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December 18, 2018To prospective state colleges and universities, and state service organizations (CUSSOs):Thank you for your partnership with the Colorado Combined Campaign (CCC), the workplace giving campaign of State of Colorado government employees. We are pleased to present you with this document: the 2019-2020 CCC CUSSO Application Form. We look forward to receiving your application. Remember that CUSSOs are required to apply every year, regardless of prior campaign-year status. Please note below important details and reminders about the application and the application process. A CUSSO is an entity that meets several criteria. It has registered as a nonprofit organization in Colorado by obtaining a Certificate of Registration from the Secretary of State; is exempt from federal income tax under Internal Revenue Code 501(a) as described in Section 501(c)(3); is directly associated with a department of the State of Colorado government; and, otherwise meets the criteria established in CCC bylaws. CCC bylaws, revised November 2017, can be downloaded at: . Cover Letter: Please address your application cover letter to Doug Platt, Chair, Colorado Combined Campaign. Mr. Platt oversees the CCC Advisory Committee. This all-state-employee entity reviews and approves CCC applications, in March of each year. Applicants are then notified of their status by April at the latest. Administration and Fundraising Ratio (AFR): All member nonprofits must use their most recent IRS Form 990 or IRS Form 990 pro forma to calculate the AFR required in the application. The CCC has provided an equation for calculating this ratio (see page 12). Explanation of Administration and Fundraising Ratio: CCC bylaws state that the AFR of participating nonprofits shall not exceed 35% of the total expenses of the charitable organization. Any member nonprofit with an AFR over 35% is REQUIRED to submit an explanation as to why 35% has been exceeded (see page 13). Upon receipt of an adequate explanation, the committee, at its discretion, may grant a waiver of the 35% AFR maximum.Application Training: In January we will host a webinar to review the application process, provide information and answer questions. Here is information about this opportunity to learn more: Topic: CCC Application Process / 2019-2020 Campaign YearTime: Jan 18, 2019 9:00 AM Mountain TimeJoin online: in: +1 669 900 6833 or +1 646 876 9923Meeting ID: 497 849 514RemindersElectronic and hard copy of the Nonprofit Information Worksheet: Nonprofit information for CCC marketing materials must be submitted electronically as an Excel document (using the template we provide) and included as a hard copy with your submitted application. Email your completed Nonprofit Information Worksheet (formerly called Attachment A) to apply@. Registration with the Colorado Secretary of State: Applicants must provide proof of two items from the Colorado Secretary of State: current registration as a nonprofit business in good standing (“Periodic Report Number”) and current charitable registration (“Renewal ID Number”unless exempt, in accordance with the Charitable Solicitation Law). In addition to certifying item VIII (A) (7) from the bylaws, we are also collecting registration information from applicants. The Nonprofit Information Worksheet includes a column for the “Periodic Report Number” and “Renewal ID Number” for all applying charities.Please do not hesitate to contact me with any questions or concerns you might have about the CCC, the application and the application process. Along with our Advisory Committee and on behalf of the CCC, I look forward to working with you on another successful campaign!Sincerely yours,Becky HerlingerDirector, Colorado Combined Campaignbecky@720-420-3210 DEADLINE: 5 P.M. ON FRIDAY, FEBRUARY 15, 2019Colorado Combined Campaignc/o Community Shares of Colorado789 Sherman Street, Suite 230 - Denver, Colorado 80203Your application needs to be provided in hard-copy form. Either mail or hand-deliver it. Please remember to provide the Nonprofit Information Worksheet as both a hard copy with your application and via email to apply@.APPLICATION CHECKLISTThe College, University and State Service Organization (CUSSO) Application consists of the following components, which should be submitted in the order listed below. This checklist and accompanying instructions with full details is provided to help ensure a complete application. It does not need to be submitted with the application. Section I: Cover Letter (one page)Please address your application cover letter to Doug Platt, Chair, Colorado Combined Campaign. Mr. Platt oversees the CCC Advisory Committee. Section II: Contact Information Form Use the one-page template provided (see page 7).Section III: Bylaw Certifications Form Read, initial and sign the form