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                         OFFICE OF THE NEW HAMPSHIRE ATTORNEY GENERAL 
                             CHARITABLE TRUSTS UNIT 
                                 One Granite Place South 
                                     Concord, NH  03301 

                                 ANNUAL REPORT 
                                   INSTRUCTIONS

                            1
General Requirements:  

Filing                   New Hampshire-              Out of State         Express 
Requirements             Based Charitable            Charitable           Trusts/Private 
                         Corporations or             Corporations or  Foundations 
                         Associations                Associations 

Filing Fee               $75 check payable to        $75 check payable    $75 check payable to State 
                         State of New Hampshire  to State of New          of New Hampshire 
                                                     Hampshire  
Annual Report Form       NHCT-12 signed under        NHCT-12 signed       NHCT-12 signed under 
                         oath by president or        under oath by        oath by president, 
                         treasurer                   president or         treasurer, or trustee   
                                                     treasurer 
Financial Report         Schedule A or Form 990  Schedule A or Form       Form 990-PF 
                         or 990-EZ (990-N is not     990 or 990-EZ (990-
                         acceptable)                 N is not acceptable) 
Governing Board List     Schedule B or a             Schedule B or list of  Schedule B or list of 
                         document with               Board members in     trustees on Form 990-PF 
                         equivalent information      Form 990 or 990-EZ 
Conflict of              Schedule C                  N/A                            N/A 
Interest/Governance 
Report 
Financial                GAAP financial              N/A                  Copy of accounting filed 
Statements/Accountings   statements if revenue is                         with probate court (if filing 
                         between $500,000 and                             with probate court is 
                         $2 ,000,000                                      required) 

                         Audited GAAP financial 
                         statements if revenue 
                         exceeds $2,000,000 
Additional Reports (if   Schedule D (Charitable      Schedule D           Schedule E (Withdrawal due 
applicable)              Gift Annuity)               (Charitable Gift     to dissolution, merger, 
                                                     Annuity)             ceases operations in NH) 
                         Schedule E (Withdrawal 
                         due to dissolution,         Schedule E 
                         merger, ceases              (Withdrawal due to 
                         operations in NH)           dissolution, merger, 

1 Form NHCT-12 and Schedules A, B, C, D, and E may be downloaded from the All Forms web page: 
https://www.doj.nh.gov/charitable-trusts/forms.htm.  
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                                                   ceases operations 
                                                   in NH) 

                         Community Benefits        Community 
                         Report (for healthcare    Benefits Report (for 
                         organizations)            healthcare 
                                                   organizations) 

When and Where to File Annual Report: 

Annual reports are due 4 months and 15 days after the close of the organization’s fiscal 
year. If your organization changes its fiscal year end, notify the Charitable Trusts Unit.  

Fiscal year end          Report due date Fiscal year end       Report due date 
date                                     date  
January 31               June 15         July 31               December 15 
February 28              July 15         August 31             January 15  
March 31                 August 15       September 20          February 15  
April 30                 September 15    October 31            March 15  
May 31                   October 15      November 30           April 15  
June 30                  November 15     December 31           May 15  

To obtain an extension of time to file the annual report, file an extension form (NHCT-14) 
together with the $75 annual filing fee. The NHCT-14 form may be downloaded from the 
publications web page (see footnote 1). Filing an IRS Form 8868 to extend the time to file a 
return does not extend the time to file with the Charitable Trusts Unit.  

Mail or deliver all materials to Charitable Trusts Unit, Department of Justice, One Granite 
Place South, Concord, NH 03301.  

Other Information: 

   •  For newly registered organizations, the date that the first annual report is due is set
      forth in the cover letter that accompanied the certificate of registration.
   •  For an acknowledgement of receipt of an annual report by the Charitable Trusts
      Unit, enclose a self-addressed, stamped envelope.
   •  Organizations with less than $10,000 in assets may  be eligible for a suspension of
      the annual report filing requirement. The application to suspend may be
      downloaded from the publications web page (see footnote 1). To qualify,
      organizations must be current with respect to filing their annual reports.
   •  Please note that filing with the Secretary of State is not notice to the Charitable Trusts
      Unit.

