Print Reset Form For Accounting Periods Charitable Activities Section Beginning in: Oregon Department of Justice 100 SW Market Street VOICE (971) 673-1880 CT-12S Portland, OR 97201-5702 TTY (800) 735-2900 For Split-Interest Trusts Email: charitable@doj.state.or.us FAX (971) 673-1882 Website: https://www.doj.state.or.us Line-by-line instructions for completing the annual 2021 report form can be found on our website. Section I. General Information 1. Cross Through Incorrect Items and Correct Here: (See instructions for change of name or accounting period.) Registration #: Organization Name: Address: City, State, Zip: Phone: Fax: Amended Email: Report? Period Beginning: / / Period Ending: / / 2. Has the trust or any of its officers, directors, trustees, or key employees ever signed a voluntary agreement with any government agency or been a party to legal action in any court or administrative agency regarding charitable solicitation, administration, management, or fiduciary practices? If yes, attach explanation of each such agreement or action. See Yes No instructions. 3. During this reporting period, did the trust amend any trust documents OR did the trust receive a determination or ruling from the Internal Revenue Service relating to its status? If yes, attach a copy of the amended document or IRS communication. Yes No 4. Is the trust ceasing operations and is this the final report? (If yes, see instructions on how to close your registration.) Yes No 5. Provide contact information for the person responsible for retaining the trust’s records. Name Position Phone Mailing Address & Email Address 6. List of Officers, Directors, Trustees and Key Employees – List each person who held one of these positions at any time during the year even if they did not receive compensation. Attach additional sheets if necessary. If an attached IRS form includes substantially the same compensation information, the phrase “See IRS Form” may be entered in lieu of completing this section. (A) Name, mailing address, daytime phone number (B) Title & (C) and email address average Compensation weekly hours (enter $0 if devoted to position unpaid) position Name: _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ Address: _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ Phone: (_ _ _)_ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ Email: Name: _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ Address: _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ Phone: (_ _ _)_ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ Email: Name: _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ Address: _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ Phone: (_ _ _)_ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ Email: Form Continued on Reverse Side |
Section II. Fee Calculation 7. Charitable Distribution .............................................................................................................. 7. (If no charitable distributions were made during the report year write $0. Otherwise, write the total of Part III, Lines 2 a, b and c, plus Line 3, plus Line 9 from Form 5227, or the total of Line 18 plus Line 24 from Form 1041-A) 8. Charitable Distribution Fee ..................................................................................................................................................... 8. (See chart below. Minimum fee is $20.) Amount on Line 8 Charitable Distribution Fee $0 - $24,999 $20 $25,000 - $49,999 $50 $50,000 - $99,999 $90 $100,000 - $249,999 $150 $250,000 - $499,999 $200 $500,000 - $999,999 $300 $1,000,000 or more $400 9. Net Assets at the End of the Reporting Period .......................................................................... 9. (Part IV, Line 22b on Form 5227 or Line 45b on Form 1041-A) 10. Net Assets Fee ....................................................................................................................................................................... 10. (Line 9 multiplied by .0001. If the fee is less than $5, write $0. Not to exceed $2,000. Round cents to the nearest whole dollar.) Are you filing this report late? Yes No ................................................................................................................. 11. (If yes, the late fee is a minimum of $20. You may owe more depending on how late the report is. See Instruction 11 for additional information or contact the 11. Charitable Activities Section at (971) 673-1880 to obtain late fee amount.) 12. Total Amount Due .................................................................................................................................................................. 12. (Add Lines 8, 10, and 11. Make check payable to the Oregon Department of Justice.) 13. Attach a copy of the trust’s federal returns and all supporting schedules and attachments. Under penalties of perjury, I declare that I have examined this return, including all accompanying forms, schedules, and attachments, Please and to the best of my knowledge and belief, it is true, correct, and complete. Sign ⇒ Here _______________________________________ _____________________ _________________________ Signature of officer Date Title _______________________________________ _______________________________________________________ Officer’s name (printed) Address _______________________________________________________ Phone Paid Preparer’s ⇒ Use Only _______________________________________ _____________________ _________________________ Preparer’s signature Date Phone _______________________________________ _______________________________________________________ Preparer’s name (printed) Address Line-by-line instructions for completing the annual report form can be found at https://www.doj.state.or.us/charitable- activities/annual-reporting-for-charities/file-your-annual-report. If you click the appropriate link for this year’s form, the instructions are included in that document. If you would like us to send a copy of the instructions, please call us at 971-673- 1880 or send an email to charitable@doj.state.or.us. |
