SOUTH CAROLINA  ECRETARYS                        OF  TATES

                                              PUBLIC CHARITIES  IVISIOND      
                                              ANNUAL FINANCIAL  EPORTR     

                                                  Filing Instructions 

•  Organizations who file the IRS 990-N or are not required to file with the IRS should complete this form.
•  Please follow the instructions provided on pages 4 and 5 to complete this form. You may contact our office
   with any questions at 803-734-1790 or email charities@sos.sc.gov.
•  We do not accept this filing by fax or email; you may upload this report using our online filing system
   at www.sos.sc.gov or mail this form to: South Carolina Secretary of State, Attn: Division of Public Charities,
   1205 Pendleton St., Suite 525, Columbia, SC  29201.

For the fiscal year ending __________ (mm/dd/yy)     EIN: ___ - __________     Charity ID: ______________        

Organization’s Name: _________________________________________________________________      ______ 

Part I— Fundraising Events or Contracts 

If  your organization  held any fundraising events,  or  used a commercial co-venturer  (CCV)  or professional 
fundraising company (PFR)  during the previous fiscal year, you must report all revenue and expenses in the 
following table. Events include, but are not limited to, carnivals, dinners, galas, raffles, and bingo games. If you need 
additional space, you may list additional events on a separate sheet and include the amounts in the total revenue and 
expenses on this table. 

                 (A)                          (B)       (C)                  (D)   (E)                     (F) 
       Name of Event,                    Gross Receipts Cash &            Other    Total                   Net 
       CCV or PFR                             &         Noncash Prize     Expenses Expenses Revenue 
                                         Contributions  Expenses 

1.  
                                                                                   $ 0.00                  $ 0.00

2.  
                                                                                   $ 0.00                  $ 0.00

3. 
                                                                                   $ 0.00                  $ 0.00
4. 
                                                                                   $ 0.00                  $ 0.00

5. 
                                                                                   $ 0.00                  $ 0.00

6. 
                                                                                   $ 0.00                  $ 0.00
7. 
                                                                                   $ 0.00                  $ 0.00

8. 
                                                                                   $ 0.00                  $ 0.00

9. 
                                                                                   $ 0.00                  $ 0.00
10. 
                                                                                   $ 0.00                  $ 0.00

11. Gross Revenue                                       12. Total Expenses
   (add 1B through 10B)                        $ 0.00   (add 1E through 10E)       $ 0.00                  $ 0.00

Annual Financial Report, revised January 2017                                               Page1 of  5 

Part II— Gross Revenue      

Organizations must report their gross receipts from all sources of revenue. 

1. Fundraising events (from page 1, part I, box 11B) ................................................... __________________$ 0.00
2. Fundraising activity revenue not reported on line 1.................................................. __________________ 
3. Federated campaigns (such as United Way) ............................................................. __________________ 
4. Membership dues ...................................................................................................... __________________ 
5. Related organizations (such as related parent or national organizations) ................. __________________ 
6. Government grants (from federal, state or local governments) ................................ __________________ 
7. All other contributions, gifts, grants not listed above ............................................... __________________ 
8. Program service revenue  .......................................................................................... __________________ 
9. Other income ............................................................................................................. __________________ 
10. Total revenue (add lines 1 through 9) ................................................................... __________________$ 0.00

Part III— Program Service Expenses 

Describe the organization’s program accomplishments and the amount spent on each. If more space is needed you 
may attach an additional sheet if necessary. 

11. ______________________________________________________________________
    ................................................................................................................................ $__________________ 
12. ______________________________________________________________________
    ................................................................................................................................ $__________________ 
13. Total Program Service Expenses (add lines 11 and 12) ..................................... $__________________$ 0.00

