Annual Financial Report For Charitable Organizations Form

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OFFICE OF THE SECRETARY OF STATE

STATE OF SOUTH CAROLINA

ANNUAL FINANCIAL REPORT FOR CHARITABLE ORGANIZATIONS

This form, including any attachments, is a public record and a copy will be provided upon request to any interested person.

Instructions for completing the form are attached at the end of the form. There is NO FEE for filing this form.

Office of the Secretary of State

Public Charities Division

1205 Pendleton Street, Suite 525

Columbia, SC 29201

GENERAL INFORMATION

LEGAL NAME OF ORGANIZATION: ______________________________________________________________________

STREET ADDRESS OR P.O. BOX: ________________________________________________________________________

CITY, STATE, ZIP CODE: ________________________________________________________________________________

TELEPHONE (Area Code, Number, Ext.): ( _______ ) ______ - ______________ FAX: ( _____ ) _______ - ____________

EMPLOYER’S IDENTIFICATION NUMBER: ___ ___ -- ___ ___ ___ ___ ___ ___ ___

FINANCIAL REPORT FOR FISCAL YEAR BEGINNING (Month, Day, Year): _______________

FISCAL YEAR ENDING (Month, Day, Year):

_______________

IS THIS A CHANGE IN YOUR FISCAL YEAR END DATE? CIRCLE ONE: YES / NO

CHARITY REGISTRATION NUMBER: _______________

FINANCIAL SUMMARY

This Section is required of ALL organizations. Applicable schedules should be completed before this section.

Support and Revenue (Amounts Received During the Year)

Total

Direct Public Support (Transfer amount from Schedule 1, Line 11) ............................................................. _________________

Indirect Public Support (Transfer amount from Schedule 1, Line 15) .......................................................... _________________

Government Grants (Transfer amount from Schedule 1, Line 17) ................................................................ _________________

Program Service Revenue .............................................................................................................................. _________________

Other Revenue................................................................................................................................................. _________________

Total Support and Revenue (Add Lines 1 through 5) .................................................................................... _________________

Expenses (Amounts Paid Out During the Year)

Program Services (List individually. Attach sheet if necessary.)

_______________________________________________________ ......................................................._________________

Total Program Activity (Add Lines 7a through 7d.) .................................................................................._________________

Payments to Affiliates/Services to Affiliates..................................................................................................._________________

10.

Public Information Combined Fundraising ....................................................................................................._________________

11.

Fundraising ......................................................................................................................................................_________________

12.

Management and General ................................................................................................................................_________________

13. Total Expenses (Add Lines 8 through 12) ................................................................................................... _________________

14.

Excess (Deficit) of Support and Revenue over Expenses (Line 6 minus Line 13) ........................................._________________

15.

Fund Balances or Net Worth at the beginning of fiscal year ..........................................................................._________________

16.

Other changes in Fund Balances or Net Worth (Attach explanation).............................................................._________________

17.

Fund Balances or Net Worth at end of fiscal year (Add Lines 14 thru 16. Line 17 must equal Line 20.)......_________________

Summary of Balance Sheet as of Fiscal Year End

18.

Assets ..............................................................................................................................................................._________________

19.

Liabilities ........................................................................................................................................................._________________

20.

Fund Balance (Line 18 minus Line 19. Line 20 must equal Line 17.) ..........................................................._________________