Contact Us: 

   •  Call the Charitable Trusts Unit at 603-271-3591 or consult our web page:
      www.doj.nh.gov/charitable-trusts
   •  Please reference the legal name of the organization as well as the NH Charitable
      Trusts Unit registration number from our registered charities list.
      https://www.doj.nh.gov/charitable-trusts/documents/registered-charities.pdf

Charitable organizations do important work in New Hampshire. Do not put your 
organization’s reputation and its resources at risk. Failing to file annual reports in a timely 

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manner will lead to loss of good standing status and may lead to an investigation, litigation, 
and the imposition of penalties. 

Specific Instructions for Form NHCT-12 (New Hampshire Annual Report 
for Charitable Organizations and Trusts)  

Who Must File:  All charitable organizations and charitable trusts (including private 
foundations) are required to file and submit Forms NHCT-12 to the Charitable Trusts Unit 
within 4 months and 15 days after the close of the organization’s fiscal year, unless 
extended for six (6) months by the Director of Charitable Trusts. 

For Year End Date:  Enter the organization’s fiscal year end date.  For example, if the fiscal 
year begins on July 1, enter June 30, 20xx in the box labeled “For year end date.” If the 
fiscal year begins on January 1, enter December 31, 20xx in the box.  If the report is a 
multiyear report at the end of a report suspension period, also include the beginning date 
of the period of suspension (example: 1/1/2016-12/31/2020). 

Enclosures or Attachments: 

1. Filing Fee: Enclose a check in the amount of $75.00 made payable to the State of         New
   Hampshire or pay online.

2. Financial Report:
   a.        Schedule A (Financial Report):  This form must be submitted for any
             organization that does not file an IRS Form 990, 990-EZ, or 990-PF, or any
             testamentary trust that does not file a probate account. Instructions for
             completing the form are set forth below.
   b.        IRS Form 990, 990-EZ, or 990-PF: Organizations required to file a Form 990,
             990-EZ, or 990-PF, must submit a copy with NHCT-12 (Annual Report).
   c.        Probate Account:  Testamentary trusts that are required to file accountings with
             the probate court must also submit a copy with NHCT-12 (Annual Report).

3. Schedule B (Governing Board List):      The members of the board of directors or
   trustees of the organization should be listed on Schedule B or its equivalent.
   Instructions for completing Schedule B or its equivalent are set forth below.

4. Schedule C (Conflict of Interest, Governance Report): This schedule must be
   completed by all organizations based in NH except for Form 990-PF filers. If the NH-
   based organization has not filed its current conflict of interest policy with the
   Charitable Trusts Unit, it must file an updated copy along with Schedule C.
   Instructions for completing Schedule C are set forth below.

5. GAAP Financial Statement: Generally Accepted Accounting Principles (“GAAP”) is a
   commonly accepted way of recording and reporting accounting information and
   includes the income statement, the balance sheet, and the cash flow statement.
   Organizations (other than private foundations) with revenues of over $500,000 must
   submit to the Charitable Trusts Unit the organization’s GAAP financial statement as
   well as a copy of the organization’s Form 990. This financial statement may be
   prepared by the organization in-house or may be prepared by an accountant and
   reviewed and approved by the organization.

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6. Audited Financial Statement:  Audited financial statements are the financial
   statements of an organization that have been examined by a certified public
   accountant.Audited financial statements include   a signed statement from the
   auditor ,       verifying that the financial statements accurately set forth the results, a
   statement of financial position (balance sheet), statement of operations (income
   statement), and a statement of cash flows for the fiscal year end. Organizations
   (other than private foundations) with revenues greater than $2,000,000 must
   include with their annual report an audited financial statement in addition to their
   completed Form 990.

7. Schedule D (Charitable Gift Annuity Certification). Schedule D must be completed
   and submitted for any organization that issues charitable gift annuities in New
   Hampshire.            Instructions for completing Schedule D are set forth below.

8. Schedule E (Withdrawal). Schedule E must be completed and submitted for any
   organization that dissolves, merges, or ceases operations in New Hampshire. Please
   note that filing Schedule E with the Charitable Trusts Unit is not notice to the New
   Hampshire Secretary of State.