provided (see pages 8-10).Section IV: Narrative Formatting: Use 12-point font with 1-inch margins and include the HEADING provided for each question. It is not necessary to repeat the text of the questionsPage Limit: 3-page limit Narrative Questions:PROGRAMS AND ACTIVITIES: A full description of the charitable organization’s programs and activities.KEY ACCOMPLISHMENTS: Key accomplishments in the 2018 calendar year.REPORTING AND TRANSPARENCY: A full description of the organization’s diligence and methods of reporting to the public with an emphasis on financial and management transparency.METHODS OF SOLICITATION FOR DONATIONS: Briefly describe the ways in which you seek contributions from all types of donors (this includes individuals, corporate entities, government entities and other nonprofit entities). Section IV: Attachments Financial AttachmentsIRS Form 990 or IRS Form 990 pro formaAudit or Financial ReviewSources of Funding Table (see page 11)Disclosure of Expenditures Table (see page 11)Disclosure of Administration and Fundraising Ratio Form (see page 12)Explanation of Administration and Fundraising Ration Form, if applicable (see page 13)Current Budget and the Board Minutes Approving Submitted BudgetOther AttachmentsNonprofit Information Worksheet IRS Determination LetterNon-Discrimination PolicyCertificate of Good StandingCertificate of RegistrationOther Attachments continuedBoard of Directors ListLeadership Staff ListState Association Statement Form (see page 14)Statement of Local Presence Form, if applicable (see page 15)Annual Report, if availableATTACHMENT INSTRUCTIONSFinancial AttachmentsIRS Form 990 or IRS Form 990 pro formaThe organization’s most recently filed IRS Form 990 dated 6/30/2017 or more recent and covering the same fiscal period as the submitted audit or financial review. Audit or Financial Review The organization’s most recent audit or financial review dated 6/30/2017 or more recent and covering the same fiscal period as the submitted IRS Form 990.Sources of Funding TableComplete and submit the table, on page 11, for the organization as a whole, based on the most recently completed fiscal period. Categories may be modified to fit your organization’s funding sources.Disclosure of Expenditures TableComplete and submit the table, on page 11, for the organization as a whole, based on the most recently completed fiscal period. Administration and Fundraising Ratio (AFR) FormComplete and submit the form provided, on page 12, including the rmation provided must be obtained from your most recent IRS Form 990 or IRS Form 990 pro forma.Explanation of Administration and Fundraising Ratio Form, if applicable.If your AFR is greater than 35%, complete and submit the form, on page 13.Be as detailed as possible in your explanation.Current BudgetA copy of the organization’s budget for their current fiscal period.A copy of the minutes of the organization’s board of directors meeting showing approval of the budget. Please highlight the section demonstrating board approval.Other AttachmentsNonprofit Information WorksheetDownload the Excel sheet pre-formatted at: , the information from the Excel sheet will be imported into the 2019-2020 CCC resource guide, online giving site, website and social media. Be sure to carefully proof information before submitting. Submit the Nonprofit Information Worksheet as an Excel sheet via email to: apply@ and as a hard copy with your application. Detailed instructions on how to complete the worksheet can be found on the second tab labeled “Instructions” in the Nonprofit Information Worksheet workbook. To access the instructions click on the tab labeled “Instructions” at the bottom of the workbook. IRS Determination LetterName and address should match the name and address listed on your submitted IRS Form 990.A link to contact the IRS for an updated letter is included on the “nonprofit resources” page on the CCC website at . Non-discrimination policyA copy of the organization’s non-discrimination policy protecting, at minimum, the classes listed in the CCC bylaws: “race, color, religion, national origin, disability, age, gender and sexual orientation applicable to persons served by the organization.”Certificate of Good StandingA copy of your organization’s Certificate of Good Standing issued 6/1/2018 or more recent.Certificates of Good Standing can be obtained at obtain a Certificate of Good Standing, go to: go to: and do the following:Click on “Businesses, trademarks, trade names.”Under “Search & file” click on “Search business database.”Enter the charity’s name in the text box and click “search.”Click on the "# ID Number” by the charity’s name. If there are multiple records, click on the "# ID Number" by the charity's name where the “Status” is "Good Standing." Note: If the description is anything other than "Good Standing," the charity must renew its