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                                                 Charitable Activities Section 
   Form                                                                                                         You can now file reports and 
        CT-12                                 Oregon Department of Justice                                      pay by credit card using our 
   For Oregon Charities                                                                                                      online form at 
   For Accounting Periods Beginning in: 100 SW Market Street                      VOICE      (971) 673-1880 
                                        Portland, OR 97201-5702                     TTY      (800) 735-2900     https://justice.oregon.gov/ 
                                        Email: charitable@doj.state.or.us           FAX      (971) 673-1882     paymentportal/Account/Login
                                        Website: https://www.doj.state.or.us 
      2021                              Line-by-line instructions for completing the annual 
                                        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. Did a certified public accountant audit your financial records? - If yes, attach a copy of the auditor’s report, financial statements,
   accompanying notes, schedules, or other documents supplementing the report or financial statements.                                           Yes      No

3. Is the organization a party to a contract with a fundraising firm that relates to solicitations in Oregon? If yes, check the type of
   solicitations;   in-person; direct mail; advertising;  vending machine;  telephone; or  other solicitations.                            Yes      No
   If yes, also write the name of the fundraising firm(s) here: __________________________________________  (If you checked
   “other solicitations”, attach an explanation.)
4. Has the organization 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.
5. During this reporting period, did the organization amend its articles of incorporation, bylaws, or trust documents, OR did the
   organization receive a determination or revocation letter from the Internal Revenue Service relating to its tax-exempt status?  If            Yes      No
   yes, attach a copy of the amended document or letter.
6. Is the organization ceasing operations and is this the final report?  (If yes, see instructions on how to close your registration.)           Yes      No 

7. Provide contact information for the person responsible for retaining the organization’s records.
                    Name                         Position                  Phone                   Mailing Address & Email Address 

8. 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.  (Oregon law requires a minimum of three directors for nonprofit
   public benefit corporations.)
                         (A) Name, mailing address, daytime phone number                                        (B) Title &              (C) 
                                                  and email address                                             average weekly           Compensation 
                                                                                                                hours devoted to         (enter $0 if 
                                                                                                                position                 position unpaid) 
   Name: 
                _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ 
   Address: 
                _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ 
   Phone: 
                (_ _ _)_ _ _ _ _ _ _ _ Email:_ _ _  _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ 
   Name: 
                _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ 
   Address: 
                _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ 
   Phone:       (_ _ _)_ _ _ _ _ _ _ _ Email:_ _ _  _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ 
   Name: 
                _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ 
   Address: 
                _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ 
   Phone: 
                (_ _ _)_ _ _ _ _ _ _ _ Email:_ _ _  _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ 
                                                 Form Continued on Reverse Side 



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Section II.  Fee Calculation 

9.   Total Revenue ...........................................................................................................................  9. 
     (From Part I, Line 12 (current year) on Form 990; Line 9 on Form 990-EZ; Part I, Line 12a on Form 990-PF; or see the CT-
     12 instructions for how to calculate total revenue.  Attach explanation if Total Revenue is $0.) 

10.  Revenue Fee ............................................................................................................................................................................  10. 
     (See chart below.  Minimum fee is $20, even if total revenue is $0 or a negative amount.) The revenue fee is determined by the amount on line 9. 
        Amount on Line 9     Revenue 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 

11.  Net Assets or Fund Balances at End of the Reporting Period ...... 11. 
     (From Part I, Line 22 (end of year) on Form 990; Line 21 on Form 990-EZ; or Part 
     III, Line 6 on Form 990-PF; or see the CT-12 instructions to calculate.  Attach 
     explanation if amount is $0 or a negative number) 

12.  Net Fixed Assets Used to Conduct Charitable Activities ...........                        12. 
     (Generally, from Part X, Line 10c on Form 990; Line 23B and possibly 24B on Form 
     990-EZ; or Part II, Line 14b on Form 990-PF; or see the CT-12 instructions to
     calculate.  See the CT-12 instructions if organization owns income-producing 
     assets.

13.  Amount Subject to Net Assets or Fund Balances Fee ..............................................................                           13. 
     (Line 11 minus Line 12.  If Line 11 minus Line 12 is less than $50,000, write $0.)

14.  Net Assets or Fund Balances Fee ...........................................................................................................................................               14. 
     (Line 13 multiplied by .0001.  If the fee is less than $5, enter $0.  Not to exceed $2,000.  Round cents to the nearest whole dollar.)

     Are you filing this report late?   
15.                                      Yes               No.................................................................................................................  
     (If yes, the late fee is a minimum of $20.  You may owe more depending on how late the report is.  See Instruction 15 for additional information or contact the                           15. 
     Charitable Activities Section at (971) 673-1880 to obtain late fee amount.) 

