 IRS Form 990-PF The total of Column A, lines 1 through 24d should equal line 25a. The total of lines 25b, 25c and 25d , should equal line 25a 5 SECTION D: REQUIRED FOR INITIAL REGISTRATION & ANNUAL REPORTING BOARD OF DIRECTORS SIGNATURES AND ACKNOWLEDGMENT 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 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 NOTICE Documents required to be filed are public records. Please do not include social security numbers, driver's license numbers or bank account numbers on the documents filed with this Office as they are not required, but could become part of the public records. A charitable organization is not required to file a list of its donors. If it is included, it may become part of the public file. AG: #3124563-v1 6 Chapter 16 (B1) - Smithville Softball League For this exercise please use the following accounts Cash Field Improvements Salary & Wage Expense Utility Expense Concession Stand Food Costs Field Maintenance (Program Costs) Management & general (Support Costs) Fund-Raising (Support Costs) Contributions - Unrestricted Contributions - Temporarily Restricted Contributions - In-kind unrestricted Concession Stand Revenue Net Assets Unrestricted Net Assets Temporarily Restricted Net Assets - Released - Temporarily Restricted Net Assets - Released - Unrestricted Record the following transactions for Smithville Softball Association: 1) Rec'd $15,000 in cash contribution at a local fund-raising event 2) Paid the field manager $5,000 3) Paid the electric bills totaling $1,500 4) The local JC's chamber contributed $2,000 to the association 5) Smithville Rental contributed a lawnmower for the season, to help with lawn care. The fair market value of the lawnmower rental is $1,800 (Debit: Field Maintenance) 6) Revenues made at the concession stand amounted to $7,500 7) The value of the labor that people contributed to work the concession stand is valued at $3,000 8) A contribution $1,100 was received by a player's family which the donor requested that it be used for future field expansion. 9) The cost of the food sold at the concession stand was $2,500. 10)Skid steer work donated for the field expansion was valued at $2,200. (Debit: Field Improvements) 11) Dirt and sod placed for the field expansion costs $900 and a check was written. (Debit: Field Improvements) 12)Release $900 from transaction #8 for satisfaction of contribution. 13)Allocate the field manager's salary: 90% Program costs - Field Maintenance 5% Support Costs - Management and general 5% Support Costs - Fund-raising 14)Allocate the utility bill: 95% Program Costs - Field Maintenance 5% Support Costs - Management & general 15)Close the nominal accounts. GENERAL JOURNAL Debits 1. 2. 3. 4. 5. 6. 7. 8. 9. 10. 11. 12. 13. Credits 14. Close the Contributions - Temporarily Restricted to Net Assets-Temporarily Restricted 15. Close two the Net Assets - Released to their respective Net Assets Accounts 15. Close the Expenses, Revenues and the two Contributions Unrestricted accounts to Net Assets Unrestricted 15. Cash Field Improvements Salary & Wage Expense Utility Expense Concession Stand Food Costs Field Maintenance Costs Management & General Costs Fund-Raising Costs Concession Stand Revenue Contributions Unrestricted Contributions - Temporarily Restricted Net Assets - Released - Temporarily Restricted Net Assets - Released Unrestricted Net Assets Unrestricted Contributions - Inkind - Unrestricted Net Assets Temporarily Restricted Chapter 16 - Smithville Softball League Activity Assignment Based the transactions you recorded completed the financial statements to present at the annual meeting. The shaded areas are for your numbers. Smithville Softball League Statement of Activities FYE December 31, 2014 Concessio n Stand Unrestricted Temporarily Restricted Total Revenue & Other Support: Concession Stand Contributions - Cash Contributions - In-Kind New Assets Released Total Revenue & Other Support Expenses: Concession Stand Food Field Maintenance Management & General Fund-Raising Total Expenses Increase in Net Assets Beginning Net Assets Ending Net Assets c. 0 0 SOLVE STATEMENT OF FINANCIAL POSITION DECEMBER 31, 2014 Assets: Cash Field Improvements Total Assets Liabilities: Total Liabilities Net Assets: Unrestricted Temporarily Restricted Total Net Assets Total Liabilities & Net Assets 0 0 Smithville Softball League - Minnesota Annual Report http://www.ag.state.mn.us/Charities/CharityForms.asp Pull up the annual registration form for a NFP on the Minnesota Attorney General's Website and as the treasurer you are required to complete the report for the Smithville Softball League. Use the financial statements that you prepared for your chapter 13 quiz. I have provided additional information to help you complete the form. Complete Section A, C & D Tax Id #: 123456789 NFP's Registered Name: Smithville Softball League Company. This has always been the NFP's name. Mailing & Physical address: 123 Accounting Lane, Funtown, MN 55000 Contact Person: Use your name EMail, Tel. No & Fax No: You may leave blank or be creative with the information Professional fundraiser: None Accounting Year: December. No change in the accounting year. Filing Fees, and attachments: Included Change in Tax Status: None Individuals paid over $100,000: None List of Board of Directors: Assume attached 990N: Assume attached Chair: Joan Smith The Section D Document was executed by the Board of Directors on June 1, 2015 STATE OF MINNESOTA CHARITABLE ORGANIZATION INITIAL REGISTRATION & ANNUAL REPORT FORM ATTORNEY GENERAL LORI SWANSON Annual Reporting SUITE 1200, BREMER TOWER 445 MINNESOTA STREET ST. PAUL, MN 55101-2130 (651) 757-1311 (651) 296-1410 (TTY) www.ag.state.mn.us Initial Registration FEDERAL