Organization Name:  Enter the legal name of the organization on file with the NH 
Charitable Trusts Unit. If the legal name has changed, check the box and submit the 
amended governance documents reflecting the name change. 

NH Charitable Trusts Registration Number:  This is the number that appears on the 
Certificate of Registration issued by the Charitable Trusts Unit at the time that the 
organization registered. If you do not know the number, you can search for it on the list of 
registered charities on the Charitable Trusts website:  www.doj.nh.gov/charitable-trusts 

Mailing Address:  Enter the organization’s mailing address. If the organization’s address 
has changed from the previous year (or your registration application, whichever is most 
recent), please check the box for new address. 

Website Address: Enter the organization’s website address, if any. 

Name and title of primary contact: Enter the name of the primary contact for the 
organization if the Charitable Trusts Unit has any questions or concerns about the Annual 
Report. 

Email Address and Telephone Number:  Enter the email address and telephone number of 
the primary contact for the organization if the Charitable Trusts Unit has questions or 
concerns about the Annual Report. 

Signature of President, Treasurer, or Trustee:  The signature of the president or treasurer 
of the organization is required. If there is no president or treasurer, an officer of the board 
of directors/trustees authorized to sign for the organization must sign the NHCT-12 form, 
and provide a written explanation as to why the organization does not have a president or 
treasurer. If the organization is an express trust, the trustee may sign. The executive 
director (or its equivalent) of the organization may not sign.  Please note that if completing 
and submitting the electronic form, an electronic signature (such as /s/ John Q. Public) is acceptable.

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Specific Instructions for Schedule A (Financial Report) 

Who Must File:  Schedule A must be filed by any charitable organization that does not file 
IRS Form 990, 990-EZ, or 990-PF. Organizations that file Form 990, 990-EZ, or 990-PF must 
submit a copy of the form as their financial report to the Charitable Trusts Unit. 

Header: 

   Organization Name:  Insert the name of the organization as set forth on the NHCT-
   12 Form (Annual Report). 

   For year end date: Insert the organization’s fiscal year end date (the same date on 
   the top of the NHCT-12 Form).  

Questions: 

A. Employer Identification Number: The Employer Identification Number (“EIN”) is the
   number assigned to your organization by the Internal Revenue Service (“IRS”). It is
   also known as the “Federal Tax Identification Number” and is used by the IRS to
   identity the organization. Do not use the EIN issued to another organization, even if
   the organizations are related. If you have lost or misplaced your EIN, visit
   www.irs.gov for ways to locate the number.

B. Federal Tax Exempt Status: Check the box reflecting the section under the Internal
   Revenue Code under which the organization obtained its tax exempt status. The
   code reference is included in the letter of determination sent by the IRS, granting
   the organization’s tax exempt status. If you have not obtained tax exempt status but
   have applied by filing the Form 1023 or Form 1023-EZ, check the appropriate box. If
   your organization is part of a group exemption (i.e., a letter of determination was
   issued to a group of organizations that are affiliated with a central organization),
   check the appropriate box.

C. Describe the Primary Charitable Purpose:  Enter the primary purpose of your
   organization.  This purpose is the organization’s mission and should be reflected in
   your governing documents, such as the articles of agreement.

D. Largest Program Services: A program service is an activity of an organization that
   accomplishes its charitable purpose. Examples of program service accomplishments
   can include charitable activities such as providing scholarships to students in need,
   food to those suffering from food insecurity, and performance by a theater group.
   For each program service entered, include the number of people served or the
   number of events held.  Include the total expenses for each program service.  Be
   sure these amounts are also included within the expense categories in Part II, lines
   F8 through F16 below.

E. Revenue: Report all revenue the organization received during the reporting period,
   including any donations or grants, program service revenue, any membership dues
   or assessments, interest and dividends, and gross receipts from fundraisers (e.g.,
   annual gala, bingo). “Other revenue” includes revenue not listed elsewhere, such as
   refunds. “Gross receipts” are funds received before expenses are deducted.
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F. Expenses: Report all expenses the organization paid during the reporting period.
   Lines 8 and 9 request amounts paid out as part of programming. Lines 10, 11, and
   12 request employment-type expenses. Line 16 (“other expenses”) includes expenses
   not listed elsewhere, such as bank charges, return check charges, loan interest, late
   fees on loans, or vehicle repairs.