Part IV— Management, General and Fundraising Expenses 
14. Program expenses (from part III, line 13)  ................................................................ __________________$ 0.00
15. Direct expenses from fundraising events and contracts (box 12E)  .......................... __________________$ 0.00
16. Fundraising expenses (not included in the amount on line 15) ................................. __________________ 
17. Payments to related organizations ............................................................................ __________________ 
18. Salaries and other compensation  .............................................................................. __________________ 
19. Management and general expenses  .......................................................................... __________________ 
20. Professional fees and other payments to independent contractors  ........................... __________________ 
21. Other expenses not listed above ................................................................................ __________________ 
22. Total expenses (add lines 14 through 21)  ............................................................. __________________$ 0.00
23. Excess or (deficit) for the year (subtract line 22 from line 10)  ................................ __________________$ 0.00
24. Fund balances/net worth at the beginning of the fiscal year ..................................... __________________ 
25. Changes in fund balances/net worth (attach explanation) ......................................... __________________ 
26. Fund balances/net worth at the end of the fiscal year (add lines 23 through 25) ...... __________________$ 0.00

Part V— Balance Sheet 

27. Total assets  ............................................................................................................... __________________ 
28. Total liabilities  ......................................................................................................... __________________ 
29. Net assets or fund balances at end of year (subtract line 28 from line 27)  ....... __________________$ 0.00

Annual Financial Report, revised January 2017                                                                     Page2 of  5 

Certification 

As required by Section 33-56-60 of the Solicitation of Charitable Funds Act, this form shall be signed by the Chief 
Executive Officer and the Chief Financial Officer of the charitable organization. (If one person serves as both CEO 
and CFO, he or she should sign in both places below.)  

We certify that the information furnished in this statement is true and correct to the best of our knowledge and 
belief. 

CEO/President                                          CFO/Treasurer 

Name : _________________________________               Name : _________________________________ 

Signature: _______________________________             Signature: _______________________________ 

Date: _______________                                  Date: _______________ 

Mailing Address: ___________________________________________________________________ 

Email Address: ______________________________ Phone Number: _________________________ 

Annual Financial Report, revised January 2017                                         Page3 of  5 

                         SOUTH CAROLINA  ECRETARYS                       OF  TATES

                                              PUBLIC CHARITIES  IVISIOND        
                                 ANNUAL FINANCIAL  EPORT R     NSTRUCTION I     HEETS      

Please read the instructions for each line of the report. You do not need to submit these instructions with your 
report. If you are using the online filing portal for reporting these figures, you must complete this form in its entirety 
per instrucations and upload it during the filing using the               button in the reporting screen. 

Instructions for Part I— Fundraising Events or Contracts 

If your organization held any fundraising events, used a commercial co-venturer (CCV) or professional fundraising 
company (PFR) during the previous fiscal year, you must report all revenue and expenses in Part I. Events include, 
but are not limited to, carnivals, dinners, galas, raffles, and bingo games. If you need additional space, you may list 
additional events on a separate sheet and include the amounts in the total revenues and expenses on this table. 
Instructions for Each Column 
(A) Enter the name of the event, commercial entity or professional fundraising company.
(B) Total of all ticket sales, entry fees, etc… along with any donations received at the event. Do not put ordinary
contributions from individuals or revenue from ongoing program services on this table.
(C) Cash prizes given or money spent by the organization to purchase prizes. Do not include donated items.
(D) Direct expenses that are not listed in column C, facility, food and beverage, speaker costs, etc…. 
(E) For each row add the amounts listed in column C and D.
(F) For each row subtract the amounts listed in column E from column B.

Instructions for Part II— Gross Revenue    

Line 1.  Fundraising events: Enter the total gross amounts received from all special events and activities by the 
         organization, or on its behalf. This number should match the number from page 1, part I, box 11B. 
Line 2.  Fundraising activity revenue: Enter the total gross receipts received from fundraising activities not 
         reported on line 1. Fundraising activities include amounts received to raise funds to finance the 
         organization’s exempt activities. These activies include, but are not limited to, sales of goods to the public 
         and concession stand receipts. 
Line 3.  Federated campaigns: Enter the total amounds received from fundraising organizations such as United 
         Way. 
Line 4.  Membership dues: Enter only the amount of dues, fees, sponsorships, and assessments that do not exceed 
         the monetary value of the benefits available to the members. 
Line 5.  Related organizations: Enter the total contributions received from associated organizations such as 
         related affiliates, parent organizations, or national organizations. 
Line 6.  Government grants: Enter total amount of grants or other payments received from federal, state or local 
         governments that are used to carry out the organization’s charitable purpose.  
Line 7.  All other contributions, gifts, grants: Enter the total amount of contributions from individuals, 
         businesses, foundations, trusts, estates and other exempt organizations, that are not included on lines 
         above. 
Line 8.  Program service revenue: Includes total fees received by the organization for providing services or 
         activities that fulfill the organization’s stated mission or purpose. 
Line 9.  Other income: All other income not covered by lines 1-8, including, but not limited to, interest and rental 
         income, as well as sale of assets or inventory not sold through an event or activity listed on lines 1 and 2. 
Line 10. Total revenue: Add lines 1-9. 

