Form 990 Checklist
Form 990 QuestionnairePlease be sure to provide a complete questionnaire (we get a lot of incomplete questionnaires). See the last page for info about how to submit your questionnaire.Unless stated otherwise, all questions relate to the fiscal year reported on this Form 990.The IRS does not charge a filing fee for submitting Form 990. Some states require a filing similar to Form 990 and some of them assess fee for filing their report. If so, MCG might pay that fee on your behalf and add it to our pleting this questionnaire electronically using anything other than Microsoft Word? usually results in a loss of formatting and/or data integrity. If you do not have access to Word let us know so we can send a /pdf copy to fill out by hand.This info will get us started. It is possible we will need additional info as the process goes forward—if so, we’ll contact you.The filing deadline is the 15th day of the fifth month after the end of your fiscal year (May 15 if you operate on a calendar year basis); we need your data as soon after your fiscal year-end as possible but not later than 10 days before the filing deadline. Otherwise, we will probably need to apply for a six-month filing extension.By submitting this questionnaire to MCG, you are certifying that the information it contains is accurate and complete and that it may be relied upon to prepare Form 990 or Form 990EZ or Form 990-N for the period indicated.This info was provided by: Name: FORMTEXT ????? Phone: FORMTEXT ????? E-mail: FORMTEXT ?????This questionnaire covers the fiscal year ending: Month FORMTEXT ????? Year FORMTEXT ????Info about your organization:Organization’s name FORMTEXT ?????Federal ID number FORMTEXT ?????Mailing address FORMTEXT ?????Physical address FORMTEXT ????? Check here if either address is different from last year FORMCHECKBOX Organization’s phone FORMTEXT ?????Organization’s web site FORMTEXT ?????Organization is a FORMCHECKBOX Corporation FORMCHECKBOX Trust FORMCHECKBOX Association FORMCHECKBOX FORMTEXT ?????Date incorporated FORMTEXT ?????State where incorporated FORMTEXT ?????Principal officer's name FORMTEXT ?????His/her SSN FORMTEXT ?????His/her date of birth FORMTEXT ?????Did your organization cease operations this year? FORMCHECKBOX Yes FORMCHECKBOX NoDid your organization engage in significant program services this year not reported on any previous Form 990? (if yes, provide a complete explanation). FORMCHECKBOX Yes FORMCHECKBOX NoDid your organization cease conducting or make significant changes to any program services? (if yes, provide a complete explanation). FORMCHECKBOX Yes FORMCHECKBOX NoCheck if: FORMCHECKBOX Initial return FORMCHECKBOX Final return FORMCHECKBOX Change of address FORMCHECKBOX Change of nameOrganization is tax-exempt under: Section 501(c) FORMDROPDOWN Section 527 FORMCHECKBOX Who will sign the Form 990? Name: FORMTEXT ?????Position: FORMTEXT ????? Signer’s social security number FORMTEXT ?????Signer’s date of birth FORMTEXT ?????We automatically set up for you to electronically sign the Form 990 e-file authorization. Check here if you prefer to sign manually. FORMCHECKBOX I prefer to sign manually.Who has custody of the books?Name: FORMTEXT ????? Phone: FORMTEXT ????? Address: FORMTEXT ?????Has your organization filed Form 1023 or Form 1024 (application for IRS recognition of tax-exempt status)? FORMCHECKBOX Yes, we have received a determination letter from the IRS acknowledging our tax exempt status. FORMCHECKBOX Yes, it has been submitted to the IRS, but we are awaiting final approval. FORMCHECKBOX No, our revenue is less than $5000/year; therefore, we are not required to file Form 1023 or Form 1024. FORMCHECKBOX No, we need MCG's assistance in preparing Form 1023 or Form 1024 (MCG will send another questionnaire to get the necessary info). FORMCHECKBOX No, we plan to prepare/file Form 1023 or Form 1024 on our own before the filing deadline.In a sentence or two (220 or fewer characters), describe your organization's mission: FORMTEXT ?????Did you receive more than $1000 of unrelated business income (UBI). Income is UBI if the activity that produced it is not directly related to your exempt purpose, even if the income it generated is used exclusively to advance your exempt purpose. Note that regularly carried-on internet retail sales and advertising income are almost always considered UBI. FORMCHECKBOX No FORMCHECKBOX Yes—filing Form 990-T is required; please phone us immediately. Does your organization have to file a year-end report with one of more states? (If you’re not sure, assume you have to file in your home state) FORMCHECKBOX Yes, we are required to file with the following state(s) FORMTEXT ????? and: FORMCHECKBOX we want MCG to prepare it FORMCHECKBOX we will prepare it ourselves. If yes, ignore L, and complete the remainder of this questionnaire FORMCHECKBOX No, we are exempt from having to file a year-end report with all states To see if you are eligible for the super simple Form 990-N, complete this chart:Gross Income (from all sources)Total ExpenseTotal Program Service Expense**Total Assets***Current report year FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ?????First previous year FORMTEXT ?????Second previous year FORMTEXT ?????Average income * FORMTEXT ?????