Annual Financial report Of Charitbale Organization Form. This is a Ohio form and can be use in Attorney General Office Statewide.
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Charitable Law Section Office 614.466.3181 Fax 614.466.9788 150 East Gay Street, 23rd Floor Columbus, Ohio 43215-3130 www.OhioAttorneyGeneral.gov Instructions for preparing Ohio’s Annual Financial Report of Charitable Organization The filing of an annual financial report by a registered charitable organization is a requirement pursuant to both the Ohio Charitable Trust Act and the Ohio Charitable Organizations Act. Who Must File If the organization is registered pursuant to the Ohio Charitable Trust Act (Sections 109.23-.33, Ohio Revised Code), and has gross receipts of more than $5,000 or gross assets of more than $15,000, it must file an annual financial report with the Attorney General. A completed Annual Financial Report of Charitable Organization form satisfies this requirement. In lieu of this form, the organization may file a complete copy of its annual federal return that is required to be filed with the Internal Revenue Service (such as a Form 990). Enter a “3” if the organization was granted 501(c)(3) status as a charitable, religious, educational, scientific, etc., organization. Enter a “4” if the organization was granted 501(c)(4) status as a civic league or social welfare organization. This report is for the year ended (Month/Day/Year) Enter the last day of the organization’s fiscal year accounting period for which this Annual Financial Report is being completed. Fair market value of assets at year end The Ohio Charitable Organizations Act (Chapter 1716, Ohio Revised Code) requires every charitable organization that intends to solicit contributions in Ohio (with certain statutory exceptions) to register annually with the Attorney General. A completed Annual Financial Report of Charitable Organization form is required to be included as part of the registration statement filed by the organization. In lieu of this form, the organization may file a complete copy of its annual federal return that is required to be filed with the Internal Revenue Service (such as a Form 990). Completing the Annual Financial Report The following instructions are provided to assist in completing the Annual Financial Report. State registration number Enter the State of Ohio registration number assigned to the organization by the Attorney General's Charitable Law Section. Employer identification number (EIN) Enter the Federal employer identification number (EIN) assigned to the organization by the Internal Revenue Service. Exempt under IRC Section 501(c) Enter the amount of the fair market value of the organization’s assets that are irrevocably devoted to charitable purposes at the end of the fiscal year and that reflects the most recent valuation consistent with generally accepted accounting principles. The annual filing fee charged pursuant to the Charitable Trust Act is based on this amount. Part 1 – Statement of Support, Revenue, Expenses, and Changes in Net Assets or Fund Balances Support and Revenue Line 1 – Contributions, gifts, grants, and similar amounts received Enter amounts received as voluntary contributions of direct and indirect public support. Direct public support includes amounts received from the public in response to solicitation campaigns; amounts received exceeding the retail value of any items provided to the donor; and non-governmental grants received that encourage the organization to carry on its exempt purpose. Indirect public support includes amounts received from affiliates, other related organizations and federated fundraising agencies (for example, United Way). If the organization is exempt under Internal Revenue Code Section 501(c), enter the section number that identifies the type of exempt status granted the organization. Example: American LegalNet, Inc. www.FormsWorkFlow.com Line 2 – Government contributions and grants received created to conduct, and that forms the basis of the organization’s exempt status. Enter the total amount of grants and other payments received from governmental units. Line 12 – Management and general Line 3 – Program service revenue Enter the total amount expended for the administrative costs of running the organization. Enter amounts the organization received for providing the services it was created to offer. This includes income from services that primarily form the basis for the organization’s tax exemption, interest from program-related investments, and rental income from an exempt function. Line 13 – Fundraising Enter the total amount expended for soliciting contributions, gifts or grants, including the costs of direct mail and telephone solicitation campaigns and amounts paid to professional solicitors. Line 4 – Membership dues and assessments Line 14 – Total expenses Enter amounts received from members and affiliates for which they will receive membership benefits in return. To the extent that membership dues exceed the