State of Rhode Island and Providence Plantations A. Ralph Mollis, Secretary of State Corporations Division 148 W. River Street Providence, RI 02904-2615 401.222.3040 Office of the Secretary of State NON-PROFIT CORPORATION ANNUAL REPORT FOR THE YEAR __________ Filing Period: June 1 - June 30 • Filing Fee: $20.00* • THIS REPORT MUST BE TYPED OR PRINTED LEGIBLY IN BLACK INK. * In accordance with R.I.G.L. 7-6-94, each corporation failing or refusing to file its annual report within the time prescribed by law (R.I.G.L. 7-6-91) is subject to a penalty fee of $25.00. 1. Corporate ID No. 2. Name of Corporation 3. State of Incorporation 4. Corporate address in Rhode Island - Street Address 5. Foreign corporation. Enter principal office address City State City Zip Zip 6. Brief Description of the character of the affairs which are actually conducted in Rhode Island 7. NAMES AND ADDRESSES OF THE OFFICERS: (“X” BOX FOR ATTACHMENT) FILL IN SPACES BEFORE USING ATTACHMENTS President Name Vice President Name Street Address Street Address City State Zip City State State Secretary Name Zip Treasurer Name Street Address Zip Street Address City State Zip City 8. NAMES AND ADDRESSES OF THE DIRECTORS: (“X” BOX FOR ATTACHMENT) FILL IN SPACES BEFORE USING ATTACHMENTS THE NUMBER OF DIRECTORS OF A DOMESTIC (RHODE ISLAND) CORPORATION SHALL NOT BE LESS THAN THREE (3). R.I.G.L. 7-6-23 Director Name Director Name Street Address Street Address City State Zip City State State Director Name Zip Director Name Street Address Zip Street Address City State Zip City 9. REGISTERED AGENT IN RHODE ISLAND This information is currently of record in the Office of the Secretary of State. Changes require filing of Form 641 - R.I.G.L. 7-6-13/7-6-78 This report must be signed by either the President, Vice President, Secretary, Assistant Secretary, Treasurer, Receiver or Trustee Under penalty of perjury, I declare and affirm that I have examined this report, including any accompanying schedules and statements, and that all statements contained herein are true and correct. File Date ________________________________________ Signature of Officer Date Check No. ________________________________________ By: ______________________________________________ FOR SECRETARY OF STATE USE ONLY Print or Type Name of Officer Title of Officer American LegalNet, Inc. www.FormsWorkflow.com Form 631 Rev. 09/17 INSTRUCTIONS FOR FILING A NON-PROFIT CORPORATION ANNUAL REPORT To avoid possible delays, please read all instructions carefully before completing the report. ________________________________________________________________________________ All sections, including the signature and date, must be completed; otherwise, the report will be returned to you. To file this report online using Visa, MasterCard, or American Express, visit www.sec.state.ri.us/corps and simply click on the “File Annual Reports Online” link. FOR IMAGING PURPOSES, THE REPORT MUST BE TYPED OR PRINTED LEGIBLY IN BLACK INK. The report must be signed and dated. It shall be executed by the corporation's president, vice president, secretary, assistant secretary or treasurer; or, if the corporation is in the hands of a receiver or trustee, it shall be executed on behalf of the corporation by the receiver or trustee. The signature of any official other than those listed above will not be accepted. Annual Reports are to be filed yearly during the month of June, but in no event should they be submitted for filing more than sixty (60) days prior to the commencement of the filing period. Failure to file the report and filing fee may result in revocation of the Certificate of Incorporation or the Certificate of Authority. An annual report must be filed even though the corporation may not be actively engaged in its affairs at the time the report is due. Should you wish to dissolve or withdraw the corporation, please contact this office for the proper procedure. In accordance with R.I.G.L. 7-6-94, each corporation failing or refusing to file its annual report within the time prescribed by law (R.I.G.L. 7-6-91) is subject to a penalty fee of $25.00. In order to accurately complete this form, please log onto our corporate database at www.sec.state.ri.us/corps to view your entity summary screen or to obtain a copy of your last annual report filing. ________________________________________________________________________________________________ Section 1. This section lists the corporate identification number. DO NOT ALTER THIS NUMBER. Please include this number on your check and refer to it in any future correspondence or filings with the Corporations Division. Section 2. List the exact corporate name as it appears on the Articles of Incorporation or latest amendment. If the corporate name has changed, an amendment must be filed with this office. Articles of Amendment forms (Domestic Corporations) or Amended Certificate of Authority forms (Foreign Corporations) can be filed online using Visa, MasterCard, or American Express, visit www.sec.state.ri.us/corps and simply click on the “File Corporations Online” link or a paper form can be obtained by selecting “Corporate Forms.” Of course, we will provide a hardcopy of the form upon request by calling 401-222-3040. Section 3. List the state or country of incorporation. If the information is incorrect on your entity summary screen, please contact this office. Section 4. Please provide the principal office address of the corporation in the State of Rhode Island. Section 5. If a foreign corporation, please list the address of the corporation's principal office in the state or country of incorporation. If the corporation does not have a principal office in the state or country of its incorporation, please list the corporation's registered office of record in its state or country of incorporation. Section 6. Provide a brief statement of the character of affairs which the corporation is actually conducting in this state if nothing is pre-printed in this section. If the corporation is inactive, this section must still be completed. Section 7. List the names and respective addresses of the officers of the corporation on the form. Do not leave areas blank. If the answer is none, write “none”. The officers of a corporation may be designated by any additional titles that may be provided in the articles of incorporation or the by laws. If additional space is needed, attachments will be accepted only after the designated areas on the form are completed. Check the appropriate box on the front of the annual report if submitting an attachment. Attachments must include the identification number of the corporation. Section 8. List the names and respective addresses of the directors of the corporation on the form. Do not leave areas blank. If a domestic non-profit corporation, the number of directors of a corporation shall not be less than three (3). If additional space is needed, attachments will be accepted only after the designated areas on the form are completed. Check the appropriate box on the front of the annual report if submitting an attachment. Attachments must include the identification number of the corporation. Section 9. The corporation's registered agent and registered office is of record in this office and can be found on the entity summary screen. If the registered agent and/or registered office has changed, a Statement of Change of Registered Office/Registered Agent (Form 641) must be filed with this office. To file the Statement of Change online using Visa, MasterCard, or American Express, visit www.sec.state.ri.us/corps and simply click on the “File Corporations Online” link or a paper form can be obtained by selecting “Corporate Forms.” Of course, we will provide a hardcopy of the form upon request by calling 401-222-3040. American LegalNet, Inc. www.FormsWorkflow.com