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                                                 Chapter 202, Wis. Stats.         STATE OF WISCONSIN                                Division of Corporate and 
                                                 Subchapter II                    Department of Financial Institutions              Consumer Services,  
                                                                                                                                    Charities Section 

                                                                                                                                    Mailing Address: 
                                                     E-Mail:                                                                        PO Box 7879 
                                              DFICharitableOrgs@dfi.wisconsin.gov 
                                                                                                                                    Madison, WI 53707-7879 

                                                Telephone: (608) 267-1711         WEBSITE:  DFI.WI.GOV 
                                                                                                    #1952                           Courier Address: 
                       Please - Do Not Staple                                                                                       4822 Madison Yards Way 
                                                 Fax: (608) 267-6813 
                                                                                  FINANCIAL REPORT                                      North Tower 
                                                                                                                                    Madison, WI 53705 

                                                                                  WHO SHOULD FILE 

•                                             A charitable organization registered to solicit contributions in Wisconsin must file an annual report with the Department
                                              of Financial Institutions – Division of Corporate and Consumer Services.

•                                             A charitable organization should use the form 1952 if:

                                              o  The organization received more than $25,000 in contributions or more than $50,000 in contributions from the
                                                 county their principle office is located in.
                                                 AND
                                              o  The organization files an IRS 990, 990EZ or 990-PF. The 990N is not acceptable.

•                                             If the organization does not meet the above criteria please use form 1943 or form 308.

•                                             Please refer to the definitions set forth in Wis. Stat. §. 202.12 when completing registration and report forms.

                                                                                  WHEN TO FILE 

•                                             An annual financial report must be filed with the division within 12 months after the organization’s fiscal year-end.

                                                                                  WHAT TO INCLUDE 

                                                Form 1952 – Supplement to Financial Report. 

                                                IRS 990, 990EZ or 990-PF plus all schedules (except B) and attachments. 

                                                An attachment for each question on the form 1952 answered “Yes”. 

                                                A full list of the organization’s board of directors, officers, trustees and any principal salaried employees. Please 
                                                include the individual’s name, address and title. 

                                                A list of states that have issued a license, registration, permit or other formal authorization to the organization to 
                                                solicit contributions. 
If applicable: 
                                                An audited financial statement conducted according to Generally Accepted Accounting Principles for an 
                                                organization that has received $500,000 or more in contribution during its fiscal year. 
                                              OR 
                                                A reviewed or audited financial statement conducted according to Generally Accepted Accounting Principles 
                                                for an organization which has received $300,000 - $499,999 in contributions during the fiscal year 

  CRED1952 (Revised November 2022)                                                                                                      Page  1of  5

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                                                 #1952                                                      Email: 
                                                                                          DFICharitableOrgs@dfi.wisconsin.gov 
                                               FINANCIAL REPORT                               Mailing Address: 
                                                                                              PO Box 7879 
                                                                                              Madison, WI 53707-7879 
                                                                                                                  
                              ORGANIZATION INFORMATION - SECTION A 

1. Name of charitable organization and any trade names or DBA (doing business as) names the organization
   uses.

                                                                                                               -   800
2. WI Charitable Organization Number:

3. Federal Employer Identification Number:

4. Provide the name and contact information of the individual the Department should contact about this form:
First Name:                           Last Name: 

Street Address:                       City:                                                   State: 

Zip Code:              Phone:         Email: 

5. Did your organization use a professional fundraiser or fundraising                         Yes                 No
   counsel during the fiscal year in Wisconsin?

   If YES, provide contact information for each fundraiser(s), fund raising counsel(s), or person. Attach additional
   pages, if necessary.

Name:                                                                         Fundraiser: Fundraising Counsel: 

Street Address:                                  City:                                        State: 

Zip:        Telephone Number: Does this fundraiser/fundraising counsel/person have custody of contributions at any 
                              time:            Yes                  No        

6. Has any of the information your organization previously submitted to                       Yes                 No 
   the division changed? (i.e. name of the organization, address of the
   principal office, address of any Wisconsin branch officers, accounting period,
   articles, by-laws, etc.)
If YES, attach an explanation and a copy of the amended document.

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FINANCIAL INFORMATION - SECTION B

7. Organization’s Fiscal Year End Date (month, day,
and year). Enter the accounting period for the mm dd yyyy
following financial information.

1. Contributions ........................................................................................................................................................
1
("Contribution" means a grant or pledge of money, credit, property, or other thing of any kind or value, except
used clothing or household goods, to a charitable organization or for a charitable purpose. Bequests received
directly from the public and indirect public support, such as contributions received through solicitation campaigns
conducted by federated fundraising agencies like United Way should be included in this amount. "Contribution"
does not include:
• Income from bingo or raffles conducted under ch. 563, Wis. Stats.
• Government grants
• Bona fide fees, dues, or assessments paid by a member of a charitable organization, except that, if
initial membership in a charitable organization is conferred solely as consideration for making a grant
or pledge of money to the charitable organization in response to a solicitation, that grant or pledge of
money is a contribution.)