value of the benefits, the excess amounts received are considered contributions and should be included on line 1. Add lines 11 through 13 and enter the total here. Net Assets/Fund Balances Line 15 – Excess or (deficit) for the year Subtract line 14 from line 10 and enter the total here. If line 14 is more than line 10, report the loss in parentheses. Line 5 – Net gain or (loss) from the sale of assets other than inventory Enter the net gain or loss from the sale of investments such as securities, real estate, royalty interests, or partnership interests. The net gain or loss is determined by subtracting the cost from the gross sales price. If the cost is more than the gross sales price, report the loss in parentheses. Line 16 – Net assets or fund balances at beginning of year Complete Part 3, Balance Sheet, on page 3, and then enter the amount from Part 3, column (A) line 29. Line 17 – Other changes in net assets or fund balances Line 6 – Interest Enter the amount of interest income from savings and temporary cash investments. Enter the amount of any changes in net assets or fund balances between the beginning and end of the year that are not accounted for by the amount on line 15. Attach a schedule explaining any amounts reported here. Line 7 – Dividends Enter the amount of dividends from securities, stocks and bonds. Line 18 – Net assets or fund balances at end of year Line 8 – Other investment income Enter the amount of investment income not reported as interest and dividend income. Add lines 15, 16, and 17, and enter the total here. This total figure must equal the amount reported in Part 3, column (B) line 29. Line 9 – Other revenue Enter amounts from other sources, such as interest on loans to officers or other related individuals, and revenue from bingo or other gambling activities. Part 2 – Statement of Functional Expenses Report, in the appropriate column, expenses that are directly attributable to a particular functional category. Allocate total expenses (column A) into the three functional categories: program services (column B); management and general (column C); and fundraising (column D). Line 10 – Total revenue Add lines 1 through 9 and enter the total here. Expenses Complete Part 2, Statement of Functional Expenses, on page 2, and then enter on lines 11 through 13 the appropriate amounts from the totals for columns (B), (C), and (D) reported on line 28 of Part 2. Line 1 – Grants and allocations Enter the amount of awards and grants to individuals and organizations selected by the filing organization (i.e. scholarships, fellowships, research grants, etc.). Line 11 – Program services Enter the total amount expended for the activities, programs, and purposes for which the organization was (Revised 3/11) 2 American LegalNet, Inc. www.FormsWorkFlow.com Line 2 – Specific assistance to individuals Line 14 – Postage and shipping Enter the amount of payments to, or for the benefit of particular clients or patients. Enter the total cost of shipping materials, such as postage, parcel delivery, trucking, and other delivery expenses. Line 3 – Benefits paid to or for members Line 15 – Occupancy Enter the amount of benefits paid to or on behalf of members, such as death, sickness, hospitalization, disability, or unemployment compensation benefits. Do not include employee benefits, to be included on line 6 or 7 below. Enter the total expenses for the use of office space (i.e. rent, heat, light, power, utilities, outside janitorial, property insurance, mortgage interest, real estate taxes, etc.). Do not include telephone expenses reported on line 13 above. Line 4 – Compensation of officers, directors, etc. Line 16 – Equipment rental and maintenance Enter the total compensation paid to officers, directors, trustees, and key employees. Enter the cost of renting and maintaining office equipment and other equipment. Do not include automobile and truck expenses reported on lines 14 and 18. Line 5 – Other salaries and wages Line 17 – Printing and publications Enter the total amount of employees’ salaries not reported on line 4 above. Line 6 – Pension plan contributions Enter expenses related to printing, publishing, and/or purchasing newsletters, flyers, films, and other informational material. Do not include salaries and postage. Enter the employer’s share of contributions paid to pension plans. Line 18 – Travel Line 7 – Other employee benefits Enter the total travel expenses, such as fares, mileage allowances, automobile expenses, meals, and lodging. Enter the organization’s contributions to employee benefit programs (such as health, insurance, and welfare programs) that are not part of pension plans. Also, include expenses for employee events such as a picnic or holiday party. Line 19 – Conferences, conventions, meetings Enter the total expenses incurred in conducting and/or attending meetings, including registration fees and fees for speakers (but not travel expenses reported on line 18). Line 8 – Payroll taxes Line 20 – Interest Enter the amount of