Form CHAR500-C (201) Form CHAR500-C Combined Annual Financial ReportNew York State Department of Law (Office of the Attorney General)Charities Bureau Registration Section - Combined ReportsNew York, NY 10www.charitiesnys.com 2 0 This form used for combined filingsby parent Article 7-A and dual filerand its affiliates (replaces form CHAR 497-C)Open to PublicInspection1.General Information - Parent Organization a.For the fiscal year beginning (mm/dd) / 2 0 and ending (mm/dd/yyyy) b.Check if applicable: GAddress change GName change GInitial filing GFinal filing GAmended filing GNY registration pendingc.Name of organizationd.Fed. employer ID no. (EIN) (##-#######)e.NY State registration no. (##-##-##)Number and street (or P.O. box if mail is not delivered to street address)Room/suitef.Telephone numberCity or town, state or country and zip + 4g.Email2.Certification - Parent Organization - Two Signatures RequiredWe certify under penalties for perjury that we reviewed this report, including all attachments, and to the best of our knowledge and belief, they aretrue, correct and complete in accordance with the laws of the State of New York applicable to this report. SignaturePrinted NameTitleDate SignaturePrinted NameTitleDate3.Annual Report Exemption Information - Parent OrganizationEPTL annual report exemption (dual registrants only) Check -Gif the parent organization222s total gross receipts for this fiscal year did not exceed $25,000 and the assets (market value) of theorganization did not exceed $25,000 at any time during this fiscal year.For parent organizations that claim the EPTL annual report exemption, the parent organization EPTL filing fee (in part 5.c., Fee Submitted) is $0. 4.Article 7-A Schedules - Parent and Affiliate Organizations a.Did the parent organization or any of its affiliates use a professional fund raiser, fund raising counsel or commercial co-venturerfor fund raising activity in NY State?................................................................................G Yes* G No*If 223Yes224, complete Schedule 4a. b.Did the parent organization or any of its affiliates receive government contributions (grants)?....................................G Yes* G No*If 223Yes224, complete Schedule 4b.5.Fee SubmittedIndicate the filing fee(s) you are submitting along with this form:a.Parent organization Article 7-A filing fee.................................$ 25b.Affiliate organizations combined Article 7-A filing fee.......................$ c.Parent organization EPTL filing fee.....................................$ d.Affiliate organizations combined EPTL filing fee...........................$ e.Total fee.........................................................$ See instructions for help calculating fee.Submit only one check or money order for thetotal fee, payable to 223NYS Department of Law224 a.President or Authorized Officer b.Chief Financial Officer or Treasurer American LegalNet, Inc. www.FormsWorkFlow.com Form CHAR500-C (201) 6.List of Affiliate Organizationsa.List all affiliate organizations that are part of the combined report and attach one copy of Schedule 6a (Individual Affiliate Summary) for eachentity listed. Attach additional pages if necessary.Affiliate organization nameNY State reg. no.(##-##-##)Fed. ID no. (EIN) (##-#######)Fiscal yr. end(mm/dd)In last yr.222scombined report? (check one)G Yes G NoG Yes G NoG Yes G NoG Yes G NoG Yes G NoG Yes G NoG Yes G NoG Yes G NoG Yes G NoG Yes G NoG Yes G NoG Yes G NoG Yes G NoG Yes G NoG Yes G NoG Yes G NoG Yes G NoG Yes G Nob.List all affiliate organizations that file separately or are exempt from registration with the Charities Bureau, but whose financial information is includedin the combined financial summary of the IRS Form 990 group return and/or the consolidated financial statements. Attach additional pages ifnecessary.Organization nameFile separately orexempt from reg.?(check one)NY State reg. no.(##-##-##)Fed. ID no. (EIN) (##-#######)Fiscal yr. end(mm/dd)In last yr.222scombined report?(check one)G Sep. G Ex.G Yes G NoG Sep. G Ex.G Yes G NoG Sep. G Ex.G Yes G NoG Sep. G Ex.G Yes G NoG Sep. G Ex.G Yes G NoG Sep. G Ex.G Yes G NoG Sep. G Ex.G Yes G NoG Sep. G Ex.G Yes G NoG Sep. G Ex.G Yes G NoG Sep. G Ex.G Yes G NoG Sep. G Ex.G Yes G No 7.Attachments:Attach Schedules 4a and 4b if necessary, one copy of Schedule 6a for each affiliate listed in question 6.a. above, and seelast page for additional attachment requirements. American LegalNet, Inc. www.FormsWorkFlow.com Form CHAR500-C (201) Schedule 4a: Professional Fund Raisers (PFR), Fund Raising Counsels (FRC), Commercial Co-Venturers (CCV)If you checked the box in question 4.a. on page 1, complete the following schedule for each PFR, FRC or CCV that the organization engaged for fundraising activity in NY State:1.Type of fund raising professional (FRP):Professional fund raiser..........................................................................................GFund raising counsel.............................................................................................GCommercial co-venturer..........................................................................................G2.Name of FRP: Number and street (or P.O. box if mail is not delivered to street address): City or town, state or country and zip + 4: 3.FRP telephone number:4.Services provided by FRP (provide description):5.Compensation arrangement with FRP (provide description):6.Dates of contract................................................ through (mm/dd/yyyy) (mm/dd/yyyy)7.Amount paid to FRP......................................................................... $ 8.Name(s) of organization(s) on whose behalf the fund raising activity was conducted: American LegalNet, Inc. www.FormsWorkFlow.com Form CHAR500-C (201) Schedule 4b: Government Contributions (Grants)If you checked the box in question 4.b. on page 1, complete the following schedule for each government contribution (grant). Use additional copiesof this page if necessary to list each government contribution (grant) separately.Government Agency NameOrganization Receiving Grant(name specific affiliate or parent organization)Grant Amount$$$$$$$$$$$$$$$$$$$$$$$$$$$$Total Government Contributions (Grants)$ American LegalNet, Inc. www.FormsWorkFlow.com Form CHAR500-C (201) Schedule 6a: Individual Affiliate Summary Complete the following schedule for each affiliate listed in question 6.a.1.General Informationa.Name of Affiliate Organizationb.Fed. employer ID no. (EIN) (##-#######)c.NY State registration no. (##-##-##)2.Annual Report Exemption Information - Affiliate Organizationa.Article 7-A annual report exemption (Article 7-A registrants and dual registrants)Check - Gif the affiliate organization222s total contributions from NY State (including residents, foundations, corporations, government agencies, etc.) did not exceed $25,000 and the organization did not use the services of a professional fund raiser (PFR) orfund raising counsel (FRC) to solicit contributions during this fiscal year. NOTE: An organization may also check the box to claim this exemption if no PFR or FRC was used and either: 1) the affiliate organization received an allocation from a federated fund, United Way or incorporated community appeal and contributions from all other sources did not exceed $25,000 or 2) it received all or substantially all of its contributions from a singlegovernment agency to which it submitted an annual financial report similar to that required by Article 7-A).b.EPTL annual report exemption (EPTL registrants and dual registrants) Check - Gif the affiliate organization222s total gross receipts for this fiscal year did not exceed $25,000 and the assets (market value) ofthe organization did not exceed $25,000 at any time during this fiscal year.For EPTL or Article-7A registrants claiming the annual report exemption under the one law under which they are registered and for dual registrants claiming the annual reportexemptions under both laws, you (1) need not complete part 6.c. (Affiliate Financial Summary) below and (2) should indicate the affiliate filing fee(s) is (are) $0 for the law(s)under whic