G. Net Income: Subtract line 17 from line 6, and enter the “excess” or “deficit.”

H. Assets: Report all assets of the organization, including the value of cash accounts,
   investments, property (including land and buildings), equipment, and any other
   assets owned by the organization. Include prepaid expenses. “Prepaid expenses”
   include any and all expenses paid in advance, such as insurance paid in advance for
   the quarter or the year and utilities paid in advance of the winter. Note that
   organizations that use the cash method of accounting are not required to complete
   line H(4).

I. Liabilities: Report all accounts payable (e.g., utilities), loans and grants payable, and
   other liabilities, including tax liabilities. Include any accrued expenses. Examples of
   “accrued expenses” are payroll taxes that have not yet been paid to the IRS or
   payroll expenses incurred (but not paid) prior to year end. Note that organizations
   that use the cash method of accounting are not required to complete line I(7).

J. Fund Balance: Subtract line I(10) (total liabilities) from line H(6) (total assets), and
   enter the fund balance or net worth. Please note that this number can be a negative
   number.

K. Donor Restricted Funds:  Enter the value of donor-restricted funds that are
   included in the Fund Balance on line J. Donor restricted funds are funds accepted by
   the organization that were designated by the donor for a particular purpose, time,
   or other restriction. For example, donations made specifically for college
   scholarships or for a new boiler are donor-restricted funds.

L. Fund Balance/Net worth at prior year end:  This was the number calculated by
   subtracting the organization’s total liabilities from total assets. The number can be
   found on the form NHCT-2A (used prior to 2020) on Line 75 and on the Form NHCT-
   12 (used after 2020) on Line J.

M. Subtract Line L from Line J:  Subtract the net worth from last year from the net
   worth for the current year. This reflects the change in fund balance between the
   reporting year and the prior year.

N. Explanation for change in fund balance: Explain why there is a change in the fund
   balance from year to year (line M). For example, a change in fund balance could be
   the result of the fact that the organization’s revenue increased more than its
   expenses or the value of the investments increased or a loan was paid off.

O. Thefts:  Indicate whether or not the organization experienced any significant thefts,
   embezzlements, or other diversions of its assets by checking “yes” or “no.”  If yes,
   please describe the circumstances and the amount of money or value of assets
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       involved. Whether a theft, embezzlement, or diversion is “significant” depends on 
       the size of the organization, but at a minimum, involves a theft of greater than 
       $500.00 in value. 

Specific Instructions for Schedule B (Governing Board List) 

Who Must File: All charitable organizations, express trusts, and private foundations are 
required to submit a completed Schedule B or its equivalent. 

Header: 

       Organization Name:  Insert the name of the organization as set forth on the NHCT-
       12 Form (Annual Report). 

       For Year End Date: Insert the organization’s fiscal year end date (the same date on 
       the top of the NHCT-12 Form).   

Chart: 

All New Hampshire-based charitable organizations are required to submit a completed 
Schedule B listing the members of the governing board, along with their positions (e.g., 
president, director, trustee), home addresses (PO Boxes and office or organization 
addresses are not acceptable), daytime telephone numbers, email addresses, the average 
number of hours per week devoted to the positions, and any compensation or benefits 
paid. If the governing board member is unpaid and does not receive any benefits, enter 0 in 
the box for compensation and benefits. 

For New Hampshire-based organizations, the home addresses, telephone numbers, and 
email addresses of board members is required so that the Charitable Trusts Unit can 
contact board members apart from management, if needed. The personal contact 
information is not subject to public disclosure. 

If your organization is not based in New Hampshire and was not formed in New Hampshire, 
and you file a Form 990, Form 990-EZ, or Form 990-PF, you may submit the board list 
appearing at IRS Form 990, Part VII or Form 990-EZ, Part IV, or Form 990-PF, Part VIII. 

Specific Instructions for Schedule C (Conflict of Interest and Governance 
Report)  

Who Must File: All New Hampshire-based and all New Hampshire-formed charitable 
organizations, with the exception of express trusts and private foundations, must file a 
completed Schedule C.   

