Annual Unit In Good Standing Report Form

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Please complete this form and return with all the necessary documents by
th
February 15
. The purpose of this form is to ensure that your unit is meeting
the requirements necessary to maintain your 501(c)(3) non-profit status.
Annual Unit In Good Standing Report
Please mail this report BY NO LATER THAN FEBRUARY 15TH to:
Hawaii State PTSA – Treasurer
765 Amana Street, Suite 308, Honolulu, HI 96814
Please be aware that this report:
st
Contains information that must be submitted to the IRS with our annual filing on March 31
Must be completed & returned to the Hawaii State PTSA in order to remain a “Unit in Good Standing”
st
and to avoid termination of services on March 31
and possible revocation of your 501(c)(3) tax-exempt
status
Please type or print legibly:
Local Unit Name: __________________________________________________________________
School Name: _____________________________________________________________________
Mailing address
: ____________________________________________________
(include city and zip code)
Name & Title of Person Completing This Form: ___________________________________________
Email: ____________________________________ Phone: ________________________________
National PTA ID No.: ___________________
Region: _______________________________
Federal ID number: _____________________
General Excise Number: W ___________________
Date Your Unit Bylaws Were Last Reviewed: ______________ Last Updated: __________________
What did your unit charge for membership dues? This year: $_________ Last Year: $____________
What is your fiscal end of year date? __________________________________________________
Total Gross Receipts: This Year-to-Date: $____________________ Last Year: $________________
Please ESTIMATE the total number of PTA volunteer hours for your unit last year: ______________
The following attachments MUST accompany this report to be complete:
o Copy of your current year fiscal budget:
o Copy of your prior year financial audit, audit committee report, year-end statement
o Copy of your prior year annual IRS form 990 or confirmation of 990-N postcard filing. (If your
prior year 990 filing is not yet complete, please provide a copy of a valid extension filed with the
Internal Revenue Service.) Be sure “gross receipts” are shown above.
o A copy of your most recent Hawaii General Excise Tax filing (Form G-45)
o An updated and current copy of your local unit board of directors & officers roster as of this filing
[If you have questions regarding completing this form, please email: .]
Revised: January 2012

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