ANNUAL FINANCIAL REPORT
FULL OFFICIAL NAME AND ADDRESS OF ORGANIZATION
CHAR497
(Charitable Organization)
FOR THE YEAR ENDED
STATE OF NEW YORK, OFFICE OF THE ATTORNEY GENERAL
CHARITIES BUREAU
120 Broadway, New York, NY 10271
[ ] "X" BOX, IF ADDRESS HAS BEEN CHANGED
ORGANIZATION’S TELEPHONE NUMBER
Area Code:
Number:
Extension:
STATE REGISTRATION NUMBER
This form, including any attachments,
FOR OFFICE USE ONLY
is a public record and a copy will be
DATE RECEIVED
EXAMINED BY/DATE
provided upon request to any
FEDERAL I.D. NUMBER
interested persons.
RECEIPT NO.
AMOUNT
[ ]
"X" box if your total contributions did not exceed $25,000 and you did not engage the services of a professional fund raiser or a
commercial co-venturer during this fiscal year (See INSTRUCTIONS: REPORT CATEGORIES AND FEES).
[ ]
This is a combined report for
organizations (See INSTRUCTIONS: FOR REPORT CATEGORIES AND FEES).
FINANCIAL SUMMARY
TOTAL
Support and Revenue
1. Direct public support (line 14, Schedule 1, page 2)
2. Indirect public support (line 18, Schedule 1, page 2
3. Government grants (line 20, Schedule 1, page 2)
4. Program service revenue
5. Other revenue
6. Total support and revenue (add lines 1 through 5)
Expenses
Program services (list individually):
7.
8.
9.
10.
11. Public information combined with fund raising
12. Payments to affiliates/services to affiliates
13. Total program services (add lines 7 through 12)
14. Management and general expenses
15. Fund raising expenses
16. Total expenses (add lines 13 through 15)
17. Excess (deficit) of support and revenue over expenses
(line 6 minus line 16)
18. Fund balances or net worth at beginning of year
19. Other changes in fund balances or net worth (attach explanation)
20. Fund balances or net worth at end of year (add lines 17 through 19)
Summary of Balance Sheet (as of
)
21. Assets
22. Liabilities
23. Fund balances (line 21 minus line 22)
Explanation of income and expense items, if required:
CHAR497 2\99
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