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FORM NFP 114.05  
DOMESTIC/FOREIGN CORPORATION 
ANNUAL REPORT 
General Not for Profit Corporation Act 
 
Secretary of State 
Department of Business Services 
501 S. Second St., Rm 350 
Springfield, IL 62756 
217-782-7808 
ilsos.gov 
 
Payment must be made by check or money 
order payable to Secretary of State.

Filing Fee: $10 (if late, add $3 penalty fee.)   Year: ______________________ File #:___________________________ Approved: _______________ 
 
Note: A change in the Registered Agent and/or Registered Office may only be effected by filing Form NFP-105.10/105.20. 
   
1.    Corporation Name: ______________________________________________________________________________ 
2.    Registered Agent:        _______________________________________________________________________________  
      Registered Office:       _______________________________________________________________________________                                            
      City, IL, ZIP, County:    ______________________________________________________________________________                                            
3a.   Date of Incorporation/Qualification:_______________________ 3b.    State of Incorporation: ________________________                                 
4.    Names and Addresses of Corporation's Officers and Directors: (for more space, attach a sheet using the same format) 
      a. List Corporate Officers
                  NAME                            TITLE               NUMBER & STREET                                         CITY       STATE     ZIP 
                                                  President 
                                                  Secretary 
                                                  Treasurer 
 
      b. Illinois corporations must list at least three (3) Directors (Officers who also serve as Directors must be listed in a & b
                  NAME                            TITLE               NUMBER & STREET                                         CITY       STATE     ZIP 
                                                  Director 
                                                  Director 
                                                  Director 
 
NOTE:     List all officers and directors above or on an additional sheet. Illinois corporations must have three directors. 
 
5.    Brief statement of type of business the corporation is conducting: 
 
6.    Is this corporation a Condominium Association as established under the Condominium Property Act? (check one) 
      n  Yes                    n     No     
 
      Is this corporation a Cooperative Housing Corporation defined in Section 216 of the Internal Revenue Code of 1954?  
      (check one) 
      n  Yes                    n     No     
      Is this corporation a Homeowner's Association that administers a common-interest community as defined in subsection (c) 
      of Section 9-102 of the Code of Civil Procedure? (check one) 
      n  Yes                    n     No     
 
ITEM 6 MUST BE COMPLETED. Failure to answer any question on this form may result in a late penalty, involuntary dissolution or rev-
ocation. 
 
7.    Address, including street and number, of Corporation's Principal Office: 

      ________________________________________________________________________________________________                                                    
      Number and Street                                                             City                                           State       ZIP Code 
 
Under penalties of perjury and as an authorized officer, I declare that this Annual Report, pursuant to the provisions of the General Not for Profit Cor-
poration Act, has been examined by me and is to the best of my knowledge and belief, true, correct and complete.  
ITEM 8 MUST BE SIGNED. 

8.    BY: __________________________________________________________________________________________  
          Authorized Officer’s Signature                                                                    Title                              Date

                                          Printed by authority of the State of Illinois by union employees. January 2024 — 1 — C 54.27

            NOTICE 
 
Under the General Not For Profit Corporation Act, this Annual Report must be properly executed and filed in the Office of the 
Secretary of State prior to the first day of the corporation’s anniversary month each year. If filed on time, a $10 filing fee only 
is required by statute. If filed later, a statutory $3 penalty fee must be added. 
 
This Annual Report must be properly completed and submitted to the Office of the Secretary of State. 
 
Item 1: In the event of a change of corporate name, the Articles of Amendment (Form NFP 110.30) must be filed. 
 
Item 2: A registered agent and/or registered office may not be changed on an Annual Report. To change the registered agent 
and/or registered office, Form NFP 105.10/105.20 must be filed with the Secretary of State. This form may be downloaded 
at www.cyberdriveillinois.com (click Departments, Business Services, Publications and Forms). 
 
• The information requested must be given as the date of the execution of this report. 
 
• This report must be signed by an authorized officer of the corporation. 
 
• If this report is not filed, the corporation, if domestic, is subject to dissolution, or if foreign, is subject to having the authority 
 revoked. 
 
DEFINITIONS 
• “Anniversary” means the day each year exactly one year or more years after: 
 (1) the date on the Articles of Incorporation issued under Section 102.15 of this Act, if a domestic corporation. 
 (2) the date on the Application for Authority issued under Section 113.20 of the Act, if a foreign corporation. 
 
• “Anniversary month” means the month in which the anniversary of the corporation occurs.