ILLINOIS CHARITABLE ORGANIZATION ANNUAL REPORT
Illinois Attorney General Kwame Raoul
Charitable Trust Bureau, 115 S. LaSalle St
Chicago, IL 60603
For Oce Use Only
PMT #
___________________________
AMT
___________________________
INIT
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Report for the Fiscal Period:
Beginning ______/______/______
& Ending ______/______/______
MO DAY YR
Federal ID # _______________________________
Are contributions to the organization tax deductible? Yes o No o
Form AG990-IL
Revised 04/24
CO #___________________
Check all items attached:
o Copy of IRS Return
o Audited Financial Statements
o Reviewed Financial Statements
o Copy of Form IFC
o $15 Annual Report Filing Fee
o $100 Late Report Filing Fee
Make Checks
Payable to
Illinois Charity
Bureau Fund
Date organization was created: ________/________/________
MO DAY YR
Legal Name: __________________________________________________________
Mail Address: __________________________________________________________
City, State: __________________________________________________________
Zip Code: __________________________________________________________
I. SUMMARY OF ALL REVENUE ITEMS DURING THE YEAR:
D) PUBLIC SUPPORT, CONTRIBUTIONS AND PROGRAM SERVICE REV.(GROSS AMTS.)
E) GOVERNMENT GRANTS AND MEMBERSHIP DUES
F) OTHER REVENUES
G) TOTAL REVENUES, INCOME AND CONTRIBUTIONS RECEIVED (ADD D, E & F)
II. SUMMARY OF ALL EXPENDITURES DURING THE YEAR
H) OPERATING CHARITABLE PROGRAM EXPENSE
I) EDUCATION PROGRAM SERVICE EXPENSE
J) TOTAL CHARITABLE PROGRAM SERVICE EXPENSE (ADD H & I)
J1) JOINT COSTS ALLOCATED TO PROGRAM SERVICES (INCLUDED IN J) $
K) GRANTS TO OTHER CHARITABLE ORGANIZATIONS
L) TOTAL CHARITABLE PROGRAM SERVICE EXPENDITURE (ADD J & K)
M) MANAGEMENT AND GENERAL EXPENSE
N) FUNDRAISING EXPENSE
O) TOTAL EXPENDITURES THIS PERIOD (ADD L, M & N)
III. SUMMARY OF ALL PAID FUNDRAISER & CONSULTANT ACTIVITIES
(Attach Attorney General Report of Individual Fundraising Campaign (Form IFC). One for each PFR.)
PROFESSIONAL FUNDRAISERS:
P) TOTAL AMOUNT RAISED BY PAID PROFESSIONAL FUNDRAISERS
Q) TOTAL FUNDRAISERS FEES AND EXPENSES
R) NET RECEIVED BY THE CHARITY (P MINUS Q = R)
• PROFESSIONAL FUNDRAISING CONSULTANTS:
S) TOTAL AMOUNT PAID TO PROFESSIONAL FUNDRAISING CONSULTANTS
IV. COMPENSATION TO THE (3) HIGHEST PAID PERSONS DURING THE YEAR:
T) NAME, TITLE: ___________________________________________________________________
U) NAME, TITLE: ___________________________________________________________________
V) NAME, TITLE: ___________________________________________________________________
V. CHARITABLE PROGRAM DESCRIPTION:CHARITABLE PROGRAM (3 HIGHEST BY $ EXPENDED) CODE CATEGORIES
W) DESCRIPTION: _________________________________________________________________
X) DESCRIPTION: __________________________________________________________________
Y) DESCRIPTION: __________________________________________________________________
D) $
E) $
F) $
G) $
H) $
I) $
J) $
K) $
L) $
M) $
N) $
O) $
P) $
Q) $
R) $
S) $
T) $
U) $
V) $
W) #
X) #
Y) #
%
%
%
100%
%
%
%
%
%
%
%
100%
100%
%
%
A) $
B) $
C) $
A) ASSETS
B) LIABILITIES
C) NET ASSETS
YEAR-END
AMOUNTS
PERCENTAGE
AMOUNT
List on back side of Instructions
CODE
IF THE ANSWER TO ANY OF THE FOLLOWING QUESTIONS IS YES, ATTACH A DETAILED EXPLANATION:
1. WAS THE ORGANIZATION THE SUBJECT OF ANY COURT ACTION, FINE, PENALTY OR JUDGEMENT?.............1.
2. DID THE ORGANIZATION MAKE A GRANT AWARD OR CONTRIBUTION TO ANY ORGANIZATION IN WHICH
ANY OF ITS OFFICERS, DIRECTORS OR TRUSTEES OWNS AN INTEREST; OR WAS IT A PART TO ANY
TRANSACTION IN WHICH ANY OF ITS OFFICERS, DIRECTORS OR TRUSTEES HAS A MATERIAL FINANCIAL
INTEREST; OR DID ANY OFFICER, DIRECTOR OR TRUSTEE RECEIVE ANYTHING OF VALUE NOT
REPORTED AS COMPENSATION?.....................................................................................................................................2.
