ILLINOIS CHARITABLE ORGANIZATION ANNUAL REPORT                                                                   Form AG990-IL
                                                                                                                                              Revised 0 /244
 For Office Use Only
                                    Illinois Attorney General Kwame Raoul
 PMT #                              Charitable Trust Bureau, 115 S. LaSalle St
        ___________________________                          Chicago, IL 60603                                           CO #___________________
                                                                                                                             Check all items attached:
 AMT                                        Report for the Fiscal Period:                                                  o Copy of IRS Return
        ___________________________                                                                                        o Audited Financial Statements
                                            Beginning  ______/______/______                               Make Checks      o Reviewed Financial Statements
 INIT                                                                                                     Payable to       o Copy of Form IFC
        ___________________________                                                                       Illinois Charity o $15 Annual Report Filing Fee
                                            & Ending  ______/______/______                                Bureau Fund
                                                                            MO DAY                     YR                  o $100 Late Report Filing Fee
Federal ID # _______________________________
Are contributions to the organization tax deductible?   Yes o      No o                                Date organization was created: ________/________/________
                                                                                                                                       MO DAY   YR 
  Legal Name:  __________________________________________________________                                 YEAR-END
                                                                                                          AMOUNTS
 Mail Address: __________________________________________________________
                                                                                                          A) ASSETS        A)    $
 City, State:  __________________________________________________________
                                                                                                          B) LIABILITIES   B)    $
 Zip Code:     __________________________________________________________                                 C) NET ASSETS    C) $

 I. SUMMARY OF ALL REVENUE ITEMS DURING THE YEAR:                                                         PERCENTAGE                      AMOUNT
       D) PUBLIC SUPPORT, CONTRIBUTIONS AND PROGRAM SERVICE REV.(GROSS AMTS.)                             %                D) $
       E) GOVERNMENT GRANTS AND MEMBERSHIP DUES                                                           %                E) $
       F) OTHER REVENUES                                                                                  %                F) $
      G)  TOTAL REVENUES, INCOME AND CONTRIBUTIONS RECEIVED (ADD D, E & F)                                100%             G) $
 II. SUMMARY OF ALL EXPENDITURES DURING THE YEAR
       H) OPERATING CHARITABLE PROGRAM EXPENSE                                                            %                H) $
       I) EDUCATION PROGRAM SERVICE EXPENSE                                                               %                  I) $
       J) TOTAL CHARITABLE PROGRAM SERVICE EXPENSE (ADD H & I)                                            %                J) $
        J1)  JOINT COSTS ALLOCATED TO PROGRAM SERVICES (INCLUDED IN J)  $
       K) GRANTS TO OTHER CHARITABLE ORGANIZATIONS                                                        %                K) $
       L) TOTAL CHARITABLE PROGRAM SERVICE EXPENDITURE (ADD J & K)                                        %                L) $
       M) MANAGEMENT AND GENERAL EXPENSE                                                                  %                M) $
       N) FUNDRAISING EXPENSE                                                                             %                N) $
       O) TOTAL EXPENDITURES THIS PERIOD (ADD L, M & N)                                                   100%             O) $
 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                                            100%             P) $
       Q) TOTAL FUNDRAISERS FEES AND EXPENSES                                                             %                Q) $
       R) NET RECEIVED BY THE CHARITY (P MINUS Q = R)                                                     %                R) $
      • PROFESSIONAL FUNDRAISING CONSULTANTS:
       S) TOTAL AMOUNT PAID TO PROFESSIONAL FUNDRAISING CONSULTANTS                                                        S) $
 IV. COMPENSATION TO THE (3) HIGHEST PAID PERSONS DURING THE YEAR:
       T)  NAME, TITLE: ___________________________________________________________________                                T) $
       U) NAME, TITLE: ___________________________________________________________________                                 U) $
       V) NAME, TITLE: ___________________________________________________________________                                 V) $
 V. CHARITABLE PROGRAM DESCRIPTION:CHARITABLE PROGRAM (3 HIGHEST BY $ EXPENDED) CODE CATEGORIES                            List on back side of Instructions
                                                                                                                                          CODE

        W)  DESCRIPTION: _________________________________________________________________                                 W) #
       X) DESCRIPTION: __________________________________________________________________                                  X) #
      Y)  DESCRIPTION: __________________________________________________________________                                  Y) #

IF THE ANSWER TO ANY OF THE FOLLOWING QUESTIONS IS YES, ATTACH A DETAILED EXPLANATION:                                                                                                  YES NO

 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.

 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: __________________________________________________________________

                          •  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:      PRESIDENT or TRUSTEE (PRINT NAME)  SIGNATURE                                                                                                      DATE
1.)  REPORTS ARE DUE WITHIN SIX  
 MONTHS OF YOUR FISCAL YEAR END.
2.)  FOR FEES DUE, SEE INSTRUCTIONS.  _________________________________________________________________________________
3.)  REPORTS THAT ARE LATE OR         TREASURER OR TRUSTEE (PRINT NAME)  SIGNATURE                                                                                                      DATE
 INCOMPLETE ARE SUBJECT TO
 A $100.00 PENALTY.
                                      _________________________________________________________________________________
                                      PREPARER (PRINT NAME)              SIGNATURE                                                                                                      DATE