Charitable Activities Section, Oregon Department of Justice 2021 Form CT-12S Instructions organization’s fiscal year. If the due date falls on a weekend or legal holiday, the due date is the Important Note—An extension request filed General next business day. with the IRS or the Oregon Department of Revenue does NOT act as an extension with Instructions The Charitable Activities Section does not use the Charitable Activities Section unless a copy the postmark date to determine whether an is submitted to the Charitable Activities organization has filed timely. Instead, filings are Section by the due date. Purpose considered timely if they are physically received Oregon law charges the Attorney General with within 5 business days after the due date. All the duty and responsibility to represent the filings received more than 5 business days after Record Keeping public’s interest in charitable organizations and the due date will be assessed a late charge. See Please retain a copy of this report and all in assets held or received for charitable purposes. Instruction 11 Late Fees. supporting documentation for at least five years The Attorney General carries out this after the due date. responsibility by requiring charitable organizations to register and file periodic Extensions for Filing financial reports. A trust may apply for an extension of time to Rounding and Blank Lines file. Extension requests must be received on or Round all amounts on the report to the nearest Once submitted, this Form and all attachments before the due date of the report to avoid a late whole dollar. Drop amounts under 50 cents and become a part of the public record excluding fee. The maximum available extension period is increase amounts from 50 to 99 cents to the next social security numbers and similar confidential 180 days. An extension to file is also an whole dollar. If the amount is zero write “$0.” information. Any interested person may examine extension to pay any associated fees. Therefore, or obtain a copy of an annual report of a estimated payments should not be included with Do not leave any line blank. Your report may charitable organization by contacting the extension requests. be treated as incomplete if you leave blank lines. Charitable Activities Section. Please do not submit an incomplete CT-12/CT- 12F/CT-12S if you intend to later supplement or Important Reminders amend your report with a copy of your IRS Important information regarding Social Who Must File return. Instead, file an extension request so that Security numbers (SSNs) –Forms submitted All organizations registered with the Charitable you can submit a complete report by the to this office become a public record. To Activities Section of the Oregon Department of extended due date with a copy of the appropriate protect the privacy of named individuals, you Justice must annually file Form CT-12, CT-12F, IRS form attached. should redact any SSNs (if used) from copies or CT-12S unless the Attorney General has of any IRS forms submitted. Although we specifically exempted the organization from the Extensions may be requested through the endeavor to redact SSNs from any forms we reporting requirements. Department of Justice website at receive, we request your assistance in https://justice.oregon.gov/Charities/Extensions. safeguarding this information by not Follow the instructions carefully to ensure that including it in your submission. What Form to File we receive your request. Please contact our File Form CT-12 if the organization is either office if you have any questions or difficulties incorporated, organized, or headquartered in with your online request. How to Contact the Oregon. Charitable Activities You should print and retain a copy of the online File Form CT-12F if the organization is Confirmation of Extension Request. You should Section organized and headquartered outside of Oregon. also expect to receive a confirmation of receipt To obtain blank forms, mailed instructions, The Charitable Activities Section does not of your online request. technical assistance or information about a accept multi-state annual report forms in lieu of charitable organization, contact the Charitable a completed Form CT-12F. You may also submit a written request or a copy Activities Section or visit our website at: of the trust’s federal extension request (IRS File Form CT-12S if the organization is a split- Form 8868) so long as the Charitable Charitable Activities Section interest trust that holds assets for the benefit of Activities Section receives the request or copy Oregon Department of Justice both charitable and non-charitable beneficiaries. before the due date of the report. The trust’s 100 SW Market Street 4 or 5-digit registration number should be noted Portland, OR 97201-5702 If the organization does not fit within any of the on the top of all extension requests. If you Phone: (971)673-1880 above categories, file Form CT-12. would like acknowledgement that your