federal, state, and local payroll taxes imposed on the organization as an employer. Enter the total interest expense for the year. Do not include mortgage interest included as occupancy expense on line 15 above. Line 9 – Professional fundraising fees Enter the fees paid to outside fundraisers for solicitation campaigns they conducted, or for consultation services connected with a solicitation of contributions by the organization itself. Line 21 – Depreciation, depletion, etc. If the organization records depreciation, depletion, and similar expenses, enter the total for the year. Also, include depreciation of leasehold improvements. Line 10 – Accounting fees Lines 22 through 27 – Other expenses Enter the total accounting and auditing fees charged by outside firms and individuals that are not employees of the organization. Show the type and amount of each significant expense for which a separate line is not provided. Include any miscellaneous totals, investment counseling expenses, penalties, and fines. Line 11 – Legal fees Enter the total legal fees charged by outside firms and individuals that are not employees of the organization. Do not include any penalties, fines, or judgments imposed against the organization. Line 28 – Total functional expenses Add lines 1 through 27 in columns (A) through (D) and enter the totals in the appropriate columns. Line 12 – Supplies Part 3 – Balance Sheet Enter the total amount paid for office, classroom, medical, and other supplies used. Report the beginning and end of year balances for all assets, liabilities and net assets or fund balances. Line 13 – Telephone Enter the total telephone, telegram, and similar expenses. (Revised 3/11) 3 American LegalNet, Inc. www.FormsWorkFlow.com Assets Line 12 – Land, buildings and equipment Line 1 – Cash – non-interest-bearing Enter the book value (cost less accumulated depreciation) of land, buildings, and equipment used by the organization in conducting its exempt activities and not held for investment. Enter the total of non-interest-bearing checking accounts, deposits in transit, change funds, petty cash funds, or any other non-interest-bearing account. Line 13 – Other assets Attach a separate schedule listing the book value of each category of assets not reported on the previous lines. Include program-related investments, or investments made to accomplish the exempt purpose. Line 2 – Savings and temporary cash investments Enter the total of interest-bearing accounts, including money market funds, certificates of deposit, U.S. Treasury bills, and other governmental obligations that mature in less than 1 year. Line 14 – Total assets Add lines 1 through 13 and enter the totals in the appropriate columns. The amounts on line 14 must equal the amounts on line 30 for both the beginning and end of the year. Line 3 – Accounts receivable Enter the total of accounts receivable reduced by the allowance for doubtful accounts. Line 4 – Pledges receivable Enter the total pledges receivable. Do not include the amount of pledges estimated to be uncollectible. Liabilities Line 5 – Grants receivable Enter the total grants receivable from governmental agencies, foundations, and other organizations. Enter the total of accounts payable and accrued expenses, such as salaries payable, accrued payroll taxes and interest payable. Line 6 – Other notes and loans receivable Line 16 – Grants payable Line 15 – Accounts payable and accrued expenses Enter the total of notes and loans receivable not acquired as investments. Include loans for normal activities, such as by a credit union to its members or scholarship loans by a section 501(c)(3) organization. Include all receivables due from officers, directors, trustees and other related parties. Enter the unpaid portion of grants and awards that the organization has made a commitment to pay, whether or not the commitments have been communicated to the grantees. Line 7 – Inventories for sale or use Include revenue received, but not yet earned. Enter the amount of materials, goods, and supplies purchased or manufactured for future sale or use. Line 18 – Loans from officers, directors, trustees, and key employees Line 8 – Prepaid expenses and deferred charges Enter the amount of prepaid expenses incurred for a future accounting period. ` Enter the unpaid balance of loans received from officers, directors, trustees, and key employees. Line 19 – Tax-exempt bond liabilities Line 17 – Deferred revenue Enter the book value of securities held as investments. Enter the amount of tax exempt bonds issued by the organization on behalf of a state or local government, or by a state or local government on behalf of the organization. Line 10 – Investments – land, building and equipment Line 20 – Mortgages and other notes payable Line 9 – Investments – securities Enter the book value (cost less accumulated depreciation) of land, buildings, and equipment held for investments. Enter the amount of mortgages and other notes payable. Line 11 – Investments – other Enter the amount of all other investment holdings. Do not include program-related investments (the income from which is reported as program service revenue), to be reported on line 13 below. Attach a separate schedule listing the amount of each liability not reported on the previous lines. Line 22 – Total liabilities (Revised 3/11) Line 21 – Other liabilities Add lines 15 through 21 and enter the totals in the appropriate columns. 