EIN NUMBER: FOR YEAR ENDING: SECTION A: REQUIRED INFORMATION FOR INITIAL REGISTRATION & ANNUAL REPORTING 1. Legal Name of Organization: __________________________________________________________ If annual reporting, is this a new name since the organization's last filing? Yes No If so, please state former name: __________________________________________________________ 2. List all names under which the organization solicits contributions: ___________________________________________________________________________________ ___________________________________________________________________________________ Mailing Address of Organization (required) Physical Address of Organization (required) _______________________________________ ________________________________________ _______________________________________ ________________________________________ _______________________________________ ________________________________________ 3. 4. Contact Person___________________________ Tel. No. _________________________________ E-mail ________________________________ Fax No.________________________________ 5. Does the organization use the services of a professional fund-raiser (outside solicitor or consultant)? Yes No If so, provide name and address of any outside professional fund-raiser employed by the organization and state the total amount of compensation each outside fund-raiser received from the filing organization during the year. Attach schedule if more than one. Name ______________________________________________________________________________ Address ____________________________________________________________________________ City________________State______ Zip ________ Compensation _____________________________ 6. a) Does this professional fund-raiser solicit or consult in Minnesota? Yes b) Is this professional fund-raiser registered to solicit or consult in Minnesota? No Yes No 7. Month and day accounting year ends: _____________________________________________________ 8. Has the organization included the filing fee, late fee (if any) and all attachments required by the instructions? Yes No Office Use Only: 01/13 ARF $25 $50 N(e-Postcard) 990 EZ PF FES SIG BD SAL Audit Upon request this material can be made available in alternate formats. 9. This Section A(9) must be completed by organizations filing a 990-N (e-Postcard) or organizations whose filing does not contain the information requested below. This includes organizations that: 1) do not file an IRS Form 990, 2) file an IRS Form 990-EZ or 990-PF, or 3) organizations that file a group return that does not include the filing organization's individual financial information. INCOME Contributions from the public Government Grants Other revenue TOTAL REVENUE EXCESS or DEFICIT TOTAL Assets TOTAL Liabilities $__________________ $__________________ $__________________ 0.00 $__________________ $_______________ $_______________ $_______________ END OF YEAR FUND BALANCE/NET WORTH (Assets minus Liabilities) $_________________ 2 SECTION B: REQUIRED FOR INITIAL REGISTRATION ONLY 1. Address of registered agent in the State of Minnesota or the address of the person who has custody of the organization's books and records if not kept at the organization's office. Name ______________________________________________________________________________ Street and Number ____________________________________________________________________ City________________ State_______ Zip ________ Telephone # ____________________________ 2. Type of legal entity (Attach the creating document): Nonprofit corporation Trust Unincorporated association Other ______________ 3. Place and date the organization was incorporated: ___________________________________________ (state) (date) 4. Is the organization exempt from federal income taxes? Yes (Attach a copy of the IRS determination letter) Status: 501(c)(_____) No Date organization submitted Form 1023 to the IRS ____________________________________ 5. If the organization is not exempt from federal income taxes and uses a fiscal agent, state the fiscal agent's name, address and federal EIN: ____________________________________________________ ___________________________________________________________________________________ 6. Has the organization been denied the right to solicit contributions? a. By any government agency? Yes No If yes, attach explanation. b. By any court? Yes No If yes, attach explanation. 7. Explain in detail the charitable purposes of the organization, including major program activities. ___________________________________________________________________________________ ___________________________________________________________________________________ ___________________________________________________________________________________ 8. Please mark all items that describe the organization's charitable mission: Arts & Culture Human Services Civic/Lobbying International Health Environment Mental Health Education Religious Other _______________ Or: List the NTEE code(s) that describe the organization's purpose: ___________________________ 9. Which of the above two best describes the organization's primary purpose(s)? 