Header: 

       Organization Name:  Insert the name of the organization as set forth on the NHCT-
       12 Form (Annual Report). 

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For Year End Date: Insert the organization’s fiscal year end date (the same date on 
the top of the NHCT-12 Form).   

Questions: 

1.           Change to the Conflict of Interest Policy:  If the organization has changed its
             conflict of interest policy or if its current conflict of interest policy was not
             submitted to the Charitable Trusts Unit, enter “yes,” and attach or submit the
             organization’s current conflict of interest policy. Sample conflict of interest
             policies are available on the forms page of the Charitable Trusts Unit website
             (https://www.doj.nh.gov/charitable-trusts/documents/sample-conflict-
             interest.pdf).

2.           Pecuniary Benefit/Conflict of Interest Transaction:  This question asks
             whether certain persons were involved in a “pecuniary benefit transaction as” 
             the term is defined in RSA 7:19-a:

                 ‘Pecuniary benefit transaction’ means a transaction [exceeding $500 in value]
                 with a charitable trust in which a director, officer, or trustee of the charitable
                 trust has a financial interest, direct or indirect. However, the following shall not
                 be considered as pecuniary benefit transactions:
                 (1) Reasonable compensation for services of an executive director, and
                 expenses incurred in connection with official duties of a director, officer, or
                 trustee;
                 (2) A benefit provided to a director, officer, or trustee or member of the
                 immediate family thereof if:
                         (A) The benefits are provided or paid as part of programs, benefits, or
                         payments to members of the general public; and
                         (B) The charitable trust has adopted written eligibility criteria for such
                         benefit in accordance with its bylaws or applicable laws; and
                         (C) The director, trustee, or family member meets all of the eligibility
                         criteria for receiving such benefit;
                 (3) A continuing transaction entered into by a charitable trust, merely
                 because a person with a financial interest therein subsequently becomes a
                 director, officer, or trustee of the charitable trust.

                 An “indirect” financial interest arises when the transaction involves a person 
                 or entity of which a director, officer, or trustee, or a member of the 
                 immediate family of a director, officer, or trustee, is a proprietor, partner, 
                 employee, or owner.  

                 “Interested person:” A director, officer, trustee, and those with an indirect 
                 financial interest as defined above are referred to as “interested persons” in 
                 Schedule C.   

The following are examples of pecuniary benefit transactions: 

                 a. A member of the board of directors owns a landscaping company. The
                       organization pays the landscaping company for lawn care services.
                 b. A trustee’s daughter, an accountant, is hired by the organization as an
                       employee to provide bookkeeping services and prepare the organization’s
                       annual accounting.
                 c. The charitable organization pays rent to a separate corporation
                       (landlord), but a board member for the charitable organization is also a
                       shareholder or part owner of the landlord corporation.
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3.           Real Estate Transactions:  Check yes if the organization entered into a real
             estate transaction (e.g., sale or lease) with an interested person or if the
             organization operates out of real estate owned or leased by an interested person.

4.           Loan or Advance: Check yes if the organization made a loan or provided an
             advance to an interested person.

5.           Chart: For each “yes” answer to 2, 3, or 4, complete the information on the chart.
             Note that the “Name” in the first column is the person or entity that received the
             benefit. For example, if a director received the benefit directly, the first column
             would state “[name of the director]/self.”

6.           Transactions of $5,000 or more: With respect to transactions that amounted to
             a total of $5,000 or more during the fiscal year, check yes, and provide a copy of
             the notice sent to the Charitable Trusts Unit in accordance with RSA 7:19-a, II (d),
             a copy of the newspaper notice in accordance with RSA 7-19-a, II (d), and a copy
             of the board minutes, approving the transaction.

7.           Changes to Formation Documents or By-Laws: Provide to the Charitable Trusts
             Unit copies of any updated or revised formation documents (articles of
             agreement, declaration of trust, constitution) or bylaws.

8.           Board meetings: Enter the number of meetings that the Board of Directors held
             during the reporting period (fiscal year). Please note that the Director of
             Charitable Trusts may require that the organization submit copies of agendas
             and meeting minutes. See RSA 7:24.