extension TTY: (800)735-2900 request has been received, you should enclose an Fax: (971)673-1882 The form year should match the starting year additional copy of the request and a self- Email: charitable@doj.state.or.us of the fiscal period covered by the report. addressed, stamped envelope. Website: https://www.doj.state.or.us In the event your request is denied, to avoid a Due Date late fee, the annual report must be submitted by Where to File The form, all required attachments and the later of the due date or within 10 days after Send completed forms and corresponding fees to schedules, and payment of fees are due in the the trust receives notice of denial of the the above address. Do not send cash. The Charitable Activities Section’s office no later requested extension. Charitable Activities Section does not accept than 4 months and 15 days after the end of the |
CT-12S reports via electronic submission at this agency, such as a state attorney general, A failure to fully complete this part can subject time. secretary of state, or local district attorney, or the trust to late fees or civil penalties for filing been a party to legal action in any court or an incomplete form. administrative agency regarding charitable solicitation, administration, management, or Officers include those officers required by Line Instructions fiduciary practices. This includes assurances of applicable state law, such as president, secretary, voluntary compliance or discontinuance or treasurer, and also includes the person(s) involving the trust or any other proceeding in elected or appointed to implement the decisions Section I. which the trust or any current officer, director, of the governing body or for supervising the trustee, or key employee is subject to any management, administration, or operation of the injunction, order, or pending action relating to organization, regardless of title or the amount of General Information the solicitation of contributions, or compensation received. The CEO or Executive administration of charitable assets. Attach a Director is an officer for purposes of this form. written explanation of each such action or The top financial official may also be an officer 1. Missing or Incorrect agreement, including the agency involved and if they are responsible for managing the the allegations. Also, attach a copy of any organization’s finances. Information agreements or actions that occurred in the The Charitable Activities Section sends a form current reporting period. Column (C) preprinted with name, address contact information and registration number to all If an IRS form is attached that includes complete registered trusts. If the organization is returning Amendments to Trust and accurate compensation information, the one of these preprinted forms, provide the 3. phrase “See IRS Form” may be entered in lieu of requested information in this section. Documents completing this section. Check yes if during the reporting period the trust Name Changes amended the documents that created the trust or Otherwise, for each person listed, report the total if the trust received a determination or ruling amount of compensation paid or deferred for If applicable, write the trust’s new legal name. from the IRS relating to its status. payment to a later date, including salary, fees, Attach a copy of the trust document that changed bonuses, benefits, taxable allowances or the trust’s name. Important Note —Attach signed and dated reimbursements, the value of noncash copies of amended trust documents and/or IRS compensation, and severance payments. Address, Email, and Phone communication. Number Changes Enter a zero in column (C) if the person was a volunteer and was not paid or did not accrue any If applicable, write the new address where mail Final Report compensation during the reporting year. for the trust should be directed in the future. If 4. applicable, write the new daytime phone Check yes if this is the final report for the trust. number, fax number and email address for the The trust should contact the Charitable Activities The trust may provide an attachment to explain trust. Section for specific instructions and the entire compensation package for any person requirements relating to closing procedures. listed in this part, including whether the compensation includes the payment of amounts Accounting Year Changes A final report must reflect the financial previously deferred. If applicable, write the trust’s new or short transactions of the trust from the day after the reporting period. Preprinted forms are based close of its last accounting period to the date of upon the accounting period we have on record the disposition of all remaining assets. for the trust. If the trust has changed its fiscal year or is filing a final report for a period less Section II. than 12 months, the shortened period covered by 5. Who Keeps the Books? the report must be noted here. If the trust is Indicate the person to be contacted if the trust's filing a final report, see the instructions for line 5 books need to be accessed for information or Fee Calculation for closing requirements. review. Either a business or personal phone number email, and mailing address are Short Year Report—If the trust is filing a acceptable. If the person does not have an email 7. Charitable Distribution shortened report due to a change in fiscal year, address, please note that on the form. The charitable distribution represents the total see the instructions for line 9 for calculation of amount paid to charitable