1._______________________________________ 2. ______________________________________ 10. Check one or more methods of solicitation the organization anticipates using: Telephone appeals Grant writing Sweepstakes Other _________________ Direct mail Internet Media 11. State the total contributions the organization received during the accounting year last ended: $_________________________________ 12. Attach a list of organization's officers, directors, trustees, and chief executive officer, including their titles, addresses, and total annual compensation paid to each. Attached 3 SECTION C: REQUIRED FOR ANNUAL REPORTING ONLY ALL Annual Report filers MUST complete questions 1-6 . Has the organization's accounting year changed since the last report was filed? If yes, provide the new year-end date:__________________________ 1. Yes No 2. Attach an explanation if there has been any change in the organization's tax status with the Internal Revenue Service; a significant change in the purposes of the organization; or if the organization's right to solicit funds has been denied, suspended, revoked or enjoined by any state agency or court in any state, or if there are proceedings pending. None Attached 3. List of the five highest paid directors, officers, and employees of the organization and its related organizations, as that term is defined by section 317A.011, subdivision 18, that receive total compensation of more than $100,000, together with the compensation paid to each. For purposes of this subdivision, "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. The value of fringe benefits and deferred compensation paid by the charitable organization and all related organizations as that term is defined by section 317A.011, subdivision 18, shall also be reported as a separate item for each person whose compensation is required to be reported pursuant to this subdivision. Name/Title Compensation Deferred Compensation Fringe Benefits 1 2 3 4 5 4. Attach a list of organization's board of directors. Attached Included in IRS Return 5. Attach a GAAP audit if total revenue exceeds $750,000. Attached Audit not included under the Food Shelf Exemption (excluding from total revenue the value of food donated to a nonprofit food shelf for redistribution at no cost). Audit not required 6. Minnesota law requires that an organization file a copy of all tax or informational returns filed with the IRS, including IRS Form 990-N (e-Postcard), 990, 990-EZ, or 990-PF, including all schedules and amendments. Has the organization included with this annual report a copy of all tax or informational returns, including IRS Form 990-N (e-Postcard), 990, 990-EZ or 990-PF that it filed with the IRS (excluding Schedule B or any other donor list)? Yes No (Not required to file a return with IRS or files a group return). NOTE: By answering YES to the above question, you are attesting that the IRS informational return filed with this office is an exact copy, including all schedules and attachments, of the IRS informational return filed with the IRS (excluding Schedule B or any other donor list the IRS may require). 4 7. This Section C(7) must be completed by organizations that: 1) do not file an informational return with the IRS; 2) file a 990-N (ePostcard), 990-EZ, or 990-PF; 3) file a group return that does not include the filing organization's functional expense information; or 4) file an IRS Form 990 that does not contain a completed functional expenses statement within the IRS Form 990. Statement of Functional Expenses (A) Total expenses 1 2 3 4 5 6 7 8 9 10 11 a b (B) Program service expenses (C) Management and general expenses (D) Fundraising expenses $ 0.00 $ 0.00 $ 0.00 $ 0.00 Grants and other assistance to governments and organizations in the U.S. Grants and other assistance to individuals in the U.S. Grants and other assistance to governments, organizations, and individuals outside the U.S. Benefits paid to or for members Compensation of current officers, directors, trustees, and key employees Compensation not included above, to disqualified persons (as defined under section 4958(f)(1) and persons described in section 4958(c)(3)(B) Other salaries and wages Pension plan contributions (include section 401(k) and section 403(b) employer contributions) Other employee benefits Payroll taxes Fees for services (non-employees): Management Legal c Accounting d Lobbying e Professional fundraising services f g 12 13 14 15 16 17 18 19 20 21 22 23 24 Investment management fees Other Advertising and promotion Office expenses Information technology Royalties Occupancy Travel Payments of travel or entertainment expenses for any federal, state, or local public officials Conferences, conventions, and meetings Interest Payments to affiliates Depreciation, depletion, and amortization Insurance Other expenses. Itemize expenses not covered above. (Expenses grouped together and labeled miscellaneous may not exceed 5% of total expenses shown on line 25 below.) a ......................................................................... b ......................................................................... c d 25 26 ......................................................................... All other expenses Total functional expenses. Add lines 1 through 24d 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 Must be prepared in accordance with generally accepted accounting principles. For 990-EZ filers: Column A, Line 25 should equal line 17 IRS Form 990-EZ For 990-PF filers: Column A, Line 25 should equal line 26 IRS Form 990-PF The total of Column A, lines 1 through 24d should equal line 25a. The total of lines 25b, 25c and 25d , should equal line 25a 5 SECTION D: REQUIRED FOR INITIAL REGISTRATION & ANNUAL REPORTING BOARD OF DIRECTORS SIGNATURES AND ACKNOWLEDGMENT 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 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 NOTICE Documents required to be filed are public records. Please do not include social security numbers, driver's license numbers or bank account numbers on the documents filed with this Office as they are not required, but could become part of the public records. A charitable organization is not required to file a list of its donors. If it is included, it may become part of the public file. AG: #3124563-v1 6