9.           Professional solicitor, fundraising counsel, commercial co-venturer: If the
             organization has used a professional solicitor or fundraising counsel in
             connection with fundraising activities, or if it entered into a joint venture with a
             for-profit business for a charitable sales promotion, answer in the affirmative
             and provide the names and addresses of the solicitor, counsel, or co-venturer.
             See RSA 7:28-b, 7:28-c, and 7:28-d.

10. Litigation, Fines, Judgments:  Indicate whether the organization has been fined,
             penalized, or otherwise the subject of an adverse court or administrative agency
             judgment. Include, for example, any fines or penalties issued by state or federal
             agencies and any civil or criminal court actions.

11. Fiscal Sponsor: Indicate whether the organization has served as a fiscal sponsor
             for another organization. A fiscal agent in this context is a charitable
             organization that agrees to accept donations for or lend its taxpayer
             identification number to another charitable organization, including a start-up
             organization.

Specific Instructions for Schedule D (Charitable Gift Annuity 
Certification)  

Who Must File: All charitable organizations that issue charitable gift annuities in New 
Hampshire must file a completed Schedule D.   

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Header: 

   Organization Name:  Insert the name of the organization as set forth on the NHCT-
   12 Form (Annual Report). 

   For Year End Date: Insert the organization’s fiscal year end date (the same date on 
   the top of the NHCT-12 Form).   

Questions: 

1. Certification of Qualified Charitable Gift Annuity:       The person signing the Form
   NHCT-12 must certify that the “charitable gift annuity” issued by the organization is
   a “qualified charitable gift annuity” as defined in RSA 403-E:1:

   a charitable gift annuity described by section 501(m)(5), Internal Revenue Code of
   1986 (26 U.S.C. section 501(m)(5)), and section 514(c)(5), Internal Revenue Code of
   1986 (26 U.S.C. 514(c)(5)), that is issued by a charitable organization that on the date
   of the annuity agreement:

                (a) Has a minimum of $300,000 in unrestricted cash, cash equivalents, or
                publicly traded securities, exclusive of the assets funding the annuity
                agreement;
                (b) Has been in continuous operation for at least 3 years or is a successor or
                affiliate of a charitable organization that has been in continuous operation
                for at least 3 years;
                (c) Issues charitable gift annuities with payout ratios no greater than
                recommended by the American Council on Gift Annuities at the time of
                issuance;
                (d) Retains 100 percent of the contribution made in exchange for each
                charitable gift annuity, increased by earnings on the contribution and
                decreased by annuity payments and expenses properly allocated to the
                annuity, until the annuity is terminated; and
                (e) Invests contributions made in exchange for charitable gift annuities solely
                in conformance with article 9 of RSA 564-B, general standards of prudent
                investment.

   Note that the organization must check each of the boxes in section 1 to certify the 
   accuracy of the statements. 

2. Notification or Recertification:  RSA 403-E:3 requires that all charitable
   organizations that issue qualified charitable gift annuities notify the director in
   writing within 90 days after the date on which it enters into the first qualified
   charitable gift annuity agreement. Thereafter, the organization must annually
   recertify that the annuities issued by the organization are limited to qualified
   charitable gift annuities as defined in RSA 403-E:1, V.

   Note that the organization must check the appropriate box indicating whether it is
   an initial notification or an annual recertification.

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Specific Instructions for Schedule E (Withdrawal Report) 

Who Must File: All charitable organizations and trusts that withdraw their registration as a 
New Hampshire charitable organization or trust as a result of dissolution, merger, 
termination, cessation of charitable activities, or cessation of operations in New 
Hampshire.  Please note that filing Schedule E with the Charitable Trusts Unit is not notice 
to the New Hampshire Secretary of State. 

Header: 

    Organization Name:  Insert the name of the organization as set forth on the NHCT-
    12 Form (Annual Report). 

    For Year End Date: Insert the organization’s fiscal year end date (the same date on 
    the top of the NHCT-12 Form).   