16.  Total Amount Due  ...................................................................................................................................................................     16. 
     (Add Lines 10, 14, and 15.  Make check payable to the Oregon Department of Justice.)

17.  Attach a copy of the organization’s federal 990 or other return and all supporting schedules and attachments that were filed with the IRS, except that
     Form 990 & 990EZ filers do not need to attach a copy of their Schedule B.  Also, if the organization did not file with the IRS or filed a 990-N, but had
     Total Revenue of $50,000 or more, or Net Assets or Fund Balances of $100,000 or more, see the instructions.  Such organizations may be required to
     complete certain IRS forms for Oregon purposes only.  If the attached return was not filed with the IRS, then mark any such return as “For Oregon
     Purposes Only."  If your organization files IRS Form 990-N (e-Postcard) please attach a copy if available.
               Under penalties of perjury, I declare that I am an officer/director of the organization.  I have examined this return, including all 
Please         accompanying forms, schedules, and attachments, 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.   



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Charitable Activities Section, Oregon Department of Justice  
 
2021 Form CT-12 Instructions                                                                                                                      

         You can now complete and file reports online at https://justice.oregon.gov/paymentportal/Account/Login 
 
                                                    organization’s fiscal year. If the due date falls on the organization receives notice of denial of the 
                                                    a weekend or legal holiday, the due date is the      requested extension. 
General                                             next business day.                                    
                                                                                                         Important NoteAn extension request filed 
Instructions                                        The Charitable  Activities Section does not use      with the IRS  or the Oregon Department of 
                                                    the postmark  date to determine whether an           Revenue does  NOT act as an extension with 
                                                    organization has filed timely. Instead, filings are  the Charitable Activities Section unless a copy 
Purpose                                             considered timely if they are physically received    is  submitted to the Charitable Activities 
Oregon law charges the Attorney General with        within 5 business days after the due date. All       Section by the due date. 
the duty and  responsibility to represent  the      filings received more than 5 business days after      
public’s interest in charitable organizations and   the due date will be assessed a late charge.  See 
in assets held or received for charitable purposes. Instruction 15 Late Fees.                            Record Keeping 
The Attorney  General carries  out this                                                                  Please retain  a  copy  of this  report and all 
responsibility     by   requiring     charitable                                                         supporting documentation for at least five years 
organizations  to register  and file periodic       Extensions for Filing                                after the due date. 
financial reports.                                  An organization may apply for an extension of         
                                                    time to file.  Extension requests must be received 
Once submitted, this Form and  all  attachments     on or before the due date of the report to avoid a   Rounding and Blank Lines 
become a part of the public record. Any             late fee.   The maximum  available extension         Round all amounts on the report to the  nearest 
interested person may examine or obtain a copy      period is 180 days.  An extension to file is also    whole dollar. Drop amounts under 50 cents and 
of an annual report of a charitable organization    an extension to  pay  any associated fees.           increase amounts from 50 to 99 cents to the next 
by contacting the Charitable Activities Section.    Therefore, estimated payments should not be          whole dollar.  If  the amount  is zero  write “$0.”  
Reports  can  also be viewed on our website at      included with extension requests.                    and attach an explanation if requested. 
https://justice.oregon.gov/Charities.                                                                     
                                                    Please do not submit an incomplete CT-12/CT-         Do not leave any line blank. Your report may 
                                                    12F/CT-12S if you intend to later supplement or      be treated as incomplete if you leave blank lines. 
Who Must File                                       amend your report  with  a  copy  of  your  IRS 
All organizations registered with the Charitable    return. Instead, file an extension request so that 
Activities Section of the Oregon Department of      you can  submit  a complete  report  by the          Important Reminders 
Justice must annually file Form CT-12, CT-12F,      extended due date with a copy of the appropriate     Don’t lose your tax-exempt status.      Most tax-
or CT-12S unless the Attorney General has           IRS form attached.                                   exempt organizations other  than churches must 
specifically exempted the organization from the                                                          file a  yearly return with the IRS.  Very small 
reporting requirements.                             Extensions  may be requested through the             organizations are required to file IRS Form 990-
                                                    Department of          Justice    website at         N, also known  as  the e-Postcard.  The IRS is 
                                                    https://justice.oregon.gov/Charities/Extensions.     required by law to revoke the tax-exempt status 
What Form to File                                   Follow the instructions  carefully to ensure that    of any organization  that has failed to file  a 
File Form CT-12 if the  organization  is  either    we  receive  your request.   Please contact  our     required return for three consecutive years. 
incorporated,  organized, or  headquartered  in     office if you have any questions  or  difficulties    
Oregon.                                             with your online request.                            Please refer to https://www.irs.gov/charities-and-
                                                                                                         nonprofits  for  more information about  these 
File Form CT-12F if the  organization is            You should print and retain a copy of the online     requirements. 
organized and headquartered outside of Oregon.      Confirmation of Extension Request.  You should       . 
The Charitable Activities Section does not          also expect to receive a confirmation of receipt      
accept multi-state annual report forms in lieu of   of your online request.                              Important information  regarding Social 
a completed Form CT-12F.                                                                                 Security numbers (SSNs) Forms submitted 
                                                    You may also submit a written request or a copy      to this office  become a public record.   In 
File Form CT-12S if the organization is a split-    of the organization’s federal extension request      order to protect the privacy of named 
interest trust that holds assets for the benefit of (IRS Form 8868)    so long  as  the Charitable       individuals, you should redact any SSNs  (if 
both charitable and non-charitable beneficiaries.   Activities Section receives the request or copy      used)  from copies of any  IRS  forms 
                                                    before the due date of the report.   The             submitted.   Although we endeavor to  redact 
If the organization does not fit within any of the  organization’s 4 or 5-digit registration number      SSNs from any forms we receive, we request 
above categories, file Form CT-12.                  should be noted on the  top  of all extension        your assistance      in  safeguarding        this
                                                    requests.   If you would like acknowledgement        information by not including it  in your 
The form year should match the starting year        that your extension request  has been received,      submission. 
of the fiscal period covered by the report.         you  should enclose an  additional copy of the        
                                                    request and a self-addressed, stamped envelope. 
                                                     