organizations. For prorated Net Assets fee. Charitable Remainder trusts there will generally 6. Officers, Directors, be no charitable distributions until the final year when the trust terminates. If no charitable Amended Reports Trustees, and Other Key distributions were made during the report year, If amending previously submitted information Employees enter zero on line 8. Otherwise, if IRS Form for the same accounting period, check the 5227 was filed, add the amounts on Part III, amended report box. Either complete a blank List each person who was an officer, director, form that includes the amended information or trustee, or key employee (defined below) of the Lines 2 a, b and c, plus Line 3, plus Line 9. If provide a copy of the previously submitted form trust at any time during the year even if they are IRS Form 1041-A was filed, add the amounts on that clearly shows what information is being a volunteer and do not receive any compensation lines 18 and 24. amended. Submit any additional fee due with the from the organization. Give the daytime phone amended report. number and preferred mailing address at which officers, etc., want the Charitable Activities Section to contact them. Use an attachment if 2. Disclosure of Legal Action 8. Charitable Distribution Fee there are more persons to list than there are lines available. Use the charitable distribution figure from line 8 Check yes if the trust or any of its officers, to calculate the charitable distribution fee directors, trustees or key employees ever signed according to the following schedule. a voluntary agreement with any government |
Charitable Distribution Fee Schedule covered by the short report. No similar proration should be made if the short report is due to the Important Note—Indicate on the check the Charitable initial or final reporting period. trust’s 4 or 5-digit Oregon Department of Justice Amount on Line 8 Distribution Fee $ 0 - $ 24,999 $ 20 registration number. The registration number is 25,000 - 49,999 50 located on line 1 of the preprinted Form CT-12S 50,000 - 99,999 90 11. Late Fees or can be obtained by contacting the Charitable 100,000 - 249,999 150 If the report is not filed or the fee is not paid by Activities Section. 250,000 - 499,999 200 the due date (or the extended due date), an initial 500,000 - 999,999 300 1,000,000 or more 400 late fee of $20 will be due. If the report or payment remains outstanding more than 13 13. IRS Forms, Schedules, The maximum amount subject to the charitable months past the end of the fiscal year covered by and Attachments distribution fee is $1,000,000. The maximum the report, the late fee will increase to $50. If All trusts must attach a complete copy of all charitable distribution fee is $400. The minimum the delinquency is not corrected within 16 forms, supporting schedules, and attachments charitable distribution fee is $20. months of the end of the fiscal year covered by filed with the IRS. This may include IRS Form the report, the late fee increases to $100. 1041-A and/or IRS Form 5227. Late Fee Schedule 9. Net Assets at the End of Fiscal Late Late Late Important Note for CPAs/Paid the Reporting Period Year End Report Report Report Preparers/Beneficiaries— Forms submitted Dates Receive Received Received to this office become a public record. To protect The Charitable Activities Section has adopted d Before Between After This the privacy of named individuals, you should the definition for “Net Assets” used by the This These Date redact Social Security Numbers (if used) from Internal Revenue Service. If the trust completed Date Dates the copy of the IRS Form 990/990-EZ/990- one of the following IRS Forms for this Late $20 $50 $100 PF/5227/1041-A (Schedule K) submitted to this reporting period, the Net Assets figure should Fee: office. Although we endeavor to redact social come from the line number listed: 12/31/21 2/1/23 2/1/23- 4/30/23 security numbers from any forms we receive, we • IRS Form 1041-A, Part IV, line 45b 4/30/23 • IRS Form 5227, Part IV, line 22b 1/31/22 3/1/23 3/1/23 5/31/23 request your assistance in safeguarding this 5/31/23 information by not including it in your 2/28/22 4/1/23 4/1/23- 6/30/23 submission. If the trust was not required to complete one of 6/30/23 these IRS Forms, a summary of what constitutes 3/31/22 5/1/23 5/1/23- 7/31/23 Net Assets is provided within these instructions. 7/31/23 Signature Block A more detailed definition can be found in the 4/30/22 6/1/23 6/1/23- 8/31/23 To make the return complete, a trustee, receiver IRS instructions for forms listed above. 8/31/23 or assignee must sign any return he or she files 5/31/22 7/1/23 7/1/23- 9/30/23 for the trust. Signature stamps and labels are not Net Assets refer to the trust’s assets minus 9/30/23 acceptable. Power of Attorney signature is not liabilities. 6/30/22 8/1/23 8/1/23- 10/31/23 accepted. 10/31/23 “Assets” are items of value to the trust, such as 7/31/22 9/1/23 9/1/23- 11/30/23 11/30/23 In the paid preparer’s information section, cash, receivables less any allowance for doubtful 8/31/22 10/1/23 10/1/23- 12/31/23 include the name, daytime phone number, and accounts, inventory, prepaid expenses, 12/31/23 address of any person who was paid by the trust investments, land, buildings & equipment less 9/30/22 11/1/23 11/1/23- 1/31/24 to complete this report. any accumulated depreciation if the trust records 1/31/24 depreciation. 