For your most recent full accounting period (beginning ending ) list: Gross annual revenue $ Total assets $ MAIL TO: Registry of Charitable Trusts P.O. Box 903447 Sacramento, CA 94203-4470 (916) 210-6400 WEB SITE ADDRESS: www.ag.ca.gov/charities/ ANNUAL REGISTRATION RENEWAL FEE REPORT TO ATTORNEY GENERAL OF CALIFORNIA Section 12586 and 12587, California Government Code 11 Cal. Code Regs. section 301-307, 311, and 312 Failure to submit this report annually no later than the 15th day of the 5th month after the end of the organization's accounting period may result in the loss of tax exemption and the assessment of a minimum tax of $800, plus interest, and/or fines or filing penalties as defined in Government Code section 12586.1. IRS extensions will be honored. State Charity Registration Number Name of Organization Address (Number and Street) City or Town, State and ZIP Code Check if: Change of address Amended report Corporate or Organization No. Federal Employer I.D. No. ANNUAL REGISTRATION RENEWAL FEE SCHEDULE (11 Cal. Code Regs. sections 301-307, 311, and 312) Make Check Payable to Attorney General's Registry of Charitable Trusts Gross Receipts Fee Less than $25,000 0 Between $25,000 and $100,000 $25 Gross Annual Revenue Fee Between $100,001 and $250,000 $50 Between $250,001 and $1 million $75 Gross Annual Revenue Fee Between $1,000,001 and $10 million $150 Between $10,000,001 and $50 million $225 Greater than $50 million$300 PART A - ACTIVITIES / / / / PART B - STATEMENTS REGARDING ORGANIZATION DURING THE PERIOD OF THIS REPORT Note: If you answer "yes" to any of the questions below, you must attach a separate page providing an explanation and details for each "yes" response. Please review RRF-1 instructions for information required. 1.During this reporting period, were there any contracts, loans, leases or other financial transactions between the organization and anyofficer, director or trustee thereof either directly or with an entity in which any such officer, director or trustee had any financial interest? 2.During this reporting period, were there any theft, embezzlement, diversion or misuse of the organization's charitable property or funds? 3.During this reporting period, did non-program expenditures exceed 50% of gross revenue? 4.During this reporting period, were any organization funds used to pay any penalty, fine or judgment? If you filed a Form 4720 with theInternal Revenue Service, attach a copy. 5.During this reporting period, were the services of a commercial fundraiser or fundraising counsel for charitable purposes used? If "yes,"provide an attachment listing the name, address, and telephone number of the service provider. 6.During this reporting period, did the organization receive any governmental funding? If so, provide an attachment listing the name ofthe agency, mailing address, contact person, and telephone number. 7.During this reporting period, did the organization hold a raffle for charitable purposes? If "yes," provide an attachment indicating thenumber of raffles and the date(s) they occurred. 8.Does the organization conduct a vehicle donation program? If "yes," provide an attachment indicating whether the program is operatedby the charity or whether the organization contracts with a commercial fundraiser for charitable purposes. 9.Did your organization have prepared an audited financial statement in accordance with generally accepted accounting principles for thisreporting period? Yes No Organization's area code and telephone number ( ) Organization's e-mail address - I declare under penalty of perjury that I have examined this report, including accompanying documents, and to the best of my knowledge and belief, the content is true, correct and complete. Signature of authorized officer Printed Name Title Date RRF-1 (08/2017) American LegalNet, Inc. www.FormsWorkFlow.com