Form Char500 - Annual Filing For Charitable Organizations - 2013

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Annual Filing for Charitable Organizations
2 0 13
CHAR500
New York State Department of Law (Office of the Attorney General)
Form
Charities Bureau - Registration Section
120 Broadway
This form used for
Open to Public
Article 7-A, EPTL and dual filers
New York, NY 10271
(replaces forms CHAR 497, CHAR
Inspection
010 and CH AR 006)
1. General Information
/ 2 0 1 3 and ending
a. For the fiscal year beginning
(mm/dd/yyyy)
(mm/dd/yyyy)
b. Check if applicable for NYS:
c. N am e of organization
d. Fed. em ployer ID no. (E IN ) (##-#######)
-
G
Address change
e. N Y S tate registration no. (##-##-##)
G
Name change
-
-
G
Initial filing
N um ber and street (or P.O . box if m ail not delivered to street address)
R oom /suite
f.
T elephone num ber
G
Final filing
(
)
-
G
Amended filing
G
C ity or town, state or country and zip + 4
g. E m ail
NY registration pending
2. Certification - Two Signatures Required
We certify under penalties of perjury that we reviewed this report, including all attachments, and to the best of our knowledge and belief, they are true,
correct and complete in accordance with the laws of the State of New York applicable to this report.
a. President or Authorized Officer
S ignature
P rinted N am e
T itle
D ate
b. Chief Financial Officer or Treas.
S ignature
P rinted N am e
T itle
D ate
3. Annual Report Exemption Information
a. Article 7-A annual report exemption (Article 7-A registrants and dual registrants)
Check
if total contributions from NY State (including residents, foundations, corporations, government agencies, etc.) did not exceed
$25,000 and the organization did not engage a professional fund raiser (PFR) or fund raising counsel (FRC).to solicit
contributions during this fiscal year.
NOTE: An organization may claim this exemption if no PFR or FRC was used and either: 1) it received an allocation from a federated fund,
United Way or incorporated community appeal and contributions from other sources did not exceed $25,000 or 2) it received all or
substantially all of its contributions from one government agency to which it submitted an annual report similar to that required by Article 7-A.
b. EPTL annual report exemption (EPTL registrants and dual registrants)
Check
if gross receipts did not exceed $25,000 and assets (market value) did not exceed $25,000 at any time during this fiscal year.
For E P T L or A rticle-7A registrants claim ing the annual report exem ption under the one law under which they are registered and for dual registrants claim ing the annual report
exem ptions under both laws, sim ply com plete part 1 (G eneral Inform ation), part 2 (C ertification) and part 3 (A nnual R eport Exem ption Inform ation) above.
D o not subm it a fee, do not complete the following schedules and do not subm it any attachm ents to this form .
4. Article 7-A Schedules
If you did not check the Article 7-A annual report exemption above, complete the following for this fiscal year:
a. Did the organization use a professional fund raiser, fund raising counsel or commercial co-venturer for fund raising activity in NY State? . . G Yes* G No
* If “Yes”, complete Schedule 4a.
b. Did the organization receive government contributions (grants)? . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . G Yes* G No
* If “Yes”, complete Schedule 4b.
5. Fee Submitted: See last page for summary of fee requirements.
Indicate the filing fee(s) you are submitting along with this form:
a. Article 7-A filing fee . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . $ ________
Submit only one check or money order for the
total fee, payable to “NYS Department of Law”
b. EPTL filing fee . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . $ ________
c. Total fee . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . $ ________
6. Attachments - For organizations that are not claiming annual report exemptions under both laws, see last page for required attachments
1
CHAR500 - 2013

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