10/31/22 12/1/23 12/1/23- 2/28/24 2/28/24 “Liabilities” are the amount of debts and 11/30/22 1/1/24 1/1/24- 3/31/24 obligations owed by the trust, such as accounts 3/31/24 payable, accrued expenses, deferred revenue, loans, and mortgages. The above late fees apply automatically and cannot be waived. The Department has the Important Note— If the trust disposed of all or authority to obtain additional civil penalties substantially all of the trust’s assets during this against the organization and its officers and reporting period, attach a letter listing a directors or take other administrative action in description of the asset and the name, address, connection with the failure to file timely and phone number, and contact person of each entity complete reports. which received the trust’s assets. 12. Total Amount Due 10. Net Assets Fee Add lines 8, 10, and 11. This is the total amount Multiply the amount subject to a Net Assets fee due. Make check or money order payable to the from line 10 by .0001 and enter this figure on “Oregon Department of Justice”. The line 11. Round to the nearest whole dollar. If the Department does not accept payment by credit result is less than $5 enter $0. If the result is card. Do not send cash. more than $2,000 enter $2,000. Important Note—If the trust is filing a short report of less than one year due to a change in Mail payment together with the report to: accounting periods, the amount entered on line 11 should be prorated by the number of months Charitable Activities Section covered by the report. To determine the prorated Oregon Department of Justice amount, divide the amount determined above by 100 SW Market Street Portland, Oregon 97201-5702 12 and multiply by the number of months |
Contact the Following Agencies for Assistance Charitable Activities Internal Revenue Service Secretary of State Section Phone: (877)829-5500 Corporation Division Oregon Department of Justice Website: https://www.irs.gov/charities-and- 100 SW Market Street nonprofits Public Service Building Portland, Oregon 97201-5702 255 Capitol Street NE, Suite 151 Phone: (971)673-1880 Salem, OR 97310-1327 TTY: (800)735-2900 Issues Phone: (503)986-2200 Fax: (971)673-1882 • Obtaining federal tax identification Website: Email: charitable@doj.state.or.us number or federal tax-exempt status https://sos.oregon.gov/business/Pages/ Website: https://www.doj.state.or.us • Completing federal tax forms default.aspx Issues Forms Issues • Questions about annual reports for • 990, Return of Organization Exempt • Forming a new corporation charitable organizations-Forms CT-12, From Income Tax • Merging nonprofit corporations CT-12F, and CT-12S • 990-EZ, Short Form - Return of • Dissolving nonprofit corporations • Registration of charitable organizations Organization Exempt From Income Tax • Amending articles of incorporation and trusts • 990-PF, Return of Private Foundation • Obtaining copies of filed articles of • Merging nonprofit organizations • 990-T, Exempt Organization Business incorporation and amendments • Dissolving nonprofit organizations Income Tax Return • Reporting illegal activity by nonprofit • 1023/1023-EZ, Application for Forms organizations Recognition of Exemption Under • Articles of Incorporation • Serving as a board member of a §501(c)(3) • Assumed Business Name Registration nonprofit organization • 1024, Application for Recognition of • Articles of Amendment • Information about charitable Exemption Under §501(a) • Restated Articles organizations and copies of annual • 1041, U.S. Income Tax Return for • reports Estates and Trusts Articles of Dissolution • • Questions about raffles and other • 1041-A, U.S. Information Return - Revocation of Dissolution charitable gaming Trust Accumulation of Charitable Amounts Publications • Forms 1128, Application to Adopt, Change, or • Oregon Business Guide Retain a Tax Year • RF-C, Registration Form for Charitable • 4720, Return of Certain Excise Taxes Organizations on Charities and Other Persons Oregon Department • RF-T, Registration Form for Trusts • 5227, Split-Interest Trust Return • CT-12, Annual Report Form for • 5768, Election/Revocation of Election of Revenue Oregon Charities by an Eligible Section 501(c)(3) • CT-12F, Annual Report Form for Organization to Make Expenditures to Revenue Building Foreign Charities Influence Legislation 955 Center St. NE • CT-12S, Annual Report Form for Split- • 8822, Change of Address Salem, OR 97301-2555 Interest Trusts • 8868, Application for Extension of Phone: (503)378-4988 and (800)356-4222 • Closing Form Time to File an Exempt Organization Website: https://www.oregon.gov/DOR Return Publications • 8976, Notice of Intent to Operate Under Issues Section 501(c)(4) • Oregon Wise Giving Guide • State taxation and filing requirements • A Guide to Non-Profit Board Service in Oregon Publications Forms • Pub. 526, Charitable Contributions • 20, Oregon Corporation Excise Tax Oregon Revised Statutes • Pub. 538, Accounting Periods and Return Methods • Chapter #65, Nonprofit Corporations • 41, Oregon Fiduciary Income Tax • Pub. 557, Tax-Exempt Status for Your • Chapter #128, Trusts; Charitable Return Organization Activities • • Chapter #130, Uniform Trust Code Pub. 583, Starting a Business and Keeping Records State of Oregon • Chapter #464, Charitable Gaming • Pub. 598, Tax on Unrelated Business • Chapter #646, Trade Practices & Income of Exempt Organizations Website: https://www.oregon.gov Antitrust Regulations • Pub. 3079, Gaming Publication for Tax-Exempt Organizations Oregon Administrative Rules • Pub. 4220, Applying for 501(c)(3) Tax- • Chapter #137-010-0005 et seq. Exempt Status • Pub. 4221, Compliance Guide for 501(c)(3) Organizations |