For Office Use Only
                                                                                                                          Form AG990-IL 
PMT #                  ILLINOIS CHARITABLE ORGANIZATION ANNUAL REPORT                                                                   Revised  /119
                       Attorney General KWAME RAOUL State of Illinois
                                    Charitable Trust Bureau, 100 West Randolph
AMT                                 11th Floor, Chicago, Illinois 60601                                            CO #
                                                                                                                      Check all items attached:
                                    Report for the Fiscal Period:                                                     Copy of IRS Return
                                                                                                      Make Checks     Audited Financial Statements
INIT                                Beginning                    /            /                       Payable to      Copy of Form IFC
                                                                                                      the Illinois 
                                                                                                      Charity         $15.00 Annual Report Filing Fee
                                            & Ending          /       /                               Bureau Fund     $100.00 Late Report Filing Fee
Federal ID #                                              MO      DAY      YR                                             MO              DAY        YR
Are contributions to the organization tax deductible? Yes No                    Date Organization was created:                   /         /
                                                                                                      Year-end 
      LEGAL
                                                                                                      amounts
      NAME
         MAIL                                                                                         A) ASSETS       A) $
ADDRESS                                                                                               B)LIABILITIES   B) $
CITY, STATE                                                                                           C)NET ASSETS    C) $
ZIP CODE

I. SUMMARY OF ALL REVENUE ITEMS DURING THE YEAR:                                                      PERCENTAGE          AMOUNT
     D)PUBLIC SUPPORT, CONTRIBUTIONS & PROGRAM SERVICE REV. (GROSS AMTS.)                                     %       D) $
     E) GOVERNMENT GRANTS & MEMBERSHIP DUES                                                                   %       E) $
     F) OTHER REVENUES                                                                                        %       F) $
     G)TOTAL REVENUE, INCOME AND CONTRIBUTIONS RECEIVED (ADD D,E, & F)                                100%            G) $
II. SUMMARY OF ALL EXPENDITURES DURING THE YEAR:
     H)    OPERATING CHARITABLE PROGRAM EXPENSE                                                               %       H) $
      I)   EDUCATION PROGRAM SERVICE EXPENSE                                                                  %       I) $
     J)    TOTAL CHARITABLE PROGRAM SERVICE EXPENSE (ADD H & I)                                               %       J) $
     J1)   JOINT COSTS ALLOCATED TO PROGRAM SERVICES (INCLUDED IN J):         $
     K) GRANTS TO OTHER CHARITABLE ORGANIZATIONS                                                              %       K) $
     L) TOTAL CHARITABLE PROGRAM SERVICE EXPENDITURE (ADD J & K)                                              %       L) $
     M) MANAGEMENT AND GENERAL EXPENSE                                                                        %       M) $
     N) FUNDRAISING EXPENSE                                                                                   %       N) $
     O) TOTAL EXPENDITURES THIS PERIOD (ADD L, M, & N)                                                100 %           O) $
III.SUMMARY OF ALL PAID FUNDRAISER AND CONSULTANT ACTIVITIES:
     (Attach Attorney General Report of Individual Fundraising Campaign- Form IFC.  One for each PFR.)
     PROFESSIONAL FUNDRAISERS:
     P) TOTAL AMOUNT RAISED BY PAID PROFESSIONAL FUNDRAISERS                                          100 %           P) $
     Q) TOTAL FUNDRAISERS FEES AND EXPENSES                                                                   %       Q) $
     R) NET RECEIVED BY THE CHARITY (P MINUS Q=R)                                                             %       R) $
     PROFESSIONAL FUNDRAISING CONSULTANTS:
     S) TOTAL AMOUNT PAID TO PROFESSIONAL FUNDRAISING CONSULTANTS                                                     S) $

IV.COMPENSATION TO THE (3) HIGHEST PAID PERSONS DURING THE YEAR:
     T) NAME, TITLE:                                                                                                  T) $
     U) NAME, TITLE:                                                                                                  U) $
     V) NAME, TITLE:                                                                                                  V) $
                                                                                                                      List on back side of instructions
V. CHARITABLE PROGRAM DESCRIPTION:CHARITABLE PROGRAM (3 HIGHEST BY $ EXPENDED) CODE CATEGORIES                            CODE
     W) DESCRIPTION:                                                                                                  W)#
     X) DESCRIPTION:                                                                                                  X) #
     Y) DESCRIPTION:                                                                                                  Y) #

IF THE ANSWER TO ANY OF THE FOLLOWING IS YES, ATTACH A DETAILED EXPLANATION:                            YES NO 

1. WAS THE ORGANIZATION THE SUBJECT OF ANY COURT ACTION, FINE, PENALTY OR JUDGMENT?                 1. 

2. HAS THE ORGANIZATION OR A CURRENT DIRECTOR, TRUSTEE, OFFICER OR EMPLOYEE THEREOF,
   EVER BEEN CONVICTED BY ANY COURT OF ANY MISDEMEANOR INVOLVING THE MISUSE OR
   MISAPPROPRIATION OF FUNDS OR ANY FELONY?                                                        2