Due Date                                                                                                 Online Filing Option 
The  form, all required attachments and                                                                  The Department has  an online  filing option if 
schedules, and payment of fees are due in the       In  the event your  request  is denied,  to avoid a  you would like to complete and file your report 
                                                    late fee, the annual report must be submitted by     electronically  and pay via credit card.  For 
Charitable Activities Section’s office no  later    the later of the due date or within 10 days after    additional           information,            visit
than 4 months and 15 days after the end of the                                                           https://www.doj.state.or.us/charitable-



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activities/annual-reporting-for-charities/file-     shortened period covered by the report must be       attach a copy  of any agreements or actions 
your-annual-report/                                 noted  here.   If the organization is filing a final that occurred in the current reporting period. 
                                                    report, also see the  instructions for line 6 for 
                                                    closing requirements. 
How to Contact the                                                                                       5.  Amendments to Articles of 
Charitable Activities                               Short Year Report—If the  organization               Incorporation, Bylaws, Trust 
                                                    is filing a shortened report due to  a  change in 
Section                                             fiscal  year,  see the instructions  for line 13 for Documents, or Tax-Exempt 
To obtain blank forms, mailed instructions,         calculation of  prorated Net  Assets or Fund         Status 
technical assistance or information  about  a       Balances fee.                                        Check yes if during the reporting period the 
charitable organization,  contact the Charitable                                                         organization amended its  articles, bylaws, or 
Activities Section or visit our website at:                                                              trust documents, or if the IRS issued a new tax-
       Charitable Activities Section                Amended Reports 
                                                                                                         exempt status ruling  for the organization, 
       Oregon Department of Justice                 If amending previously submitted information         including revocation. 
       100 SW Market Street                         for the same  accounting period, check the            
       Portland, OR 97201-5702                      amended report box. Either  complete a  blank        Important     Note—Attach       copies       of
       Phone:  (971)673-1880                        form  that includes the  amended information or      amendments to articles of incorporation bearing 
       TTY:    (800)735-2900                        provide a copy of the previously submitted form      the Secretary of State’s  file stamp, signed and 
       Fax:      (971)673-1882                      that clearly shows what information is being         dated copies of amended bylaws, amended trust 
       Email: charitable@doj.state.or.us            amended. Submit any additional fee due with the      documents, and/or IRS determination letters. 
       Website: https://www.doj.state.or.us         amended report. 