2. Other Revenues .................................................................................................................................................... 2

3. Total Revenue (line 1 plus line 2) ......................................................................................................................... 3 0

4. Expenses:

a. Expenses Allocated to Program Services ................................................. 4a

b. Expenses Allocated to Management and General ..................................... 4b

c. Expenses Allocated to Fundraising ........................................................... 4c

d. Expenses Allocated to Payments to Affiliates .......................................... 4d

e. Total Expenses ............................................................................................................................................. 4e 0

5. Excess or Deficit (line 3 minus line 4e) ................................................................................................................ 5 0

6. Net Assets at Beginning of Year .......................................................................................................................... 6

7. Other Changes in Net Assets or Fund Balances (See 990, part XI) ....................................................................... 7

8. Net Assets at End of Year .................................................................................................................................... 8 0

CRED1952 (Revised November 2022) Page 3of 5

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ATTACHMENTS

Check the box next to the items that are attached to your annual report. Items A., B., and C. are required. Item D. or E.
(or Waiver Application of D. or E.) is required if the contributions received by your organization fall into the described
ranges. (Note: If you are submitting this form with your initial application, DO NOT submit the following attachments.
Submit the attachments cited in the application form instead).

A. List of all officers, directors, trustees, and principal salaried employees – The list must include each
individual’s name, address, and title. Please note that “principal salaried employees” refers to the chief
administrative officers of your organization, but does not include the heads of separate departments or
R smaller units within the organization. (You can disregard this item if you are attaching an IRS 990 that
E already includes the requested information.)
Q
U
I B. A list of states that have issued a license, registration, permit, or other formal authorization to the
R organization to solicit contributions. (You can disregard this item if you are attaching an IRS 990 that
E already includes the requested information.)
D
C. IRS Form #990, 990EZ, or 990-PF Do. not include Schedule B of the 990.
(Note: If you file an IRS Form 990-N, you cannot use this form. You must complete a Form #308 or
Form #1943 instead.)

C
H D. Audited Financial Statements if the organization received contributions in excess of $500,000 during
E
C its fiscal year. The financial statements must be prepared in accordance with generally accepted
K accounting principles and be accompanied by the opinion of an independent certified public accountant.
OR
O Apply for Waiver of “D. Audited Financial Statements” if (1.) the organization’s contributions were,
N
E during each of the past 3 fiscal years, less than $100,000; and (2.) during the fiscal year for which
the waiver is being requested, the organization received one or more contributions from one contributor
I that exceeded $400,000. Include waiver form 1953.
F

A E. Reviewed Financial Statements if the organization received contributions in excess of $300,000, but
P not more than $500,000 during its fiscal year. The financial statements must be prepared in accordance
P with generally accepted accounting principles by an independent certified public accountant. Audited
L financial statements are also acceptable.
I
C OR
A Apply for Waiver of “E. Reviewed Financial Statements” if (1.) the organization’s contributions
B were, during each of the past 3 fiscal years, less than $100,000; and (2.) during the fiscal year for which
L the waiver is being requested, the organization received one or more contributions from one
E
contributor that exceeded $200,000. Include waiver form 1953.

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                                             CERTIFICATION - SECTION C 
  
 This document  MUST be  signed by the chief fiscal  officer and another officer.  Two  different  officer 
 signatures required. Completion of this form is required under Section 202.12, Wisconsin Statutes. 
           
          We, the undersigned, state and acknowledge that we are duly constituted officers of this 

          organization, and that, under penalties of perjury, we have reviewed this report, including 

          all attachments, and to the best of our knowledge and belief, they are true, correct and 

          complete in accordance with the laws of the State of Wisconsin applicable to this report. 
           
           Name (Print) 
   
           Signature of Officer 
   
           Date 
   
                                             AND 

           Name (Print) 
  
           Signature of Chief Fiscal Officer 

           Date 

  RETURN MATERIALS TO: 
  
 Department of Financial Institutions 
 Division of Corporate and Consumer Services 
  
 Mailing Address:  
 WDFI/ Charitable Orgs Section 
 PO Box 7879 
 Madison, Wisconsin 53707-7879 
  
 E-Mail: DFICharitableOrgs@dfi.wisconsin.gov 
  
 This form is required under Section 202.12, Wisconsin Statutes.  Refusal to provide this information may result in the denial of 
 this registration application.  Personally identifiable information on this form may be matched against tax information, outstanding 
 child and family support data and law enforcement agencies.  Failure to complete this application completely and accurately may 
 result in denial or revocation of registration, and any other penalties as provided by law.   
  
 This document can be made available in alternate formats upon request to qualifying individuals with disabilities. 
                    
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 CRED1952 (Revised November 2022)                                                                                   Page  5of  5

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