registration before it will be eligible for participation.Scroll down and click on “Get a certificate of good standing.”Certificate of RegistrationA copy of your organization’s Certificate of Registration with a “GOOD” status and in effect since 6/1/2018 or more recent.Certificates of Registration can be obtained at obtain a Certificate of Registration do the following:Click on “charities and fundraisers.”Under “Consumers,” click on “Search charities database.”Enter the charity’s name in the text box and click “search.”Click on the charity’s name.Scroll down to and click on "Get certificate of registration." Board of Directors ListA list of current board members including names, professional affiliations and contact information.Leadership Staff ListNames, titles and contact information for current leadership/key personnel.State Association Statement FormComplete the form, on page 14, by providing information on how your organization has a direct association with a State of Colorado department by identifying the type of association, the name of the department and as description of that association.Statement of Local Presence Form, if applicableTo be completed only by organizations who do not have a physical address or presence in the state of plete the form, on page 15, by providing a description of how your organization does have a presence in the state of Colorado through services and funding.Include documentation or verification that supports your description of your local presence with your application.Most recent Annual Report, if available.CONTACT INFORMATION FORMCUSSO Name: Mailing Address: City: State: Zip code: Main Telephone Number: Fax: Website URL: Contact Person Name: Contact Person Email: Contact Person Direct Telephone Number: I, ______________________________, the duly appointed representative of __________________________________________________ have verified and I certify and affirm all statements enclosed in this application to be true.SignatureTitleDate of Application?NameByLaw Certifications FORMListed below are the requirements to participate in the Colorado Combined Campaign as set forth in CCC bylaws, revised November 2017. A copy is available for your reference at . The items below are listed in corresponding order with the bylaws Section VIII (A) (1-15) and Section VIII (B) (1-9) for your convenience. Please initial the box next to each certification statement.The CCC Advisory Committee reserves the right to deny participation to an organization for false certification.Section VIII (A) Criteria and Procedures for All Charitable Organizations-37147528829000INITIAL-37147561023500I certify that the organization named in this application has a policy and procedure of non-discrimination with regard to race, color, religion, national origin, disability, age, gender and sexual orientation applicable to persons served by the organization. -37147561849000I certify that the organization named in this application uses the funds contributed to the charitable organization by state employees for their intended purposes within Colorado. No more than 15% of CCC funds may be used for the organization’s administration costs. -37147543561000 I certify that the organization named in this application will limit direct monetary solicitation of support from state employees to the CCC. -37147561785500I certify that the organization named in this application can demonstrate a history of service in the State of Colorado as a charitable organization under the criteria set forth in this Section VIII for no less than 12 months prior to the date of application.-37147545466000I certify that the organization named in this application is exempt from federal income tax under Internal Revenue Code 501(a) as described in Section 501(c)(3).-37147541910000I certify that the organization named in this application is registered as a nonprofit organization with the Colorado Secretary of State by obtaining from that office a Certificate of Good Standing. -37147540830500I certify that the organization named in this application is registered, unless exempt, with the Colorado Secretary of State in accordance with the Colorado Charitable Solicitation Act. -37147579565500I certify that the organization named in this application uses a financial accounting system that is in accordance with generally accepted accounting principles unless the organization’s annual expenditures are less than $100,000, in which case a cash basis of accounting is acceptable provided that books and records are sufficient to allow for review by an auditor.I certify that the organization named in this application conducts financial operations in accordance with a detailed annual budget that is approved by its board of directors and authorization by the organization’s board of directors is required for any significant variation from its approved budget. -342900-2603500-34290043815000I certify that the organization named in this application is supported in part by voluntary contributions from the public. -34290044450000I certify that the organization named in this application engages only in activities that are consistent with its stated goals and objectives.