* Average Income is the total of the three years divided by the number of years that had a balance greater than zero.** Program Service Expense is the amount spent to run your programs. It is total expense minus admin & fundraising costs.*** For small organizations this is usually the year-end balance of all bank accounts plus cash on hand.Based on the chart above, was your organization’s average gross income greater than: $75,000 if this was your very first year, or $60,000 if your organization has existed 1-3 years, or $50,000 if your organization has existed more than 3 years? FORMCHECKBOX Yes—you are not eligible to file Form 990-N. Complete the remainder of the questionnaire. FORMCHECKBOX No—you are eligible to file Form 990-N. You do not need to complete the remainder of this questionnaire; return to MCG only pages 1 and 2.Board Members & Corporate Officers— include former members/officers if they served at any time during the report year FORMCHECKBOX Check here if any board member or officer can NOT be reached at the organizations' address and provide their address on the last page.NamePosition(s) (e.g., board member, President, etc.) (List all that apply)Board MbrOfficerFormerHours/Week This OrgHours/Week Related OrgsAnnual Comp from This OrgComp from Related OrgsBenefits from This Org FORMTEXT ????? FORMTEXT ????? FORMCHECKBOX FORMCHECKBOX FORMCHECKBOX FORMTEXT ??? FORMTEXT ??? FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMCHECKBOX FORMCHECKBOX FORMCHECKBOX FORMTEXT ??? FORMTEXT ??? FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMCHECKBOX FORMCHECKBOX FORMCHECKBOX FORMTEXT ??? FORMTEXT ??? FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMCHECKBOX FORMCHECKBOX FORMCHECKBOX FORMTEXT ??? FORMTEXT ??? FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMCHECKBOX FORMCHECKBOX FORMCHECKBOX FORMTEXT ??? FORMTEXT ??? FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMCHECKBOX FORMCHECKBOX FORMCHECKBOX FORMTEXT ??? FORMTEXT ??? FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMCHECKBOX FORMCHECKBOX FORMCHECKBOX FORMTEXT ??? FORMTEXT ??? FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMCHECKBOX FORMCHECKBOX FORMCHECKBOX FORMTEXT ??? FORMTEXT ??? FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMCHECKBOX FORMCHECKBOX FORMCHECKBOX FORMTEXT ??? FORMTEXT ??? FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMCHECKBOX FORMCHECKBOX FORMCHECKBOX FORMTEXT ??? FORMTEXT ??? FORMTEXT ????? FORMTEXT ????? FORMTEXT ?????List any other person or entity (other than corporations) you paid $100,000 or more for services rendered during the report year Note: these entities should have received Form 1099-MISC for these payments. Compensation includes salaries, wages, housing allowances, bonuses, stipends, contractor payments, etc; do not include purchases of merchandise; do include the cost of parts if they were associated with services rendered.NamePositionAddressCompensationBenefits FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ?????In no more than 1-3 brief sentences each, describe your top program service accomplishment(s).# People ImpactedVolunteers UtilizedExpenses *Direct Revenue **Grants Received FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ?????All other programs FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ?????Total expenses (this total must equal the Program Expense total in #34 below) FORMTEXT ?????* Don’t forget to include the value of donated services in program expenses if those expenses are included in the program expenses column of question #34 below.** Direct revenue includes any revenue derived directly from the activity, such as fees for services or from the sale of goods that directly relate to the listed activity. This revenue includes program service revenue, investment income, royalties, rents, net sales of inventory, and fundraising event income.QuestionYesNoExplanation or Other ResponseLast year's Form 990 was... FORMCHECKBOX Prepared by MCG FORMCHECKBOX Not required to file FORMCHECKBOX Required but not filed FORMCHECKBOX Prepared elsewhere—send a copy of Form 990 for the last TWO yearsCheck the exempt purpose(s) for which the organization exists as stated in your Articles of Incorporation, Code of Regulations, Constitution, or By-Laws (check all that apply; if you are not sure, refer to your Articles of Incorporation or to a previous Form 990 or to Form 1023): FORMCHECKBOX Religious FORMCHECKBOX Charitable FORMCHECKBOX Educational FORMCHECKBOX Scientific FORMCHECKBOX Literary FORMCHECKBOX Testing for public safety FORMCHECKBOX Amateur sports FORMCHECKBOX Prevention of cruelty to children or animalsAre any board members or corporate officers related to one another (by blood, marriage, or significant business/financial dealings)? FORMCHECKBOX Explain FORMCHECKBOX FORMTEXT ?????How many times did the board of directors meet during the year? FORMTEXT ??Were all board and committee meetings and decisions contemporaneously documented (i.e., did you keep minutes)? FORMCHECKBOX FORMCHECKBOX a. Number