4 American LegalNet, Inc. www.FormsWorkFlow.com Net Assets or Fund Balances Line 1a – Did the organization solicit contributions from the general public Line 23 – Unrestricted funds Indicate “yes” if this is a charitable organization that solicited contributions in this state by any means or had contributions solicited in this state on its behalf. If “yes”, complete questions 1b and 1c. If “no”, proceed to Part 5. Enter the balance per financial records of net assets without donor-imposed restrictions. Line 24 – Temporarily restricted funds Line 1b – Please indicate the amount of contributions received from person in Ohio Enter the balance per financial records of the temporarily restricted class of net assets. The donors’ restrictions may include time restrictions or purpose restrictions. This question should only be completed by organizations outside the state of Ohio. Indicate the amount of solicited contributions received from persons in Ohio. Line 25 – Permanently restricted funds Enter the balance per financial records of permanently restricted net assets, such as land or works of art, donated with stipulations that they be used for a specific purpose, be preserved, and not be sold, or assets donated with stipulations that they be invested to provide a permanent source of income. Line 1c – Amount of Distributions to Ohio Receipts This question should only be completed by organizations outside the state of Ohio. Indicate the amount of the solicited contributions from 1b that were distributed to Ohio recipients. Line 26 – Capital stock, trust principal, or current funds Line 2 – Use of an Organization to Solicit Contributions For trusts, enter the amount of trust principal or corpus account. For corporations, enter the balance per financial records for capital stock accounts. Indicate if the charitable organization contracted with a fund-raising counsel, professional solicitor, commercial coventurer or other charitable organization to solicit contributions on its behalf. If “yes”, indicate the name of the fund-raising counsel, professional solicitor, commercial co-venturer or other charitable organization and indicate the amount of funds received. Line 27 – Paid-in or capital surplus, or land, bldg., and equipment fund Enter the balance per financial records for all paid-in capital in excess of par or stated value for all stock issued. Enter the fund balance for the land, building, and equipment fund. Part 5 – General Information Line 28 – Retained earnings, accumulated income, endowment, or other funds Line 1 – Changes to the Governing Documents For trusts, enter the balance per financial records of the accumulated income or similar account. For corporations, enter the balance in the retained earnings account minus the cost of any corporate treasury stock. For fund accounting, enter the fund balances for the permanent and term endowment funds plus balances of any funds not included on lines 26 and 27 above. Indicate if there were changes to the organization’s governing documents during the preceding fiscal year. If “yes”, a copy must be provided to the Ohio Attorney General’s Office. Line 29 – Total net assets or fund balances Indicate if there were changes to the organization that would affect the original Registration Statement that is on file with the Ohio Attorney General’s Office. If “yes”, a schedule of the changes must be provided to the Ohio Attorney General’s Office. Line 2 – Changes to the Original Registration Statement filed with the Ohio Attorney General’s Office Add lines 23 through 28 and enter the totals in the appropriate columns. Line 30 – Total liabilities and net assets/fund balances Line 3 – Certification by Organization Add lines 22 and 29 and enter the totals in the appropriate columns. This amount must equal the amount for total assets reported on line 14 for both the beginning and end of the year. An individual within the organization should review and examine the Annual Financial Report and accompanying documents and provide a signature to confirm the validity of the report. Part 4 – Solicitation of Contributions Part 4 should only be completed by all soliciting organizations. (Revised 3/11) 5 American LegalNet, Inc. www.FormsWorkFlow.com Annual Financial Report of Charitable Organization This form is to be completed by an organization which does not file an annual federal information return with the Internal Revenue Service. Name of Organization State registration number Address Employer identification number (EIN) City, State, ZIP Code E-mail address Exempt under IRC Section 501(c) This report is for the year ended (Month/Day/Year): Current value of assets at year end: Part 1 Statement of Support, Revenue, Expenses, and Changes in Net Assets or Fund Balances Support and Revenue 1 Contributions, gifts, grants, and similar amounts received 2 Government contributions and grants received 3 Program service revenue 4 Membership dues and assessments 5 Net gain or (loss) from the sale of assets other than inventory 6 Interest 7 Dividends 8 Other investment income 9 Other revenue 10 Total revenue (add lines 1 through 9) Expenses 11 Program services (from Part 2, line 28, column B) 12 Management and general (from Part 2, line 28, column C) 13 Fundraising (from Part 2, line 28, column D) 14 Total expenses (add lines 11 through 13) Net Assets/Fund Balances 15 Excess or (deficit) for the year (subtract line 14 from line 10) 16 Net assets or fund balances at beginning of year (from Part 3, line 29, column A) 17 Other changes in net assets or fund balances (attach explanation) 18 Net assets or fund balances at end of year (add lines 15 through 17) American LegalNet, Inc. www.FormsWorkFlow.com Page 2 Part 2 Statement of Functional Expenses (A) Expenses Total (B) (C) (D) Program services Management and general Fundraising 1 Grants and allocations 2 Specific assistance to individuals 3 Benefits paid to or for members 4 Compensation of officers, directors, etc. 5 Other salaries and wages 6 Pension plan contributions 7 Other employee benefits 8 Payroll taxes 9 Professional fundraising fees 10 Accounting fees 11 Legal fees 12 Supplies 13 Telephone 14 Postage and shipping 15 Occupancy 16 Equipment rental and maintenance 17 Printing and publications 18 Travel 19 Conferences, conventions, meetings 20 Interest 21 Depreciation, depletion, etc. 22 Other expenses (itemize): 23 24 25 26 27 28 Total functional expenses (add lines 1 through 27) (carry columns (B)-(D) totals to Part 1, lines 11-13) American LegalNet, Inc. www.FormsWorkFlow.com Page 3 Part 3 Balance Sheet (A) (B) Beginning of year End of year Assets 1 Cash - non-interest-bearing 2 Savings and temporary cash investments 3 Accounts receivable 4 Pledges receivable 5 Grants receivable 6 Other notes and loans receivable 7 Inventories for sale or use 8 Prepaid expenses and deferred charges 9 Investments - securities 10 Investments - land, building and equipment 11 Investments - other 12 Land, buildings and equipment 13 Other assets (attach schedule) 14 Total assets (add lines 1 through 13) (must equal line 30 below) Liabilities 15 Accounts payable and accrued expenses 16 Grants payable 17 Deferred revenue 18 Loans from officers, directors, trustees, and key employees 19 Tax-exempt bond liabilities 20 Mortgages and other notes payable 21 Other liabilities (attach schedule) 22 Total liabilities (add lines 15 through 21) Net Assets or Fund Balances 23 Unrestricted funds 24 Temporarily restricted funds 25 Permanently restricted funds 26 Capital stock, trust principal, or current funds 27 Paid-in or capital surplus, or land, bldg., and equipment fund 28 Retained earnings, accumulated income, endowment, or other funds 29 Total net assets or fund balances (add lines 23 through 28) 30 Total liabilities and net assets/fund balances (add lines 22 and 29) (must equal line 14 above) American LegalNet, Inc. www.FormsWorkFlow.com Page 4 Part 4 Solicitation of Contributions Yes No 1 a. Did the organization solicit contributions from the general public? b. Please indicate the amount of contributions received from persons in Ohio. $ __________ c. For National Organizations or soliciting organizations not located in the State of Ohio, please indicate the amount of distributions to Ohio recipients. $ __________ 2 Did the organization use the services of a fund-raising counsel, professional solicitor, commercial co-venturer or other charitable organization to solicit contributions? If "Yes", complete the following information including the amount of funds received from each. Attach additional pages, if necessary. Name Address Funds received Part 5 General Information Yes No 1 Were any changes made in the governing documents of the organization? If "Yes", attach a copy of the new document. 2 Were any changes made to the information contained on the organization's registration statement on file with the Attorney General? If "Yes", attach a schedule of the changes. 3 Provide the following information for the location where the organization's books and records are maintained. Name Address Telephone No. Part 6 Certification by Organization I certify that I have examined this financial report, including accompanying attachments, and to the best of my knowledge and belief, it is true, correct, and complete. Signature of officer Printed name Date Title Telephone No. Direct correspondence to the following address (include the organization's state registration number): Charitable Law Section Office 614.466.3181 Fax 614.466.9788 150 East Gay Street, 23rd Floor Columbus, Ohio 43215-3130 www.OhioAttorneyGeneral.gov (revised 3/11) American LegalNet, Inc. www.FormsWorkFlow.com