Annual Financial Report Form for Charities or Sponsors - simple annual financial report template

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North Carolina Department of the Secretary of State Annual Financial Report Form
Charitable Solicitation Licensing Division for charitable or sponsor organizations
1. Organization Name: 2. For Fiscal Year Ending:
Section 1. Balance Sheet - Concise Statement of Financial Position
A. Assets and liabilities: Amount
3. Unrestricted Assets:
4. Restricted Assets:
5. Fixed Assets:
6. Total Current Assets:
7. Total Current Liabilities:
8. Total Net Assets:
B. Fund balance:
9. Unrestricted net assets at beginning of fiscal year:
10. Unrestricted net assets at end of fiscal year:
11. Total Change in unrestricted net assets:
Sections 2 and 3: Statement of Activities for Reporting Period
Section 2. Support and revenues: Amount
12. Government grants and contracts:
13. ?131F-2(18) qualifying organization grants:
14. ?131F-2(5) qualifying bona fide membership fees
15. Program service revenues not exceeding service or good fair market value:
16. Program service revenues over and above service or good fair market value:
17. Corporate or business grants:
18. Contributions designated or received through third party channels (e.g., via
parent group, federated fundraising group):
19. ?131F-2(5) non-qualifying donation-based membership fees:
20. Fair market value of "in-kind" contributions and forbearances received:
21. Restricted direct contributions (e.g., endowment giving, charitable gift
annuities, unrealized bequests):
22. Unrestricted direct contributions:
23. Total G.S. ?131F-2(5) "contributions" (add items 16 through 22 and enter
total here):
24. Total Support and Revenue (add items 12 through 22 and enter total here):
CSL Contact Information: Annual Financial Report Form
Agency Internet Site: www.sosnc.gov Electronic Mail: csl@sosnc.gov
Telephone: (919) 814-5400 - Toll free for NC residents: 1-888-830-4989 Form Revision:September 24, 2020
Facsimile: (919) 807-2220 Effective Date: July 24, 2012
Mailing Address: P.O. Box 29622, Raleigh, NC 27626-0622 Page 1 of 3
North Carolina Department of the Secretary of State Annual Financial Report Form
Charitable Solicitation Licensing for charitable or sponsor organizations
Section 3. Functional Expense Statement:
Functional Expenses (A) TOTAL (B) Program (C) Management (D) Fund raising
Services and General
25. Grants and allocations
26. Specific assistance to individuals
27. Benefits paid to or from members
28. Compensation of officers, directors,
etc.
29. Other salaries and wages
30. Pension plan contributions
31. Other employee benefits
32. Payroll taxes
33. Professional fundraising fees
34. Accounting fees
35. Legal fees
36. Supplies
37. Telephone
38. Postage and shipping
39. Occupancy
40. Equipment rental and maintenance
41. Printing and publications
42. Travel
43. Conferences, conventions and
meetings
44. Interest
45. Depreciation, depletion, etc.
46. Other expenses not covered above
Total Expense Amounts: Total: Program Services: Management and Fundraising:
General:
47. TOTAL EXPENSES:
CSL Contact Information: Annual Financial Report Form
Agency Internet Site: www.sosnc.gov Electronic Mail: csl@sosnc.gov
Telephone: (919) 814-5400 - Toll free for NC residents: 1-888-830-4989 Form Revision: September 24, 2020
Facsimile: (919) 807-2220 Effective Date: July 24, 2012
Mailing Address: P.O. Box 29622, Raleigh, NC 27626-0622 Page 2 of 3
North Carolina Department of the Secretary of State Annual Financial Report Form
Charitable Solicitation Licensing for charitable or sponsor organizations
Joint cost allocations:
48. Are any joint costs from a combined educational campaign and fundraising YES NO
solicitation reported in the expense totals for Section 3 (B) Program Services?
If the answer to item 48 is "No", skip items 49 through 52 and proceed to item 53. If
the answer to item 48 is "Yes", answer items 49 through 52: Amount
49. Aggregate (total) amount of joint costs:
50. Amount allocated to Program Services:
51. Amount allocated to Management and General:
52. Amount allocated to Fundraising:
Optional Attachments:
53. You may submit additional explanatory or descriptive information as attachments.
Please check "Yes" here if attaching additional information: YES NO
54. FINANCIAL REPORT CERTIFICATION - MUST HAVE THREE (3) SIGNATURES (18 NCAC 11 . 0506 (a))
We, as members of the audit and/or finance committee or as members of the board of directors of the
organization identified above, do hereby certify that the information in this report and any attachments is
true and correct to the best of our individual and collective knowledge.
Name: Signature
Title:
Name: Signature
Title:
Name: Signature
Title
55. Report Completion and Signature Date:
CSL Contact Information: Annual Financial Report Form
Agency Internet Site: www.sosnc.gov Electronic Mail: csl@sosnc.gov
Telephone: (919) 814-5400 - Toll free for NC residents: 1-888-830-4989 Form Revision: September 24,2020
Facsimile: (919) 807-2220 Effective Date: July 24, 2012
Mailing Address: P.O. Box 29622, Raleigh, NC 27626-0622 Page 3 of 3


How to prepare an annual report for your company? Prepare to Write. Before you start writing an annual report, determine what range of your company's financial year the financial report is meant to cover. Typically, financial reports are presented quarterly and yearly. To define the time range your financial report should cover, check the governing records of your company, such as its ...

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