Fillable Form Char500 - Annual Filing For Charitable Organizations

Form Char500 - Annual Filing For Charitable Organizations - 2013 Page 2

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Schedule 4a: Professional Fund Raisers (PFR), Fund Raising Counsels (FRC), Com mercial Co-Venturers (CCV)

If you checked the box in question 4.a. on page 1, complete the following schedule for each PFR, FRC or CCV that the organization engaged for

fund raising activity in NY State:

Type of fund raising professional (FRP):

Professional fund raiser . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Fund raising counsel . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Commercial co-venturer . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Name of FRP:

Number and street (or P.O. box if mail is not delivered to street address):

City or town, state or country and zip + 4:

3. FRP telephone number:

(

)

Services provided by FRP (provide description):

5. Compensation arrangement with FRP (provide description):

6. Dates of contract . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . _____________________ through _____________________

(mm/dd/yyyy)

7. Amount paid to FRP . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . $ _____________________

§ 173-a.

If services were provided by a CCV, did the CCV provide the charitable organization with the interim report(s) required by §

3 of the

Yes

Executive Law?

CHAR500 - 2013