Where to File                                          Independent Audit                                 6.  Final Report 
                                                    2.                                                   Check yes  if this is  the final report for  the 
Send completed forms and corresponding fees to      Check  yes if the organization had  an               organization. 
the above address. Do not send cash.                independent  audit of its financial records           
                                                    performed by  a certified public accountant.         If the organization is dissolving, the Charitable 
                                                    Attach a copy of the auditor’s report, the           Activities Section must be notified in writing 30 
Line Instructions                                   financial statements, the accompanying notes,        days prior to the dissolution or the distribution of 
                                                    schedules, or other documents supplementing          the organization’s assets. This  notification may 
                                                    the  report or financial  statements.    Do not      be done either through a letter or submission of a 
             Section I.                             submit copies that are professionally bound.  If     completed Closing Form which can be obtained 
                                                    the audit  has not  been completed  prior to the     by contacting the Charitable  Activities Section 
                                                    report due date,  please note that  and the          or from our website. Notification must include 
 General Information                                estimated completion date on the CT-12.              the disposition  of assets including the name, 
                                                                                                         address, phone  number, and  contact person of 
1.  Missing or Incorrect                                                                                 each organization that will receive any 
                                                    3.  Fundraising Contracts                            remaining assets  and  the amount  of the assets 
Information                                         Check  yes if  the organization entered into  a      involved or a copy of the minutes of the board 
The Charitable  Activities Section sends a form     contract with  a  fundraising firm  that  relates to meeting that approved the dissolution containing 
preprinted   with   name,      address,     contact solicitations in Oregon,  including  in-person,      the same information. 
information and  registration number to all         direct mail, advertising, vending machine,            
registered organizations. If the  organization  is  telephone, or other solicitations made in Oregon.    If the organization is filing a final report for a 
returning one of these preprinted forms, provide    Check  the type(s) of campaign to  which the         reason other than a dissolution, such as  the 
any  missing or corrected information. If the       contract(s)  relates  and  write the name(s) of  the discontinuance  of soliciting contributions, 
organization is completing a blank form, provide    fundraising firm(s) in the space provided. If you    holding assets or conducting charitable activities 
the requested information in this section.          checked  “other  solicitations”  as the  type of     in Oregon, there are similar notification 
                                                    campaign, attach an explanation.                     requirements. 
Name Changes                                                                                              
                                                                                                         If the organization is a trust and is filing a final 
If applicable, write the organization’s new legal                                                        report for any reason, the Charitable Activities 
name. Attach  a  copy of  the filed amended         4.  Disclosure of Legal Action 
                                                                                                         Section should be  contacted for specific 
articles of  incorporation or trust document that   Check yes if  the organization or any of its         instructions and requirements  related  to closing 
changed the organization’s name.                    officers, directors, trustees  or key employees      procedures. 
                                                    ever signed a voluntary  agreement  with any          
                                                    government agency,  such as  a  state attorney       A final report must reflect the financial 
Address, Email, and Phone                           general, secretary of state, or local district       transactions of the charitable organization from 
Number Changes                                      attorney, or been a party to  legal action  in any   the day after the close of  its last  accounting 
If applicable, write the new address where mail     court  or administrative agency  regarding           period to the  date of the disposition of all 
for the organization should be directed  in  the    charitable    solicitation,       administration,    remaining assets. 
future. If  applicable, write the new daytime       management, or fiduciary practices.   This 
                                                                                                          
phone number, fax number and email address for      includes assurances of voluntary compliance or                         —Dissolving   corporations 
                                                                                                         Important     Note
the organization.                                   discontinuance involving the organization or any     must submit a copy of any articles of dissolution 
                                                    other proceeding in which the organization or        filed with the Corporation Division in addition to 
                                                    any current officer, director,  trustee,  or  key    the information required above. If  articles of 
Accounting Year Changes                             employee is subject to any injunction, order, or     dissolution have not been filed, then the 
If applicable, write the  organization’s new or     pending  action relating to the solicitation of      anticipated date of dissolution must be provided. 
short reporting period. Preprinted forms  are       contributions, or administration of charitable        
based upon the accounting period we have on         assets.  Attach  a written  explanation of each                        —The organization must 
                                                                                                         Important  Note
record for the organization.  If the organization   such action or agreement, including the              submit this  information even if the distribution 
has changed  its fiscal year or  is filing a final  agency involved  and  the  allegations.   Also,      of assets has already occurred. 
report for a period less  than 12  months, the 



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                                                                                                        to continue operations. See the instructions for 
7.  Who Keeps the Books?                             The organization may provide an attachment to      line 6 if this is the organization’s final report. 
Indicate the person to be contacted if the           explain the entire compensation package for any 
organization's books need  to be accessed for        person listed in this part, including whether the 
information or review.  Either a  business or        compensation includes the payment of amounts       10.  Revenue Fee 
personal phone number,  email,  and mailing          previously deferred.                               Use the Total  Revenue figure from       line 9  to 
address  are acceptable.   If the person  does not                                                      calculate  the revenue  fee according to the 
have an email  address, please note  that on the                                                        following schedule. 
form.                                                         Section II. 
                                                                                                         