of voting board members b. Number of independent voting board members (i.e., not related to another board member; not on the organization's payroll)a. FORMTEXT ??b. FORMTEXT ??Does any board member or officer (or anyone related to them) also serve on the board of any entity with whom this organization has a business or other significant relationship? FORMCHECKBOX Explain FORMCHECKBOX FORMTEXT ?????Did the organization make any loans to or receive loans from any board member, officer or other person with whom it has a significant business/financial relationship (or anyone related to them)? FORMCHECKBOX Explain FORMCHECKBOX FORMTEXT ?????Did any person or entity receive an economic benefit OR use any of the organization’s resources that was:a. Not formally authorized by the organizationb. Not reasonable in nature or amountc. Not properly reported for tax purposesa. FORMCHECKBOX Explain b. FORMCHECKBOX Explain c. FORMCHECKBOX Explain a. FORMCHECKBOX b. FORMCHECKBOX c. FORMCHECKBOX a. FORMTEXT ?????b. FORMTEXT ?????c. FORMTEXT ?????How many of these tax forms did you issue for the report year? Form 1099-MISC or 1099-NEC FORMTEXT ?? From W2G FORMTEXT ?? Form W2 FORMTEXT ?? (if greater than 0, check here if you filed all required employment tax returns FORMCHECKBOX )Did the organization have an interest in or signature authority over a financial account (of any type) in a foreign country? FORMCHECKBOX Explain FORMCHECKBOX FORMTEXT ?????Did the organization receive non-cash contributions (not including the value of donated services or donated facilities) with an aggregate value over $25,000 during the year? FORMCHECKBOX Explain FORMCHECKBOX FORMTEXT ?????Did the organization invest in, contribute assets to, or participate in a joint venture or similar arrangement with a taxable entity? FORMCHECKBOX Explain FORMCHECKBOX FORMTEXT ?????Was the organization involved a partnership or other joint venture for which Schedule K-1 (Form 1065) was received? FORMCHECKBOX Explain FORMCHECKBOX FORMTEXT ????? If yes, send a copy of Sch K-1; K-1 income usually must be treated as unrelated business income.Did the organization lobby any legislative body (Congress, state legislature, city council, school board, etc)? FORMCHECKBOX Explain FORMCHECKBOX FORMTEXT ?????Did you make significant changes to what you do or to your governing documents since the latter of a) the date your Form 1023 was approved or b) filing your most recent Form 990? FORMCHECKBOX Explain FORMCHECKBOX FORMTEXT ?????QuestionYesNoExplanation and/or ResponseDo you have a written conflict of interest policy? (Note: this is sometimes incorporated into your constitution or bylaws) FORMCHECKBOX FORMCHECKBOX If no, check here if you desire to hire MCG to assist in creating one FORMCHECKBOX Do you have a written whistle blower policy? (Note: this is sometimes incorporated into your constitution or bylaws) FORMCHECKBOX FORMCHECKBOX If no, check here if you desire to hire MCG to assist in creating one FORMCHECKBOX Do you have a written document retention and destruction policy? (Note: this is sometimes incorporated into your constitution or bylaws) FORMCHECKBOX FORMCHECKBOX If no, check here if you desire to hire MCG to assist in creating one FORMCHECKBOX Are officers, directors and key employees required to annually report any interests that could result in a conflict of interest? FORMCHECKBOX Explain FORMCHECKBOX FORMTEXT ?????Did the organization engage in a business transaction with any current or former (who served in the previous five years) board member, officer or key employee, or any person related to such a person or any business in which such a person is involved? FORMCHECKBOX Explain FORMCHECKBOX FORMTEXT ?????Is all compensation for officers, directors and key employees subject to each of the following (hint: it must be!): a) review and approval by the board independent of undue influence from the affected employee, b) a review of compensation data for people in comparable positions with other organizations, and c) written documentation of the entire decision-making process and final result. FORMCHECKBOX FORMCHECKBOX Did you solicit any donations that were not tax deductible? FORMCHECKBOX FORMCHECKBOX Did you receive one or more payments of more than $75 made partly as a contribution and partly in exchange for goods or services provided to the payer?If yes, did you notify the donor of the value of the goods or services provided and include only the net amount in the donation receipt? FORMCHECKBOX Explain FORMCHECKBOX FORMCHECKBOX FORMCHECKBOX FORMTEXT ?????Did all donation acknowledgments include all five of the following: a) your organization's name, b) your organization's address, c) the donor's name, d) a list itemized by date of all donations (i.e., not just a total), e) a disclaimer statement (such as, 'Donor received no goods or services in exchange for these donations'. FORMCHECKBOX FORMCHECKBOX Did you maintain an office, employees or agents outside the US? FORMCHECKBOX Explain FORMCHECKBOX FORMTEXT ?????Did you have total revenue or expense of more than $10,000 from grantmaking, fundraising, business or program service activities out