Questions: 

 1. Reason for Withdrawal: Check the applicable box(es) for the reason why the
    organization or trust seeks to withdraw its registration with the Director of
    Charitable Trusts. Attach to Schedule E the required documentation:
                •      Dissolution of NH Nonprofit Corporation: attach NH Secretary of State
                       Form NP-5. 2The form also must be filed with the NH Secretary of State.
                •      Merger of NH Nonprofit Corporation: attach a certified copy of the
                       minutes of the meeting at which the Board voted to merge with another
                       nonprofit corporation. See RSA 292:7.
                •      Termination of an Express Trust: Attach the document reflecting
                       termination, such as a trustee action or proof of termination event
                       contemplated in the trust instrument (e.g., the death of a living
                       beneficiary, a fixed date, or the exhaustion of the trust assets).
                •      Dissolution of unincorporated association: If the organization is not
                       incorporated, attach the minutes of the meeting at which the governing
                       body voted to dissolve.
                •      Cessation of charitable activities (non-501(c)(3) organizations): for
                       organizations that are exempt under a section of the Internal Revenue
                       Code other than 501(c)(3) (e.g., 501(c)(10), 501(c)(4), 501(c)(6), 501(c) (7)),
                       attach minutes of the vote of the governing body to cease conducting
                       charitable activities. For example, if a fraternal organization exempt
                       under 501(c)(10) decides that it no longer will raise public funds for
                       scholarships and will not conduct any other charitable activities, it is not
                       required to register and may withdraw its registration. The fraternal
                       organization must demonstrate to the Charitable Trusts Unit that it no
                       longer will conduct charitable activities by providing a copy of the vote of
                       the governing body and any other relevant documentation.
                •      Withdrawal from NH of foreign nonprofit corporation: If a nonprofit
                       corporation formed in a state other than New Hampshire seeks to
                       withdraw from conducting any charitable activities in New Hampshire, it

2 The form can be found on the NH Secretary of State website: http://sos.nh.gov/
nhnpforms.aspx.                                                                          Page 11 of 13 
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                       must submit to the New Hampshire Secretary of State and the Charitable 
                       Trusts Unit a completed Form FNP-5.  3

 2. Distribution of assets:  Required of all entities that seek to withdraw registration
    except foreign nonprofit corporations who seek to withdraw from New Hampshire.

          •     Assets: List the charitable assets of the organization or trust by type and
                value. For example, if the organization has only cash and real estate assets,
                identify the amount of cash assets and the value of the real estate assets. Use
                separate sheets if necessary.
          •     Donor restrictions on use of any assets:  If the organization or trust has
                any donor restricted assets, indicate the restriction by identifying the name
                of the fund, the amount of the fund, and the language of the restriction. For
                example:
                       o Smith Scholarship Fund, $100,000, for a student from X High School
                         to study agriculture in college
                       o Doe Fund, $50,000, income only to be used for maintenance of the X
                         park
          •     Note that court action may be required to redirect donor restricted assets.

 3. Legal Name of Recipient Organization: Identify the name of the organization that
    will receive distribution of the assets. If the assets will be distributed to more than
    one organization, complete separate forms for each organization, listing the assets
    that will be distributed to that particular organization. For example, if the
    organization will be distributing the cash assets equally to organizations A and B
    and the real estate to C, complete 3 separate forms.

 4. Federal Tax Identification Number: Complete the federal tax identification number
    of the recipient organization.

 5. Mailing address: Complete the mailing address of the recipient organization.

 6. Website address: Complete the website address of the recipient organization.

 7. Date of distribution: Complete the date that the assets will be (or were) distributed
    to the recipient organization.

 8. Recipient organization contact name/title: Complete the name of the contact for
    the recipient organization who can answer questions regarding the work of the
    organization (e.g., executive director, president, chair of the board, trustee). Include
    the email address and telephone number of the contact.

 9. Recipient organization federal tax status: Check the appropriate box for the
    federal tax status of the recipient organization. For example, if the organization is a
    501(c) (10) organization, check the second box and add “10.” If tax exempt, the
    recipient organization should be able to provide a determination letter from the IRS

3 The foreign nonprofit forms may be found on the NH Secretary of State website: 
http://sos.nh.gov/fornpforms.aspx.   
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that identifies the section under the Internal Revenue Code under which the 
organization is exempt.  

Instructions for NHCT-12 Page                                               13 of 13 
September 2022 v. 3. 2






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