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:
      NAME                OFFICE                  NUMBER & STREET       CITY                                           STATE ZIP
                          President
                          Secretary
                          Treasurer
                          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)

                                                        NOTICE

Under the General Not For Profit CorporationAct, 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. .ilsosgov (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.