the US or aggregate foreign investments of $100,000 or more? FORMCHECKBOX Explain FORMCHECKBOX FORMTEXT ?????Did you have more than $5000 of aggregate grants or assistance to any organization or entity outside the US? FORMCHECKBOX Explain FORMCHECKBOX FORMTEXT ?????Did you have more than $5000 of aggregate grants or assistance to individuals outside the US? FORMCHECKBOX Explain FORMCHECKBOX FORMTEXT ?????a. Did you receive a donation of an airplane, boat or car?b. If yes, did you issue Form 1098-C to the donor and to the IRS?a. FORMCHECKBOX Explain b. FORMCHECKBOX a. FORMCHECKBOX b. FORMCHECKBOX a. FORMTEXT ?????a. Did you sell, exchange, or otherwise dispose of any donated car (valued at $500 or more) or any other item (valued at $5000 of more) within two years of receiving the donated item? b. If yes, did you issue Form 8282 to the donor and to the IRS?a. FORMCHECKBOX Explain b. FORMCHECKBOX a. FORMCHECKBOX b. FORMCHECKBOX a. FORMTEXT ?????Were any changes made to beginning net assets (other than recording current year net income)? FORMCHECKBOX Explain FORMCHECKBOX FORMTEXT ?????Financial Data FORMCHECKBOX We were an MCG' AdMinistry client at the end of the report year: you do not need to complete the Items in red. Responses to all other questions are still required. FORMCHECKBOX We were NOT an MCG' AdMinistry client at the end of the report year: ALL of the financial data questions on the following pages must be completed. We cannot complete Form 990 without this information! In lieu of providing this financial data you can send a balance sheet, income statement, and donor summary (including address info), preferably in Excel format. However, that generally requires more of our time to parse and format the data which could result in a commensurately larger preparation fee. We are happy to do that; we just want to make you aware of this potentially cost saving option.Report all income and expenses for the report period (i.e., your fiscal year). If your fiscal year is not a calendar year, your payroll expenses may be different than the amount reported on your Forms W-2.Accounting basis: FORMCHECKBOX Accrual FORMCHECKBOX Cash FORMCHECKBOX Modified cashIncome for the report year (prior year data needed only if MCG did not prepare your Form 990 last year). Please round all amounts to the nearest dollar (no cents)Income CategoriesReport YearPortion received from 501C3 EntitiesFirst Previous YearSecond Previous YearFederal campaigns FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ?????Membership dues FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ?????Fundraising events; if the amount is $15,00 or more please provide below a description and income/expense report for each event FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? Direct expenses for fundraising events FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ?????Income from related organizations FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ?????Government grants FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ?????All other donations, gifts, & grants FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ?????Value of donated high-end professional services not included above * FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ?????Value of other non-cash donations received * FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ?????Program fees: FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ?????Program fees: FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ?????Program fees: FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ?????Program fees: FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ?????Interest & other investment income FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ?????Royalty income FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ?????Gross rental income FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? Less: rental expenses FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? Was the rental property subject to a mortgage FORMCHECKBOX Yes FORMCHECKBOX No Was the property rented exclusively to one or more tax-exempt entities? FORMCHECKBOX Yes FORMCHECKBOX NoGross proceeds from sales of assets other than inventory FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? Less: costs basis of assets sold FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ?????Sales of inventory items FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? Cost of inventory items purchased (whether sold or still in inventory) FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ?????Total Income FORMTEXT ????? FORMTEXT ?????