Illinois Charitable Organization Annual Report Form

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For Office Use Only
ILLINOIS CHARITABLE ORGANIZATION ANNUAL REPORT
Form AG990-IL
Attorney General LISA MADIGAN State of Illinois
PMT #
Revised 3/05
Charitable Trust Bureau, 100 West Randolph
CO #
11th Floor, Chicago, Illinois 60601
01-009426
Check all items attached:
AMT
Report for the Fiscal Period:
X
Copy of IRS Return
X
Audited Financial Statements
Make Checks
Beginning
/
/
07
01
11
Payable to
Copy of Form IFC
the Illinois
X
$15.00 Annual Report Filing Fee
INIT
Charity
& Ending
/
/
06
30
12
Bureau Fund
X
$100.00 Late Report Filing Fee
36-2894128
MO
DAY
YR
Federal ID #
MO
DAY
YR
X
Are contributions to the organization tax deductible?
Yes
No
Date Organization was created:
08
/
27
/
1976
Year-end
amounts
HOWARD BROWN HEALTH CENTER
LEGAL
7,906,411.00
A) ASSETS
A)
$
NAME
4025 NORTH SHERIDAN ROAD
MAIL
B) LIABILITIES
$
6,592,342.00
B)
ADDRESS
C) NET ASSETS
$
CHICAGO, IL
C)
1,314,069.00
CITY, STATE
60613
ZIP CODE
PERCENTAGE
AMOUNT
I. SUMMARY OF ALL REVENUE ITEMS DURING THE YEAR:
75.9396
14,164,696.00
D) PUBLIC SUPPORT, CONTRIBUTIONS & PROGRAM SERVICE REV. (GROSS AMTS.)
%
D)
$
E) GOVERNMENT GRANTS & MEMBERSHIP DUES
23.3248
%
E)
$
4,350,686.00
0.7356
137,212.00
F) OTHER REVENUES
%
F)
$
18,652,594.00
G) TOTAL REVENUE, INCOME AND CONTRIBUTIONS RECEIVED (ADD D, E, & F)
100%
G)
$
II. SUMMARY OF ALL EXPENDITURES DURING THE YEAR:
79.7375
14,119,696.00
%
H)
$
H) OPERATING CHARITABLE PROGRAM EXPENSE
I) EDUCATION PROGRAM SERVICE EXPENSE
%
$
I)
79.7375
14,119,696.00
%
$
J) TOTAL CHARITABLE PROGRAM SERVICE EXPENSE (ADD H & I)
J)
J ) JOINT COSTS ALLOCATED TO PROGRAM SERVICES (INCLUDED IN J):
$
1
K)
K) GRANTS TO OTHER CHARITABLE ORGANIZATIONS
%
$
79.7375
%
$
14,119,696.00
L)
L) TOTAL CHARITABLE PROGRAM SERVICE EXPENDITURE (ADD J & K)
15.6238
2,766,620.00
M) MANAGEMENT AND GENERAL EXPENSE
%
$
M)
N)
N) FUNDRAISING EXPENSE
4.6387
%
$
821,405.00
17,707,721.00
O)
100%
$
O) TOTAL EXPENDITURES THIS PERIOD (ADD L, M, & N)
III. SUMMARY OF ALL PAID FUNDRAISER AND CONSULTANT ACTIVITIES:
(Attach Attorney General Report of Individual Fundraising Campaign - Form IFC. One for each PFR.)
PROFESSIONAL FUNDRAISERS:
$
100%
P)
P) TOTAL AMOUNT RAISED BY PAID PROFESSIONAL FUNDRAISERS
$
%
Q)
Q) TOTAL FUNDRAISERS FEES AND EXPENSES
100.0000
%
$
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:
JAMAL A. EDWARDS, PRESIDENT & CHIEF EXECUTIVE OFFICER
265,054.00
T) NAME, TITLE:
T)
$
MAGDA HOULBERG, CHIEF MEDICAL OFFICER & VICE PRESIDENT
162,147.00
U) NAME, TITLE:
U)
$
WILL RAJ, VICE PRESIDENT, ADMINISTRATION
115,685.00
V) NAME, TITLE:
V)
$
List on back side of instructions
V. CHARITABLE PROGRAM DESCRIPTION:
CHARITABLE PROGRAM (3 HIGHEST BY $ EXPENDED) CODE CATEGORIES
CODE
062
HEALTH CLINIC
W) DESCRIPTION:
W)
#
X) DESCRIPTION:
X)
#
Y) DESCRIPTION:
Y)
#
1J1514 1.000

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