Enter Filing Year                                 ANNUAL REPORT 
Secretary of State Office           FOREIGN NONPROFIT  ORPORATIONC
500 E Capitol Ave                                     SDCL 47-27-18, 59-11-24 to 26 
Pierre, SD  57501 
(605) 773-4845
corpinfo@state.sd.us                                  FILING FEE: $10 
                                     Make check payable to SECRETARY OF STATE 

1. Business ID and Name:

Business ID

Business Name
2. The jurisdiction under whose law it is formed

3. The address of the principal executive office (business address).

Actual Street Address                                                        City   State ZIP+4 

Mailing Address, if Different from Street Address                            City   State ZIP+4 

Email Address (Optional) 

4. The South Dakota Registered Agent’s name
South Dakota law permits the registered agent to be either: A) a noncommercial registered agent (this may be an
individual), B) a commercial registered agent, or C) an office holder.  Complete only one below, either (a) or (b) or (c).

(a) The South Dakota Noncommercial Registered Agent’s name:

Actual Street Address in this State                                          City   State ZIP+4 

Mailing Address in this State, if Different from Street Address              City   State ZIP+4 

Email Address (Optional) 

(b) When listing a Commercial Registered Agent, please state their CRA#. This number can be obtained from the
    Commercial Registered Agent.

Commercial Registered Agent Name                                                    CRA# 

(c) Title of the office or other position with the business:
                                                                                           ____________  
Business Office’s Actual Street Address in this State                        City   State ZIP+4 

Mailing Address in this State, if Different from Street Address              City   State ZIP+4 
                                                                                                ______  
Email Address     (Optional) 

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5. The names and addresses of its principal officers and directors (governors).

Principal Officer/Director/Governor Actual Street Address                      City         State ZIP+4 

Principal Officer/Director/Governor Actual Street Address                      City         State ZIP+4 

Principal Officer/Director/Governor Actual Street Address                      City         State ZIP+4 

Principal Officer/Director/Governor Actual Street Address                      City         State ZIP+4 

6. Beneficial Interest (optional) - A beneficial owner is a person who has or in some manner controls an equity security.
Please consult an attorney for legal advice if you have any questions concerning this entry. Any question under this
heading is considered a request for legal advice and the Secretary of State’s office is, by statute, not permitted, to
provide legal advice.

Owner                               Address                                    City         State ZIP+4 

Owner                               Address                                    City         State ZIP+4 

Owner                               Address                                    City         State ZIP+4 

No person may execute this report knowing it is false in any material respect.  Any violation may be subject to a criminal 
penalty (SDCL 22-39-36). 

Dated 
                                                          Signature of an authorized person 

Email 
      (Optional)                                          Printed Name 

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                                                                                            annualreportforeignnonprofit Feb 2018