                                                                                                                        Revenue Fee Schedule 
                                                                                                                               
8.  Officers, Directors,                             9.  Total Revenue                                     Amount on Line 9            Revenue Fee 
Trustees, and Other Key                              The Charitable  Activities Section has adopted     $             0 -  $   24,999        $   20 
                                                                                                          25,000        -     49,999              50 
                                                     the definition for “Total Revenue” used by the       50,000        -     99,999              90 
Employees                                            Internal Revenue Service. If the  organization      100,000        -     249,999           150 
List each  person who was an  officer, director,     completed  one  of the following IRS Forms for      250,000        -     499,999           200 
trustee, or key employee (defined below) of the      this  reporting  period, the  Total Revenue figure  500,000        -     999,999           300 
organization at any time during the year even if     should come from the line number listed:            1,000,000      or    more              400 
they are  a volunteer and do  not receive any         • IRS Form 990, Part I,  line 12 (current          
compensation  from the  organization. Give the          year)                                           The maximum amount subject to a revenue fee is 
daytime  phone number and  preferred  mailing         • IRS Form 990-EZ, Part I, line 9                 $1,000,000. The maximum revenue fee is $400.  
address at which officers, etc., want the             • IRS Form 990-PF, Part I, line 12a               The minimum  revenue  fee  is $20, even if total 
Charitable Activities Section to contact them.       If the organization was not required to complete   revenue is zero or a negative amount. 
Use an attachment if there are more persons to       one of these IRS Forms, or filed an IRS Form 
list than there are lines available.                 990-N, a summary of what constitutes  Total 
                                                     Revenue is provided within these instructions. A   11.  Net Assets or Fund 
A failure to fully complete this part can subject    more detailed definition can be found in the IRS   Balances at the End of the 
the organization to late fees or civil penalties for instructions for the forms listed above. 
                                                                                                        Reporting Period 
filing an incomplete form.                            
                                                     “Total Revenue” includes such items as:            The  Charitable Activities Section has adopted 
If the organization is an Oregon public benefit       • Contributions, gifts, or grants                 the definitions for “Net Assets”  and  “Fund 
corporation, it  must have a  minimum of three        • donated real property                           Balances” used by the Internal Revenue Service. 
                                                                                                        If the organization  completed one of the 
individuals serving on its board of directors.        • donated thrift items 
                                                                                                        following IRS  forms for this reporting period, 
Officers include  those officers required by          • membership dues & assessments                   the Net Assets  or Fund Balances figure should 
applicable state law, such as president, secretary,   • program service revenue                         come from the line number listed: 
or  treasurer, and also  includes  the  person(s)     • government fees & contracts                      • IRS Form 990, Part I, line 22 (end of 
elected or appointed to implement the decisions       • interest or dividend income                        year) 
of  the governing  body or for  supervising the       • gross rental income less rental expense          • IRS Form 990-EZ, Part I, line 21 
management, administration, or operation of the       • other investment income                          • IRS Form 990-PF, Part III, line 6 
organization, regardless of title or the amount of    • gain or loss on sales of assets other than       
compensation received.  The CEO or  Executive           inventory                                       If the organization was not required to complete 
Director is an officer for purposes of this form.     • gain or loss from special events &              one of  these IRS  forms, or filed an IRS Form 
The top financial official may also be an officer       activities which may include bingo,             900-N, a summary  of what constitutes Net 
if they  are responsible for  managing the              raffles, and Monte Carlo events                 Assets or Fund Balances is provided below.  A 
organization’s finances.                              • gain or loss on sale of inventory               more detailed definition can be found in the IRS 
                                                      • all other sources of revenue.                   instructions for the forms listed above. 
A "key employee" is any person, other than an         • include amounts obtained from both               
officer, director, or      trustee,  who       has      Oregon and out of state sources.                Net Assets and Fund Balances refer  to  the 
responsibilities  over the organization  that  are                                                      organization’s assets minus liabilities. 
similar to those  of  its officers, directors, or    To report contributions received in a form other    
trustees.  If the organization  attaches a  990  or  than cash, use the market value as of the date of  “Assets” are items of value to the organization, 
990EZ, it may rely on the IRS definition of key      the contribution. When market  value cannot  be    such as cash, receivables less any allowance for 
employee in the corresponding IRS instructions       readily determined, use  an appraised or           doubtful accounts, inventory,  prepaid expenses, 
for purposes of this form.                           estimated value.                                   investments, land, buildings & equipment less 
                                                                                                        any accumulated depreciation if the organization 
                Column (C)                           To determine  the amount of any noncash            records depreciation. 
If an IRS form is attached that includes complete    contribution  that is subject to an outstanding     
and  accurate compensation information,  the         debt, subtract  the debt from  the property’s fair “Liabilities”  are the amount  of  debts and 
phrase “See IRS Form” may be entered in lieu of      market value in assigning a value to the revenue   obligations owed by the organization, such as 
completing this section.                             received.   “Fair market value”  is the amount a   accounts payable, accrued  expenses, deferred 
                                                     reasonable person would pay for the item at the    revenue, loans, and mortgages. 
Otherwise, for each person listed, report the total  time it was donated to the organization. 
amount of  compensation paid  or deferred for        Important Note—Do not include the value of 
payment to a later date, including salary,  fees,    services donated to  the organization, or items         Net Fixed Assets Used to 
                                                                                                        12.
bonuses,  benefits, taxable allowances  or           such as the free use of materials, equipment, or 
reimbursements,    the    value      of noncash      facilities in reporting Total Revenue.             Conduct Charitable Activities 
compensation, and severance payments.                                                                   Enter the amount of the organization’s Net Fixed 
                                                     Important Note—If Total Revenue  is zero,          Assets that were held for use in the operation of 
Enter a zero in column (C) if the person was a       attach an explanation of why  Total Revenue is     charitable activities at the end  of  the reporting 
volunteer and was not paid or did not accrue any     zero and indicate whether the organization plans   period. 
compensation during the reporting year.                                                                  



