Mail to: 
Pennsylvania Department of State                                   Charitable Organization 
Bureau of Corporations and Charitable Organizations 
                                                                   Registration Statement 
401 North St Rm 207                                                BCO-10 (rev. 11/2023) 
Harrisburg, PA 17120 
                                                                                Fee:  See instructions 
See www.dos.pa.gov/charities  for more information 

                                 Read all instructions prior to completing form. 

Certificate number: ________________________
                      (N/A if initial registration) If this is a voluntary registration, check and complete the 
                                                    applicable box(es). For a registration to be voluntary, at 
                                                    least one of the following must apply: 
Fiscal year ended: _______/________/_________         Organization is exempt from registration because  
                 MM           DD      YYYY
                                                      ___________________________________________ 
                                                      Organization does not solicit contributions in 
FEIN:         ̶  
                                                                   Pennsylvania 

1.     Legal name of organization:  ________________________________________________________
          Check if name change and give previous name ________________________________________

2.     All other names used to solicit contributions:  ___________________________________________ 
       ________________________________________________________________________________
       ________________________________________________________________________________

3.     Contact person: ___________________________ Contact’s e-mail: ________________________

4.     Principal address of organization:                          Mailing address (if different than principal address):     
       _______________________________________  _______________________________________ 
       _______________________________________  _______________________________________ 
       _______________________________________  _______________________________________       

       County: ________________________________     Phone number: __________________________
       800 number: ____________________________                    Fax number: ____________________________ 
       Email (if different than Contact’s email): ______________________________________________            
       Website: ________________________________________________________________________ 

                           Item 5 to be completed by initial registrants only 

5.     Type of organization (e.g. non-profit corporation, unincorporated association, etc.):

       ________________________________________________________________________________
       Where established: ________________________  Date established:* _______________________

       *Initial registrants must submit copies of organizational documents such as charter, articles of incorporation,
       constitution or other organizational instrument and by-laws.

Page 1 of 6                                                                        Form BCO-10 (rev. 11/2023) 

6. Name and addresses of all offices, chapters, branches, auxiliaries, affiliates or other subordinate
   units located in Pennsylvania, which share in the contributions or other revenue raised in the
   Commonwealth: (Attach a separate sheet if necessary)
      Not Applicable
   ________________________________________________________________________________
   ________________________________________________________________________________
   ________________________________________________________________________________

7. Short form registration applicability – Specified types of charitable organizations described in
   §162.7(a) of the Act may file a short form registration, which permits the organization to register
   without filing a financial report. Check the section that describes the organization. If the
   organization does not meet any of the criteria below for short form registration, check “Not
   Applicable”:

      §162.7(a)(1) – Persons or organizations which solicit contributions for the relief of a specific individual, when 
    all of the contributions collected are turned over to the named beneficiary for his/her use without any deductions 
    and provided that all contributions collected shall be held in trust 

      §162.7(a)(2) – Organizations which only solicit within the membership of the organization by other members of 
    the organization. The term “membership” shall not include those persons who are granted a membership solely 
    upon making a contribution as the result of solicitation. “Member” means a person having membership in a 
    nonprofit corporation, or other organization, in accordance with the provisions of its articles of incorporation, 
    bylaws or other instruments creating its form and organization and having bona fide rights and privileges in the 
    organization such as the right to vote, to elect officers and directors, to hold office or position as ordinarily 
    conferred on members of such organizations. 

      §162.7(a)(3) – Organizations which receive gross contributions of no more than $25,000 per fiscal year whose 
    fundraising activities are carried on only by volunteers, members, officers or permanent employees and only 
    permanent employees are compensated for those fundraising activities 

      §162.7(a)(4) – Veterans organizations chartered under Federal law, organizations of volunteer firemen, 
    ambulance associations, rescue squad associations and their auxiliaries or affiliates, which are not exempt from 
    registration, did not receive gross contributions in excess of $100,000 and did not use a professional solicitor. 

      Not Applicable 

   Charitable organizations which check boxes §162.7(a)(1) – §162.7(a)(4) are not required to file 
   a financial report with this registration. If “Not Applicable” is checked, the charitable 
   organization must submit financial reports which are audited, reviewed, compiled or internally 
   prepared. See Instructions. 

            Items 8 and 9 are required to be completed by initial registrants only 

8. Date organization first solicited contributions from Pennsylvania residents: ______/______/______
                                                                         MM           DD            YYYY 
   Other ________________________________________________________

9.  If organization solicited Pennsylvania residents and received gross* contributions totaling more
   than $25,000 in any given fiscal year, provide the date the organization first received contributions
   totaling more than $25,000.                                                  ______/______/______  
                                                                           MM                DD           YYYY 
   Other _________________________________________________________ 
    *Includes contributions received both within and outside Pennsylvania before any deductions or expenses.

