Fill Out Your Wisconsin Template

DO NOT STAPLE

WHO SHOULD FILE

A charitable organization registered to solicit contributions in Wisconsin must file an annual report with the Department of Financial Institutions – Division of Corporate and Consumer Services.

A charitable organization who files an IRS 990, 990EZ or 990-PF must use form #1952.

OIf the organization files an IRS 990, 990EZ or 990-PF you must complete form #1952. (Note: If you file an IRS Form 990-N, you cannot use this form. You must complete Form #1943 or Form #308 instead.)

Please refer to the definitions set forth in Wis. Stat. §. 202.12 when completing registration and report forms.

WHEN TO FILE

An annual financial report must be filed with the division within 12 months after the organization’s fiscal year-end.

WHAT TO INCLUDE

(No part of submission should be stapled)

฀Form 1952 WISCONSIN – Supplement to Financial Report.

฀IRS 990, 990EZ or 990-PF plus all schedules (except B) and attachments.

฀A full list of the organization’s board of directors, officers and trustees. Please include the individual’s name, address and title.

฀A list of states that have issued a license, registration, permit or other formal authorization to the organization to solicit contributions.

DO NOT STAPLE

2.WI Charitable Organization Number:

3.Federal Employer Identification Number:

-800

6.Has any of the information your organization previously submitted to the division changed? (i.e. name of the organization, address of the

principal office, address of any Wisconsin branch officers, accounting period, articles, by-laws, etc.)

If YES, attach an explanation and a copy of the amended document.

Yes

No

7.Organization’s Fiscal Year End Date (month, day, and year). Enter the accounting period for the following financial information.

mm

dd

yyyy

1. Contributions ........................................................................................................................................................

("Contribution" means a grant or pledge of money, credit, property, or other thing of any kind or value, except used clothing or household goods, to a charitable organization or for a charitable purpose. Bequests received directly from the public and indirect public support, such as contributions received through solicitation campaigns conducted by federated fundraising agencies like United Way should be included in this amount. "Contribution" does not include:

Income from bingo or raffles conducted under ch. 563, Wis. Stats.

Government grants

Bona fide fees, dues, or assessments paid by a member of a charitable organization, except that, if initial membership in a charitable organization is conferred solely as consideration for making a grant or pledge of money to the charitable organization in response to a solicitation, that grant or pledge of money is a contribution.)

1

2. Other Revenues ....................................................................................................................................................

2

3. Total Revenue (line 1 plus line 2) .........................................................................................................................

3

a. Expenses Allocated to Program Services .................................................

4a

b. Expenses Allocated to Management and General .....................................

4b

c. Expenses Allocated to Fund-raising .........................................................

4c

d. Expenses Allocated to Payments to Affiliates ..........................................

4d

e. Total Expenses .............................................................................................................................................

5.Excess or Deficit (line 3 minus line 4e) ................................................................................................................

6.Net Assets at Beginning of Year ..........................................................................................................................

7.Other Changes in Net Assets or Fund Balances (See 990, part XI).......................................................................

8.Net Assets at End of Year (Total of lines 5,6 &7) ..................................................................................................

4e

5

6

7

8

C H E C K

O N E

I

F

A P P L I C A B L E

C.IRS Form #990, 990EZ, or 990-PF. Do not include Schedule B of the 990.

(Note: If you file an IRS Form 990-N, you cannot use this form. You must complete a Form #1943 or Form #308 instead.)

D. Audited Financial Statements if the organization received contributions in excess of $500,000 during its fiscal year. The financial statements must be prepared in accordance with generally accepted accounting principles and be accompanied by the opinion of an independent certified public accountant.

OR

Apply for Waiver of “D. Audited Financial Statements” if (1.) the organization’s contributions were, during each of the past 3 fiscal years, less than $100,000; and (2.) during the fiscal year for which the waiver is being requested, the organization received one or more contributions from one contributor that exceeded $400,000. Include documentation to support (1.) and (2.).

E. Reviewed Financial Statements if the organization received contributions in excess of $300,000, but not more than $500,000 during its fiscal year. The financial statements must be prepared in accordance with generally accepted accounting principles by an independent certified public accountant. Audited financial statements are also acceptable.

OR

Apply for Waiver of “E. Reviewed Financial Statements” if (1.) the organization’s contributions were, during each of the past 3 fiscal years, less than $100,000; and (2.) during the fiscal year for which the waiver is being requested, the organization received one or more contributions from one contributor that exceeded $200,000. Include documentation to support (1.) and (2.).