Not-for-Profit Annual Questionnaire

Organization's Legal Name

Fiscal Year End Date

Date

Client Status

Organization's Phone Number

Please enter a valid phone number.Format: (000) 000-0000.

Organization's Website

Please enter a valid website.

NYS Registration No.

Briefly describe the organization's mission: (This will be used on the IRS 990 and will be available to the public)

Please upload your organization's prior year tax returns and your formation documents.

Primary Contact Name

Professional Title

Phone Number

Please enter a valid phone number.Format: (000) 000-0000.

Email

example@example.com

Has the primary address changed since the last tax return filed?

Is the primary address the same as the mailing address?

Primary Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code

Mailing Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code

Do you have a NYS online portal account with the NYS Charities Bureau?

If NO, please follow these steps below to create a NYS Charities Bureau Account here:

Scroll down to select "Registration"
Scroll down to check the box "I have read the requirements above."
Select "Continue to charities online registration."
Select "Create Account."

Please provide us with your username and password once you have registered.

Organization's Gross Receipts & Total Assets

The Organization's Gross Receipts for the fiscal year were:

Did the Organization have any income from activity not related to its exempt purpose (UBI- unrelated business income)?

Does the organization maintain an office or have employees in New York State?
YES NO*

Does the organization have assets in New York State?
Assets may include cash, investments, accounts receivable, inventory, real estate, and the like.
YES NO*

Was the total amount of assets less than $25,000 at the fiscal year end?
YES NO*

Did the organization solicit or receive contributions during the fiscal year from New York State residents, foundations, corporations, or government agencies, etc.?
YES NO*

Were the total contributions less than $25,000?
YES NO*

Does the organization plan to receive more than $25,000 annually in total contributions from New York State residents, foundations, corporations, or government agencies or other entities?
YES NO*

Did your organization use a professional fundraiser or fundraising counsel for fundraising activity in New York State?
An employee or volunteer for a charity is not a professional fundraiser. A professional fundraiser is an individual or company contracted by a charity to manage, conduct or assist a charity in its solicitations and paid by the charity for such work. Typically, a professional fundraiser solicits contributions on a charity's behalf, and may have access to the contributions raised for a charity.
YES NO*

Choose the range that represents the organization's total New York State contributions in this filing's fiscal year.
*

Did the organization receive government grants during this fiscal year?
YES NO*

Please list EACH government grant awarded by a domestic (federal, state or local) agency; interstate or intergovernmental agency; and state or local authorities. Please include any funding from municipalities that include the organization in their standard budgeting (for example, a volunteer ambulance corps).

Rows	Name of Government Agency	Total Amount
Grant Awarded
Grant Awarded
Grant Awarded
Grant Awarded
Grant Awarded

Please provide the following information for each Board Member relating to the organization:

Rows	First Name	Last Name	Email Address	Role	Average Hours Per Week	Wages Received
Board Member
Board Member
Board Member
Board Member
Board Member
Board Member
Board Member
Board Member
Board Member
Board Member

The NYS CHAR500 must be signed by two indivudals authorized by the Organization. To help us obtain the required e-signatures, please provide the contact information below:

Signatory #1

First NameLast Name

Email Address

example@example.com

Title

Signatory #2

First NameLast Name

Email Address

example@example.com

Title

The New York State EPTL fee due at filing is based on the organization's net worth. If both net assets and gross receipts were less than $25,000, there is no NYS filing fee. Otherwise, please reference the table below for the estimated amount due when we file your CHAR500 return.

Bank Name

Account Type

Routing Number

Accounting Number

What method do you use to maintain your books and records for the company?

If your organization received more than $50,000 in gross receipts for the fiscal year, then please provide all applicable materials:

Access to QuickBooks Online or copy of QuickBooks/other bookkeeping file;
All income earned and expenses incurred during the fiscal year; and
The following statements showing the balance at fiscal year-end:
- Bank Accounts
- Credit Cards
- Loans
- Investment Accounts

Please upload any supporting documents here:

Engagement Authorization

RAC Fee ($ Amount)

Questions/Comments/Notes:

Not-for-Profit Annual Questionnaire

Annual Questions