* Include only if you use the accrual basis of accounting; if you record non-cash amounts also complete #40 below.Expenses for the report year. If gross income is less than $200,000 and net assets is less than $500,000, you only need to complete the ‘Annual Total’ column. If gross income exceeds $200,000 or if net assets exceed $500,000, expenses MUST be allocated between Program Services, Management & General, and Fundraising (the lavender section). Further, the Program Services total MUST be equal to the program initiatives expense total in Question #3 (on page 3).Please round all amounts to the nearest dollar (no cents)Allocation of Total Expense required only if your gross income was $200k or greater or net assets were $500k or greaterRequired if MCG did not prep Form 990 last yearExpense CategoriesAnnual TotalProgram ServicesManagement & GeneralFund Raising1st Prev Year2nd Prev YearGrants paid from donor advised funds FORMTEXT ????? FORMTEXT ????? FORMTEXT ?????Other grants paid; if > $5000 provide a list of recipients, addresses & amounts FORMTEXT ????? FORMTEXT ????? FORMTEXT ?????Assistance to individuals; if > $5000 provide a list of recipients, addresses & amounts FORMTEXT ????? FORMTEXT ????? FORMTEXT ?????Benefits paid to or for members FORMTEXT ????? FORMTEXT ????? FORMTEXT ?????Compensation: current officers & directors FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ?????Compensation: former officers & directors FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ?????Compensation: all others FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ?????Pension plan contributions FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ?????Other employee benefits FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ?????Payroll taxes paid by employer FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ?????Management fees FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ?????Legal fees FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ?????Accounting fees FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ?????Lobbying fees FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ?????Professional fundraising fees FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ?????Investment management fees FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ?????Other professional fees FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ?????Advertising & promotion FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ?????Office expenses FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ?????Information technology FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ?????Royalties paid FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ?????Occupancy costs (rent/util/insurance/etc) FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ?????Travel FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ?????Conferences, conventions & meetings FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ?????Interest expense FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ?????Payments to affiliates FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ?????Depreciation & depletion* FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ?????Insurance FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ?????Value of non-cash donations received FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ?????Value of donated professional services* FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ?????Other: FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ?????Other: FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ?????Other: FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ?????Other: FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ?????Other: FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ?????Other: FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ?????Totals FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ?????* Include only if you use the accrual basis of accounting This total must equal the expense total in #3 on page 3Balance sheet as of the last day of the fiscal year (prior year data needed only if MCG did not prepare your Form 990 last year). Please round all amounts to the nearest dollar (no cents)Assets * accrual-based accounting onlyBeginning of YearEnd of YearLiabilities* accrual-based accounting onlyBeginning of YearEnd of YearChecking accounts & cash on hand FORMTEXT ????? FORMTEXT ?????* Accounts payable FORMTEXT ????? FORMTEXT ?????Savings accounts FORMTEXT ????? FORMTEXT ?????* Grants payable FORMTEXT ????? FORMTEXT ?????Amounts receivable from directors, officers and key employees FORMTEXT ????? FORMTEXT ?????Loans payable to officers, directors, and key employees FORMTEXT ????? FORMTEXT ?????* Other accounts receivable FORMTEXT ????? FORMTEXT ?????* Deferred revenue FORMTEXT ????? FORMTEXT ?????* Other notes and loans receivable FORMTEXT ????? FORMTEXT ?????* Tax-exempt bond liability FORMTEXT ????? FORMTEXT ?????* Inventories FORMTEXT ????? FORMTEXT ?????* Mortgages/other notes payable FORMTEXT ????? FORMTEXT ?????* Pre-paid expenses FORMTEXT ????? FORMTEXT ?????* Other liability: FORMTEXT ????? FORMTEXT ????? FORMTEXT ?????* Fixed assets other than real estate FORMTEXT ????? FORMTEXT ?????* Other liability: FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? * Accumulated depreciation FORMTEXT ????? FORMTEXT ?????Net Assets* Real estate FORMTEXT ????? FORMTEXT ?????Complete this section if you follow SFAS 117 * Accumulated depreciation FORMTEXT ????? FORMTEXT ?????Unrestricted net assets FORMTEXT ????? FORMTEXT ?????* Other asset: FORMTEXT ????? FORMTEXT ????? FORMTEXT ?????Temporarily restricted net assets FORMTEXT ????? FORMTEXT ?????