3. HAS THE ORGANIZATION INVESTED IN ANY CORPORATE STOCK IN WHICH ANY OFFICER, DIRECTOR
OR TRUSTEE OWNS MORE THAN 10% OF THE OUTSTANDING SHARES? ..............................................................3.
4. IS ANY PROPERTY OF THE ORGANIZATION HELD IN THE NAME OF OR COMMINGLED WITH
THE PROPERTY OF ANY OTHER PERSON OR ORGANIZATION? ...............................................................................4.
5. DID THE ORGANIZATION USE THE SERVICES OF A PROFESSIONAL FUNDRAISER? (ATTACH FORM IFC.).....5.
6a. DID THE ORGANIZATION ALLOCATE THE COST OF ANY SOLICITATION, MAILING, ADVERTISEMENT OR
LITERATURE COSTS BETWEEN PROGRAM SERVICE AND FUNDRAISING EXPENSES? ......................................6.
6b
. IF “YES”, ENTER
(I) THE AGGREGATE AMOUNT OF THESE JOINT COSTS $ ____________________________ ;
(II) THE AMOUNT ALLOCATED TO PROGRAM SERVICES $ ____________________________ ;
(III) THE AMOUNT ALLOCATED TO MANAGEMENT AND GENERAL $ ____________________________ ; AND
(IV) THE AMOUNT ALLOCATED TO FUNDRAISING $ ____________________________ .
7. DID THE ORGANIZATION EXPEND ITS RESTRICTED FUNDS FOR PURPOSES OTHER THAN RESTRICTED
PURPOSES?..........................................................................................................................................................................7.
8. HAS THE ORGANIZATION EVER BEEN REFUSED REGISTRATION OR HAD ITS REGISTRATION OR
TAX EXEMPTION SUSPENDED OR REVOKED BY ANY GOVERNMENTAL AGENCY? ..............................................8.
9. WAS THERE OR DO YOU HAVE ANY KNOWLEDGE OF ANY KICKBACK, BRIBE OR ANY THEFT, DEFALCATION,
MISAPPROPRIATION, COMMINGLING OR MISUSE OF ORGANIZATIONAL FUNDS? ..............................................9.
• ALL ATTACHMENTS MUST ACCOMPANY THIS REPORT – SEE INSTRUCTIONS •
UNDER PENALTY OF PERJURY, I (WE) THE UNDERSIGNED DECLARE AND CERTIFY THAT I (WE) HAVE EXAMINED THIS ANNUAL REPORT
AND THE ATTACHED DOCUMENTS, INCLUDING ALL THE SCHEDULES AND STATEMENTS, AND THE FACTS THEREIN STATED ARE TRUE
AND COMPLETE AND FILED WITH THE ILLINOIS ATTORNEY GENERAL FOR THE PURPOSE OF HAVING THE PEOPLE OF THE STATE OF
ILLINOIS RELY THEREUPON. I HEREBY FURTHER AUTHORIZE AND AGREE TO SUBMIT MYSELF AND THE REGISTRANT HEREBY TO THE
JURISDICTION OF THE STATE OF ILLINOIS.
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.
10. LIST THE NAME AND ADDRESS OF THE FINANCIAL INSTITUTIONS WHERE THE ORGANIZATION MAINTAINS ITS
THREE LARGEST ACCOUNTS:
11. NAME AND TELEPHONE NUMBER OF CONTACT PERSON: __________________________________________________________________
_________________________________________________________________________________
PRESIDENT or TRUSTEE (PRINT NAME) SIGNATURE DATE
_________________________________________________________________________________
TREASURER OR TRUSTEE (PRINT NAME) SIGNATURE DATE
_________________________________________________________________________________
PREPARER (PRINT NAME) SIGNATURE DATE
YES NO