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Important NoteYou should not include any            months covered by the report. To determine the 
cash, bank     accounts,   stock       holdings,     prorated amount, divide the amount determined          16.  Total Amount Due 
investment accounts, or other liquid assets in       above by 12  and multiply by the number of             Add lines 10,  14,  and 15.  This is  the total 
Line 12.  Line 12 should only include fixed          months covered by the short report. No similar         amount  due. Make check or money order 
assets that are used for charitable purposes, such   proration should be made if the short  report is       payable to  the “Oregon Department of 
as land, buildings,  or  equipment  that are used    due to the initial or final reporting period.          Justice”.  Do  not send  cash. Mail payment 
directly for charitable purposes.                                                                           together with the report to: 
                                                                                                             
The following instructions provide guidance on       14.  Net Assets or Fund                                        Charitable Activities Section 
how to calculate Net Fixed Assets, where the                                                                        Oregon Department of Justice  
amount may be located  on the organization’s         Balances Fee                                                   100 SW Market Street 
IRS return, and whether that amount should be        Multiply the amount subject to a Net Assets or                 Portland, Oregon 97201-5702 
adjusted to include only those fixed assets used     Fund Balances  fee from  line 13 by .0001 and           
for charitable purposes.                             enter this figure on line 14. Round to the nearest     Important Note—Indicate on the  check the 
                                                     whole dollar. If  the result is less than $5 enter     organization’s 4 or 5-digit Oregon Department 
The Charitable  Activities Section defines “Net      $0. If  the amount is more  than $2,000 enter          of Justice  registration  number. The registration 
Fixed Assets”  as the organization’s book value      $2,000.                                                number is  located on line 1 of the preprinted 
(cost or other basis less any accumulated                                                                   Form CT-12 or can be obtained by contacting 
depreciation) of all owned land, buildings, or                                                              the  Charitable Activities Section or looking up 
equipment,    that are used directly for             15.  Late Fees                                         the    charity   on our         website  at
charitable purposes.  For  example, if the           If the report is not filed or the fee is not paid by   https://justice.oregon.gov/Charities. 
charity owns  and operates  a museum, the            the due date (or the extended due date), an initial 
building that houses the museum is a net fixed       late fee of $20 will be due.   If the report or 
asset.   However, undeveloped land, a building       payment remains outstanding more than 13               17.  IRS Forms, Schedules, 
owned and used for rental income, or any other       months past the end of the fiscal year covered by      and Attachments 
fixed asset used for investment purposes should      the report, the  late  fee will increase to  $50.   If 
not be included in Line 12.  Accordingly, the net    the delinquency is not corrected within 16             All organizations must attach a complete copy 
fixed assets used for charitable purposes on Line    months of the end of the fiscal year covered by        of all forms, supporting schedules, and 
12 may be less than the organization’s total net     the report, the late fee increases to $100.            attachments filed with the IRS, except 
fixed assets.                                                                                               publicly-supported charities are not required 
                                                                Late Fee Schedule                           to attach Schedule B, Listing of Contributors. 
If the organization  completed one of the                                                                    
following  IRS  Forms for this  reporting period      Fiscal   Late     Late      Late                      Even if your organization is not required to file a 
and all its Net Fixed Assets are held for use in      Year     Report   Report    Report                    Form 990, 990-EZ, or 990-PF  with the IRS, if 
conducting charitable  activities, the figure         End      Received Received  Received                  the organization’s revenues or net assets exceed 
should come from the line number listed:              Dates    Before   Between   After This                certain  thresholds,  it may  be required to 
 •    IRS Form 990, Part X, line 10c                           This     These     Date                      complete one of these forms  for Oregon 
                                                               Date     Dates                               purposes to meet the Charitable Activities 