-34290044132500I certify that the organization named in this application can demonstrate that its publicity and promotional activities are based upon its actual programs and operations. I certify that the organization named in this application provides annually updated information which is available to the general public and includes: A full description of the charitable organization’s activities.Methods of solicitation for contributions. The names and contact information for all chief administrative personnel. The names, contact information and business affiliation for all members of the board of directors. A full disclosure of the sources and uses of contributions. The percentage of expenditures out of total revenues used for direct services and the percentage used for administrative and fundraising costs-34290015494000I certify that I have provided to the CCC the percentage of total revenues not spent on direct services, referred to as the Administration and Fundraising Ratio (AFR). The AFR was calculated using the most recent IRS Form 990 or IRS Form 990 pro forma.If the administrative cost exceeds 35% of total revenue in any given year, the charitable organization must submit an explanation as to why 35% has been exceeded. Upon receipt of an adequate explanation, the committee, at its discretion, may grant a waiver of the 35% maximum. -34290011938000I certify that the organization named in this application if accepted for participation: Will not imply directly or indirectly that approval for payroll contribution constitutes endorsement of the organization by the State of Colorado. Will not sell or permit others to make use of the lists of contributors who donate through the CCC. Will not involve the mailing of unordered tickets or other merchandise to state employees with a request for money in return. Will maintain an active volunteer board of directors that serves without compensation through regular meetings and exercises satisfactory administrative controls in accordance with the charitable organization’s articles of incorporation and bylaws. Will demonstrate that its programs reside within and serve the state of Colorado as evidenced by the presence within the state of Colorado of a staffed facility at which goods or services may be obtained such as an office, clinic, mobile unit or field agency. Is a member of an umbrella federation that is approved for payroll contribution according to the criteria set forth in Section VIII (A) and (B) of CCC bylaws or is designated as a college, university or state service organization (CUSSO).Will not participate in more than one umbrella organization that receives state employee contributions in a single campaign year. Will not use donated state employee funds for lobbying activities. Will be in compliance with all applicable federal and state statutes or regulations. Will be in compliance with all statutes of the United States of America Patriot Act.-34290056451500Section VIII (C) Additional Requirements for Colleges, universities and State Service OrganizationsI certify that the organization named in this application has a direct association with a department of the government of the State of Colorado. In order to be considered, the organization must:Be supported by the state of Colorado by state ownership of capital improvements or equipment, or state sharing of operating or maintenance funding; or Have a direct relationship to a state agency by providing enhanced services of that agency; or -34290020764500Act as an agent of the state to operate, manage or administer a function of the state.I certify that the organization named in this application will submit annually to the Colorado Combined Campaign a separate application that consists of documents that proves it is in compliance with all criteria set forth in Section VIII (A) and (C) for a CUSSO. -34290012890500I certify that the organization named in this application maintains in its files the information required by the application for three years and will make these files available for inspection or audit by the CCC Advisory Committee or the state auditor within one business day advance notice.-34290010541000I certify that the organization named in this application will provide information required by the CCC manager, CCC Advisory Committee and/or Department of Personnel and Administration executive director. I, ______________________________, the duly appointed representative of ______________________________________________________ have read and certified as true all statements contained in this document.SignatureTitleDate of CertificationNameSOURCES OF FUNDING TABLEPercentage?Funding Source?