Page 2 of 6                                                              Form BCO-10 (rev. 11/2023) 

10.  Has the organization been granted IRS tax-exempt status?     Yes        No  
 
        A. If “Yes,” under which IRS code section: ________________________________ and attach                                a 
            copy of the IRS exemption letter if not previously submitted. 
             
        B.  Has the organization’s tax-exempt status ever been denied, revoked or modified?   Yes     No 
            (If “Yes,” attach a copy of the denial, revocation or modification and subsequent reinstatement, if any, and if not 
            previously submitted.) 
 
11.  Was the organization required to file any type of IRS 990 return, including 990, 990EZ, 990PF 
        or 990N and applicable schedules, for its most recently completed fiscal year?    Yes       No
 
        (If “Yes,” attach a copy of the most recently filed 990, 990EZ, 990PF or 990N and include all schedules.  
        If “No,” attach an explanation of why the organization is exempt from filing an IRS 990 return. An organization 
        that is not required to file an IRS 990 return or an organization that files a 990N, 990EZ or 990PF, must file a 
        Pennsylvania public disclosure form (BCO-23).)  
 
12.   Manner in which contributions are solicited (e.g. direct mail, telephone, internet, social media, 
        etc.):           Does not solicit contributions 
        _____________________________________________________________________________ 
        _____________________________________________________________________________ 
 
13.  A clear description of the specific programs for which contributions are used or will be used, 
        and a statement describing whether such programs are planned or in existence. 
        _____________________________________________________________________________ 
        _____________________________________________________________________________ 
        _____________________________________________________________________________ 
        _____________________________________________________________________________ 
         
14.   Is the organization registered to solicit contributions in any other state or municipality? 
            Yes        No          (If “Yes,” list all states and municipalities.  Attach a separate sheet if necessary.)   
        _____________________________________________________________________________ 
        _____________________________________________________________________________ 
        
15.  Is any person compensated, or does the organization intend to compensate any person, who solicits 
        contributions in Pennsylvania, including, but not limited to, employees of the organization and 
        professional solicitors? (Do not check “Yes” if the organizations only uses or intend to only use a professional 
        fundraising counsel.)        Yes        No     
 
        If “Yes,” give the date the person or entity started or will start soliciting contributions from 
        Pennsylvania residents: ________/________/___________  
                                                Month     Day                Year 
        
16.  Names, addresses, and telephone numbers of all professional solicitors the organization uses or 
        intends to use to solicit contributions from Pennsylvania residents. For each entry, include the 
        beginning and ending dates of all contracts and dates Pennsylvania residents were first solicited, 
        or will be solicited: (Attach a separate sheet if necessary) 
           Not Applicable  
        _____________________________________________________________________________ 
        _____________________________________________________________________________ 

Page 3 of 6                                                                                            Form BCO-10 (rev. 11/2023) 

17.  Names, addresses, and telephone numbers of all professional fundraising counsel the 
   organizations uses or intends to use to provide services with respect to the solicitation of 
   contributions from Pennsylvania residents. For each entry, include the beginning and ending 
   dates of all contracts and dates services began, or will begin, with respect to soliciting 
   contributions from Pennsylvania residents: (Attach a separate sheet if necessary) 
      Not Applicable  
   _____________________________________________________________________________ 
   _____________________________________________________________________________ 
 
18.  Names, addresses, and telephone numbers of any commercial coventurers under contract with 
   the organization: (Attach a separate sheet if necessary) 
      Not Applicable  
   _____________________________________________________________________________ 
   _____________________________________________________________________________ 

19.  If the registering charity is a parent organization located in Pennsylvania, does the organization 
   elect to file a combined registration covering all of its Pennsylvania affiliates?              (See note “Affiliate 
   and Parent Organization”)       Yes       No            Not Applicable  
 
   If “Yes,” give all names and certificate numbers of the affiliate organizations:   
   (Each affiliate whose parent organization files an IRS 990 group return must submit a copy of the parent 
   organization’s 990 group return and file a public disclosure form (BCO-23) for each affiliate.) 
   _____________________________________________________________________________ 
   _____________________________________________________________________________ 
   _____________________________________________________________________________ 
 
20.  Is the registering charity a Pennsylvania affiliate of a parent organization, which elected to file a 
   combined registration on the registering charity’s behalf?  (See note “Affiliate and Parent Organization”) 
    Yes       No            NotApplicable 
 
   If “Yes,” provide the name and, if available, certificate number of the parent organization.   
   (Each affiliate whose parent organization files an IRS 990 group return must submit a copy of the parent 
   organization’s 990 group return and file a public disclosure form (BCO-23) for each affiliate.) 
 