 •    IRS Form 990-EZ, Part II, line 23B              Late                                                  Section’s filing requirements.  
      and/or 24B to the extent 24B includes           Fee:     $20      $50       $100                       
      equipment or similar assets used for            12/31/21 2/1/23   2/1/23-   4/30/23                   In general, if your organization’s total revenues 
      charitable programs.                                              4/30/23 
 •    IRS Form 990-PF, Part II, line 14b              1/31/22  3/1/23   3/1/23    5/31/23                   are at least $50,000, or its assets are more than 
                                                                        5/31/23                             $100,000, you may be asked to complete a 990-
If the organization was not required to complete      2/28/22  4/1/23   4/1/23-   6/30/23                   EZ or 990 for  Oregon purposes only.  If the 
one of these IRS Forms, or filed an IRS Form                            6/30/23                             organization has not filed the form with the IRS, 
990-N,  this figure will need to be  calculated       3/31/22  5/1/23   5/1/23-   7/31/23                   it should note on the form that it is for Oregon 
                                                                        7/31/23                             purposes only. 
from the organization’s accounting records,  but      4/30/22  6/1/23   6/1/23-   8/31/23                    
the 990/990EZ  can be used as worksheets to                             8/31/23                             Additional instructions  are  provided below for 
determine the amount to report.                       5/31/22  7/1/23   7/1/23-   9/30/23                   990-N filers and for organizations that do not file 
                                                                        9/30/23                             any type of 990 with the IRS. 
                                                      6/30/22  8/1/23   8/1/23-   10/31/23 
13.  Amount Subject to Net                                              10/31/23                             
                                                      7/31/22  9/1/23   9/1/23-   11/30/23                   
Assets or Fund Balances Fee                                             11/30/23                            For 990-N Filers—If your organization does 
Subtract line 12 from line 11. If the result is less  8/31/22  10/1/23  10/1/23-  12/31/23                  not complete an IRS Form 990 or 990-EZ 
than $50,000 enter $0 on line 13. If the result is                      12/31/23                            because it files an IRS form 990-N, the 
more than $20,000,000 enter $20,000,000.              9/30/22  11/1/23  11/1/23-  1/31/24                   Charitable Activities Section will consider 
                                                                        1/31/24                             suspending the requirement to file a Form 990 or 
Example #1    line 11    $ 100,000                    10/31/22 12/1/23  12/1/23-  2/28/24                   990-EZ for Oregon purposes upon request. 
              line 12         (25,000)                                  2/28/24                              
                              75,000                  11/30/22 1/1/24   1/1/24-   3/31/24                   If the organization files an IRS Form 990-N 
              line 13                  $ 75,000                         3/31/24 
                                                                                                            because its gross receipts are normally $50,000 
                                                                                                            or  less, but its  assets are more than $100,000, 
                                                     The above  late fees apply automatically  and          please contact this office in writing if you would 
                                                     cannot be waived.   The Department has  the            like the Charitable Activities Section to consider 
Example #2    line 11    $ 100,000                   authority to obtain additional civil  penalties        suspending the requirement to file an IRS Form 
              line 12         (80,000)               against the  organization and  its  officers and       990 or 990-EZ for Oregon purposes.   The 
                              20,000                 directors  or take  other administrative action in     amount of assets in  excess of $100,000  is 
              line 13                  $         0 
                                                     connection with the failure to  file  timely  and      material to consideration of suspension requests.  
Important Note—If the organization is filing a       complete reports.                                      Please include  a  balance sheet or similar 
short report of less than one year due to a change                                                          statement listing your assets to expedite review 
in accounting periods, the  amount entered on                                                               of your request. 
line 13 should  be prorated by the number of                                                                 