Annual Financial Report, revised January 2017                                                              Page4 of  5 

Instructions for Part III— Program Service Expenses 

Lines 11 and 12. 
    •    Program expenses: Include total costs of services or activities performed by the organization that fulfill its
         charitable purposes. 
    •    Include any donations, grants, or scholarships given to fulfill the organization’s charitable purpose.
    •    Do not include fundraising expenses in this section.
    •    Do not include management and operating expenses that are not directly related to carrying out the
         charitable purpose of the organization in this section.
Line 13. Total program expenses: Add lines 11-12. 

Instructions for Part IV— Management, General and Fundraising Expenses 

Line 14. Program expenses: Enter the total amount of program expenses from part III, line 13.  
Line 15. Event fundraising expenses: Enter the total expenses for all special events and contracts conducted by the 
         organization or on its behalf which are listed in part I. This number should match the number from 
         page 1, part I, box 12E.  
Line 16. Fundraising expenses:  Enter costs incurred in soliciting contributions, gifts, and grants. These expenses 
         include, but are not limited to, cost of printing and mailing solicitation materials as well as the cost of 
         purchasing merchandise to solicit contributions. This number should not include any of the amounts 
         listed on line 15. 
Line 17. Payments to related organizations: Enter any payments, including dues, made to related state or national 
         organizations. 
Line 18. Salaries and other compensation: Enter amounts paid for salaries or other compensation to officers and 
         employees. If a portion of these expenses relate to program services or fundraising, a reasonable 
         allocation should be made among those functions. 
Line 19. Management and general expenses: Enter amounts spent on the overall management of the organization. 
         These expenses include, but are not limited to, costs of rent, utilities, bank fees, meetings, insurance and 
         office administration and management. If a portion of these expenses relate to program services or 
         fundraising, a reasonable allocation should be made among those functions. 
Line 20. Professional fees and other payments to independent contractors: Enter the amounts spent on legal and 
         accounting services that are not related to program or fundraising expenses. 
Line 21. Other expenses: Enter any expenses not listed above.  
Line 22. Total expenses: Add lines 14 through 21. 
Line 23. Excess or (deficit) for the year: Enter the difference between line 22 and line 10. If line 22 is greater than 
         line 10, enter the difference in parentheses. 
Line 24. Fund balances/net worth at the beginning of the fiscal year: Enter the prior year’s fund balance or net 
         worth. This number should match the amount you reported on the prior year’s return. 
Line 25. Changes in fund balances/net worth: Please attach an explanation of changes in net assets or fund 
         balances between the beginning and end of the year that are not included in the amount listed on line 22. 
         Amounts here include, but are not limited to, adjustments of earlier years’ activities (such as losses on 
         uncollected pledges, refunds of contributions and program service revenue and reversal of grant expenses, 
         as well as unrealized gains and losses on investments. 
Line 26. Fund balances/net worth at the end of the fiscal year: Add lines 23 through 25. 

Instructions for Part V— Balance Sheet 

Line 27. Total assets: This amount should include the fund balance/net worth listed on line 26 along with the value 
         of any other cash or savings, and the book value of investments, land, building and other assets. 
Line 28. Total liabilities: This amount includes items such as accounts payable, grants payable, mortgages or other 
         loans payable. 
Line 29. Net assets or fund balances at end of year: Subtract line 28 from line 
Annual Financial Report, revised January 2017                                                              Page5 of  5 
27.