   ____________________________________          ___________________________________ 
   Legal name of parent organization                         Pennsylvania certificate number 
 
21.  Provide the names and addresses of all officers, directors, trustees and principal salaried executive 
   staff officers.  (Attach separate sheet if necessary. A reference to the 990 or the BCO-23 is not sufficient.) 
   _____________________________________________________________________________ 
   _____________________________________________________________________________ 
   _____________________________________________________________________________ 
   _____________________________________________________________________________ 
 
Page 4 of 6                                                                          Form BCO-10 (rev. 11/2023) 

22.   Names of the individuals or officers of the organization who: (Attach a separate sheet if necessary) 
 
    A.  Are in charge of solicitation activities: 
     __________________________________________________________________________ 
     __________________________________________________________________________ 
    B.  Have final responsibility for the custody of contributions:   
     __________________________________________________________________________ 
     __________________________________________________________________________ 
    C.  Have final responsibility for final distribution of contributions:   
     __________________________________________________________________________ 
     __________________________________________________________________________ 
    D.  Are responsible for custody of financial records:   
     __________________________________________________________________________ 
     __________________________________________________________________________ 
 
23.  Are any officers, directors, trustees, or employees related by blood, marriage, or adoption to: 
 
    A.   Any other officer, director, trustee, or employee?   Yes        No          
     
    B.    Any officer, agent, or employee of any professional fundraising counsel or solicitor under 
         contract with organization? **   Yes        No          
     
    C.    Any officers, agents or employees of any supplier or vendor providing goods or services? **  
          Yes       No           
          
         **(this includes any officer, director, trustee, or  employee of the charitable organization who is also an officer, 
         director, trustee, employee or owner of a professional fundraising counsel, professional solicitor, supplier or 
         vendor) 
     
         If “Yes” is checked to any of the above, attach a list of related individuals including names, 
         business, and residence addresses of related parties. 
 
24.   Has the organization or any of its present officers, directors, executive personnel or trustees ever: 
 
    A.  Been found  to have  engaged in unlawful practices in the solicitation of contributions or 
     administration of charitable assets or been enjoined from soliciting contributions or currently 
     has such proceedings pending in this or any other jurisdiction?    Yes        No          
     
    B.  Had its registration or license to solicit contributions denied, suspended, or revoked by any 
     governmental agency?    Yes        No          
     
    C.  Entered into any legally enforceable agreement (such as a consent agreement, an assurance of 
     voluntary compliance or discontinuance or any similar agreement) with any district attorney, 
     Office of Attorney General, or other local or state governmental agency?     Yes        No          
     
     (If “Yes” is checked in response to any of the above, attach a written explanation, including 
     the reasons for actions, and copies of all relevant documents.) 
                                    
Page 5 of 6                                                                            Form BCO-10 (rev. 11/2023) 

   Certification  –  This registration statement  must be signed by two different officers of the 
   organization, one of whom shall be the chief fiscal officer or the equivalent. 
    
        I certify that the information provided in this registration, including all statements 
        and attached documentation, is true and  correct  to the best of my knowledge, 
        information and belief. I understand that the falsification of any statement or 
        documentation  made is subject to the penalties of 18 Pa.C.S. §4904 (relating to 
        unsworn falsification to authorities) and 10 P.S. §162.17 (relating to administrative 
        enforcement and penalties). 
    
   __________________________________________                __________________________________________ 
   Signature of Chief Fiscal Officer                         Date 
       
   __________________________________________                 
   Type or print name and title of Chief Fiscal Officer 
    
   __________________________________________                __________________________________________ 
   Signature of Other Authorized Officer                     Date 
    
   __________________________________________ 
   Type or print name and title of Other Authorized Officer 
    
       Checklist for registration: 
   
         Completed registration statement properly signed and dated. 
         A copy of the IRS 990/990EZ/990PF/990N Return and required schedules, 
        signed and dated by an authorized officer                                                                                    
 
         Public Disclosure Form BCO-23 (if required)                                              
 
         Applicable Financial Statements (audited, reviewed, compiled or internally 
        prepared) 
         Registration fee and any late filing fees 
 
         Initial Registrants Only:  IRS determination letter, articles of incorporation or 
 
        charter and by-laws. 
 
       See Instructions for more information on completing this form and attachments. 
 
Page 6 of 6                                                                       Form BCO-10 (rev. 11/2023)