3. DID THE ORGANIZATION MAKE A GRANT AWARD OR CONTRIBTION TO ANY ORGANIZATION IN WHICH ANY
   OF ITS OFFICERS, DIRECTORS OR TRUSTEES OWNS AN INTEREST; OR WAS IT A PARTY TO ANY TRANSACTION IN
   WHICH ANY OF ITS OFFICERS, DIRECTORS OR TRUSTEES HAS A MATERIAL FINANCIAL INTEREST; OR DID
   ANY OFFICER, DIRECTOR OR TRUSTEE RECEIVE ANYTHING OF VALUE NOT REPORTED AS COMPENSATION?        3. 

4. HAS THE ORGANIZATION INVESTED IN ANY CORPORATE STOCK IN WHICH ANY OFFICER, DIRECTOR OR
   TRUSTEE OWNS MORE THAN 10% OF THE OUTSTANDING SHARES?                                           4. 

5. IS ANY PROPERTY OF THE ORGANIZATION HELD IN THE NAME OF OR COMMINGLED WITH THE
   PROPERTY OF ANY OTHER PERSON OR ORGANIZATION?                                                     5. 

6. DID THE ORGANIZATION USE THE SERVICES OF A PROFESSIONAL FUNDRAISER? ( ATTACH FORM IFC )         6. 

7a.  DID THE ORGANIZATION ALLOCATE THE COST OF ANY SOLICITATION, MAILING, ADVERTISEMENT OR 
   LITERATURE COSTS BETWEEN PROGRAM SERVICE AND FUNDRAISING EXPENSES?                              7. 

7b.  IF "YES", ENTER (i) THE AGGREGATE AMOUNT OF THESE JOINT COSTS $                ;(ii) THE AMOUNT 
   ALLOCATED TO PROGRAM SERVICES $                     ; (iii) THE AMOUNT ALLOCATED TO MANAGEMENT 
   AND GENERAL $                   ;AND (iv) THE AMOUNT ALLOCATED TO FUNDRAISING $  

8. DID THE ORGANIZATION EXPEND ITS RESTRICTED FUNDS FOR PURPOSES OTHER THAN RESTRICTED
   PURPOSES?                                                                                       8. 

9. HAS THE ORGANIZATION EVER BEEN REFUSED REGISTRATION OR HAD ITS REGISTRATION OR TAX EXEMPTION
   SUSPENDED OR REVOKED BY ANY GOVERNMENTAL AGENCY?                                                9. 

10. WAS THERE OR DO YOU HAVE ANY KNOWLEDGE OF ANY KICKBACK, BRIBE, OR ANY THEFT, DEFALCATION,
   MISAPPROPRIATION, COMMINGLING OR MISUSE OF ORGANIZATIONAL FUNDS?                                10. 

11. LIST THE NAME AND ADDRESS OF THE FINANCIAL INSTITUTIONS WHERE THE ORGANIZATION MAINTAINS ITS
   THREE LARGEST ACCOUNTS:

12. NAME AND TELEPHONE NUMBER OF CONTACT PERSON:

ALL ATTACHMENTS MUST ACCOMPANY THIS REPORT - SEE INSTRUCTIONS 
UNDER PENALTY OF PERJURY, I (WE) THE UNDERSIGNED DECLARE AND CERTIFY THAT I (WE) HAVE EXAMINED THIS ANNUAL REPORT 
AND THE ATTACHED DOCUMENTS, INCLUDING ALL THE SCHEDULES AND STATEMENTS, AND THE FACTS THEREIN STATED ARE 
TRUE AND COMPLETE AND FILED WITH THE ILLINOIS ATTORNEY GENERAL FOR THE PURPOSE OF HAVING THE PEOPLE OF THE 
STATE OF ILLINOIS RELY THEREUPON. I HEREBY FURTHER AUTHORIZE AND AGREE TO SUBMIT MYSELF AND THE REGISTRANT 
HEREBY TO THE JURISDICTION OF THE STATE OF ILLINOIS. 

BE SURE TO INCLUDE ALL FEES DUE:  PRESIDENT or TRUSTEE (PRINT NAME)          SIGNATURE                       DATE 
1.) REPORTS ARE DUE WITHIN SIX 
MONTHS OF YOUR FISCAL YEAR END. 
2.) FOR FEES DUE SEE INSTRUCTIONS.
3.) REPORTS THAT ARE LATE OR      TREASURER or TRUSTEE (PRINT NAME)          SIGNATURE                  DATE 
INCOMPLETE ARE SUBJECT TO A 
$100.00 PENALTY. 
                                      PREPARER (PRINT NAME)                  SIGNATURE                  DATE