%Government grants (federal, state, county, local)?%Government contracts?% Foundations?% Business?% Events (include event sponsorships)?% Individual contributions?% Fees/earned income% Workplace giving campaigns%In-kind contributions (optional)% Other % TOTAL (must equal 100%)DISCLOSURE OF EXPENDITURES TABLEPercentageCategory of Expense%Administration%Fundraising%Programs%TOTAL (must equal 100%)DISCLOSURE OF ADMINISTRATION AND FUNDRAISING RATIO (AFR) FORMThe AFR is the percentage of expenditures of revenues not used for direct services, calculated using the most recent IRS Form 990 or IRS Form 990 Pro Forma.Go to Part IX Statement of Functional Expenses located on page 10. Add lines 25(C) Management and General Expenses and 25(D) Fundraising Expenses. Go to Part VIII Statement of Revenue located on page 9.Divide the total of 25(C) and 25(D) by line 12(A) Total Revenues.This is the percentage of administrative and fundraising costs for CCC reporting.ADMIN & FUNDRAISING %= Expenses Line 25C+ Line 25(D)Revenues:Line 12(A)Please complete:733424272415____________________ + ___________________ = AFR% _________ ______________________EXPLANATION OF ADMINISTRATION AND FUNDRAISING RATIO FORM(REQUIRED OF NONPROFITS WITH AN AFR OF 35% OR HIGHER)Per CCC bylaws, administration and fundraising costs shall not exceed 35% of the total expenses of the charitable organization. If these costs exceed 35% of total expenses in any given year, the nonprofit organization must submit an explanation as to why 35% has been exceeded. is submitting an application with an AFR % of ______ because we experienced the following situations(s):8572517081500Absence of direct services/high overhead expenses8572513017500Investments in personnel and programming9525013652500Major fundraising initiatives/changes in funding9525015240000Other: Detailed Explanation (Required and Includes):How situation has directly affected AFR calculationAFRs for the last 3 yearsPlans to address situation(s) which caused an AFR over 35% or explanation why operationally your organization has AFRs over 35% _________________________________________________________SignatureDate STATE ASSOCIATION STATEMENT FORM Per CCC bylaws, an organization must have a direct association with a unit of government of the State of Colorado (a department, division, agency, office, college, university, etc.) to apply as a CUSSO. Please check the box that applies to your organization:5524502095500The State of Colorado has ownership of capital improvements or equipment that supports the applicant organization. (Example: your organization utilizes equipment or other assets owned by a unit of state government.)5524502159000The State of Colorado shares operations or maintenance funding that supports the applicant organization. (Example: your organization is physically housed within a unit of state government.)5524504127500The applicant organization, through a direct relationship, provides enhanced services to a State of Colorado agency. (Example: your organization is the nonprofit arm of a unit of state government.)552450381000The named organization acts as an agent of the state to operate, manage or administer a function of the State of Colorado. (Example: your organization is contracted by a unit of state government to operate a program or provide a service.)The applicant organization has a direct association with the following department of the state of Colorado.Name of the department of direct association: Describe the relationship indicated by the statement checked above. This statement should address the specific criteria of the checked box AND IS REQUIRED. [For example, a list of equipment owned by the state, types of direct service provided to a state agency, management function served, etc.]STATEMENT OF LOCAL PRESENCE FORMPer CCC bylaws, an organization must have a physical presence within the state of Colorado.Bylaws Section VIII (A) (15e):All Charitable Organizations must ensure that they demonstrate that their programs reside within and serve the state of Colorado as evidenced by the presence within the state of Colorado of a staffed facility at which goods or services may be obtained such as an office, clinic, mobile unit or field agency. If your organization does not have a physical address or presence in the state of Colorado as described in the CCC Bylaws, provide an explanation and verification (budget, funding list, etc.) of how your organization serves the state of Colorado. Please include but do not limit your explanation to the following:Number of Coloradans served in the 2018 calendar.Amount of funds spent and/or grants funded in Colorado.Programs supported in Colorado. ................
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