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For organizations that  do not file a 
990/990EZ/990-N with the IRS.   Please 
attach to your CT-12 a copy of your Form 1120 
or other return your organization has filed with 
the IRS for the reporting period.  We will contact 
you  if  this office determines  that a 990-EZ or 
990 is required for Oregon purposes. 
 
Important Note—Organizations that file Form 
990 or 990-EZ with the IRS are not required to 
attach any schedule  of  contributors to filings 
with    the   Charitable Activities      Section. 
Therefore,  there  is no requirement to attach 
Schedule B.  However, if voluntarily submitted, 
this information may be made  available for 
public inspection. 
 
This  exclusion does  not apply to  Form 990-PF 
filers who  must submit  their schedule of 
contributors. 
 
Important     Note       for      CPAs/Paid
Preparers/Beneficiaries  –  Forms submitted 
to this office become a public record.  In order to 
protect  the privacy of named individuals, you 
should redact Social Security Numbers (if used) 
from the copy of the IRS Form 990/990-EZ/990-
PF/5227/1041-A (Schedule K) submitted to this 
office.  Although we endeavor  to redact social 
security numbers from any forms we receive, we 
request your assistance in safeguarding  this 
information by not including it in your 
submission. 
 
         Signature Block 
To  make the return complete, an authorized 
officer must sign in  the space  provided. For a 
corporation  or association, this  officer may  be 
the president,  vice president, treasurer,  chief 
executive  officer,  executive  director,  chief 
financial officer, or other corporate officer, such 
as tax officer.  A trustee, receiver, or assignee 
must sign any return he or she files for a trust. 
Signature stamps and labels are not acceptable.  
Power of Attorney signature is not accepted. 
 
In the paid preparer’s information section, 
include the name, daytime phone number, and 
address of any person who  was paid by  the 
organization to complete this report. 



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       Contact the Following Agencies for Assistance 
                                                                            
   Charitable Activities                          Internal Revenue Service                   Oregon 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: https://sos.oregon.gov/business/ 
Email:   charitable@doj.state.or.us                number or federal tax-exempt status      Pages/default.aspx 
Website: https://www.doj.state.or.us             • Completing federal tax forms 
                                                                                            Issues 
Issues                                          Forms                                        • Forming a new corporation 
 •     Questions about annual reports for        • 990, Return of Organization Exempt        • Merging nonprofit corporations 
       charitable organizations-Forms CT-12,       From Income Tax                           • Dissolving nonprofit corporations 
       CT-12F, and CT-12S                        • 990-EZ, Short Form - Return of            • Amending articles of incorporation 
 •     Registration of charitable organizations    Organization Exempt From Income Tax       • Obtaining copies of filed articles of 
       and trusts                                • 990-PF, Return of Private Foundation        incorporation and amendments 
 •     Merging nonprofit organizations           • 990-T, Exempt Organization Business 
 •     Dissolving nonprofit organizations          Income Tax Return                        Forms 
 •     Reporting illegal activity by nonprofit   • 1023/1023-EZ, Application for             • Articles of Incorporation 
       organizations                               Recognition of Exemption Under 
                                                                                             •
 •     Serving as a board member of a nonprofit    §501(c)(3)                                  Assumed Business Name Registration 
                                                                                             •
       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          • Articles of Dissolution 
       reports                                     Estates and Trusts                        • Revocation of Dissolution 
 •     Questions about raffles and other         • 1041-A, U.S. Information Return - Trust 
       charitable gaming                           Accumulation of Charitable Amounts       Publications 
                                                 • 1128, Application to Adopt, Change, or    • Oregon Business Guide 
Forms                                              Retain a Tax Year                            
                                                 • 4720, Return of Certain Excise Taxes on 
 •     RF-C, Registration Form for Charitable      Charities and Other Persons                 Oregon Department 
       Organizations                             • 5227, Split-Interest Trust Return 
                                                                                                        of Revenue 
 •     RF-T, Registration Form for Trusts        • 5768, Election/Revocation of Election by  
 •     CT-12, Annual Report Form for Oregon        an Eligible Section 501(c)(3)            Revenue Building 
       Charities                                   Organization to Make Expenditures to     955 Center St. NE 
 •     CT-12F, Annual Report Form for Foreign      Influence Legislation                    Salem, OR 97301-2555 
       Charities                                 • 8822, Change of Address                  Phone:  (503)378-4988 and (800)356-4222 
 •     CT-12S, Annual Report Form for Split-     • 8868, Application for Extension of Time  Website:  https://www.oregon.gov/DOR 
       Interest Trusts                             to File an Exempt Organization Return 
 •     Closing Form                              • 8976, Notice of Intent to Operate Under 
                                                   Section 501(c)(4)                        Issues 
Publications                                                                                 • State taxation and filing requirements 
 •     Oregon Wise Giving Guide                 Publications 
 •     A Guide to Non-Profit Board Service in    • Pub. 526, Charitable Contributions       Forms 
       Oregon                                    • Pub. 538, Accounting Periods and          • 20, Oregon Corporation Excise Tax 
                                                   Methods                                     Return 
Oregon Revised Statutes                          • Pub. 557, Tax-Exempt Status for Your      • 41, Oregon Fiduciary Income Tax Return 
 •     Chapter #65, Nonprofit Corporations         Organization                              
                                                 •
 •     Chapter #128, Trusts; Charitable            Pub. 583, Starting a Business and 
       Activities                                  Keeping Records                                    State of Oregon 
                                                 •                                           
 •     Chapter #130, Uniform Trust Code            Pub. 598, Tax on Unrelated Business      Website:  https://www.oregon.gov 
                                                   Income of Exempt Organizations            
 •     Chapter #464, Charitable Gaming           • Pub. 3079, Gaming Publication for 
 •     Chapter #646, Trade Practices & 
                                                   Tax-Exempt Organizations 
       Antitrust Regulation 
                                                 • Pub. 4220, Applying for 501(c)(3) Tax-
                                                   Exempt Status 
Oregon Administrative Rules                      • Pub. 4221, Compliance Guide for 
 •     Chapter #137-010-0005 et seq.               501(c)(3) Organizations 
                                                  






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