* Other asset: FORMTEXT ????? FORMTEXT ????? FORMTEXT ?????Permanently restricted net assets FORMTEXT ????? FORMTEXT ?????* Other asset: FORMTEXT ????? FORMTEXT ????? FORMTEXT ?????Complete this section if you do not follow SFAS 117* Other asset: FORMTEXT ????? FORMTEXT ????? FORMTEXT ?????Capital stock/trust principal FORMTEXT ????? FORMTEXT ?????* Other asset: FORMTEXT ????? FORMTEXT ????? FORMTEXT ?????Paid-in or capital surplus FORMTEXT ????? FORMTEXT ?????* Other asset: FORMTEXT ????? FORMTEXT ????? FORMTEXT ?????Retained earnings FORMTEXT ????? FORMTEXT ?????* Other asset: FORMTEXT ????? FORMTEXT ????? FORMTEXT ?????Total net assets/fund balance FORMTEXT ????? FORMTEXT ?????Beginning total net assets/equity+ FORMTEXT ?????Total income (question #33 above)+ FORMTEXT ?????Total expenses (question #35 above)- FORMTEXT ?????Ending total net assets/equity= FORMTEXT ?????Please note: Beginning net assets plus total income minus total expenses MUST equal ending net assets. A discrepancy in this computation is the most common financial data error we encounter. Form 990 cannot be completed until these figures agree.List here any items reported on previous Forms 990 as assets that were sold (or otherwise disposed of) during the report year)DescriptionOriginal CostDepreciation Expense Previously TakenNet Sales Price FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ?????Fundraising events. Please round all amounts to the nearest dollar (no cents)DescriptionGross IncomeDonations Included in Gross Inc.Cash Prizes Noncash PrizesFacilityFood & BeveragesEnter-tainmentOther Costs FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ?????Donors: Enter here the total amount you received from donations including grants: FORMTEXT ????? X 2% = FORMTEXT ?????Enter the greater of $5000 or the amount computed on the previous line: FORMTEXT ????? (This is the reportable amount)List each person, business or other entity (include grants) whose cash and non-cash donations totaled more than the reportable amountYou are permitted (but not required) to omit from your calculations any individual donation that was less than $1,000 (i.e., include only those donations that were $1,000 or higher). Check the TE box if the entity is tax-exempt. Round all amounts to the nearest dollar. NameTEAddressCashNon-Cash*Check here if no donor gave or more than the reportable amount FORMCHECKBOX then skip to the next question. FORMTEXT ????? FORMCHECKBOX FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMCHECKBOX FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMCHECKBOX FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMCHECKBOX FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMCHECKBOX FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMCHECKBOX FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMCHECKBOX FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMCHECKBOX FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMCHECKBOX FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMCHECKBOX FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMCHECKBOX FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMCHECKBOX FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMCHECKBOX FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMCHECKBOX FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMCHECKBOX FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMCHECKBOX FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMCHECKBOX FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMCHECKBOX FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMCHECKBOX FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMCHECKBOX FORMTEXT ????? FORMTEXT ????? FORMTEXT ?????* For non-cash amounts you must also complete the chart on the next page.Substantial Donors This computation is a little tricky. Just follow the instructions. Hint: if you made this computation if previous years you can simply copy those previous year amounts to the appropriate column on this year’s questionnaire.3rd Prev Year2nd Prev Year1st Prev YearReport YearGifts, grants, contributions and membership fees received FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ?????2% of the amount on line a FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ?????Add up the total donations for all donors whose individual donations for the year exceeded the amount on line b. Do not include governmental units or publicly supported organizations. FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ?????How many donors are included in the amount recorded on line c? FORMTEXT ??? FORMTEXT ??? FORMTEXT ??? FORMTEXT ???Line b times line d FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ?????Line c minus line e FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ?????Non-Cash Donors: list any person, business or other entity who made non-cash donations with a fair-market value that is more than the lesser of a) $5000 or b) 2% of donations, gifts, grants and similar receipts. Do not include any of the following: a) reimbursements or b) items that were negligible in value or c) the value of donated services.1 Name FORMTEXT ?????Address FORMTEXT ?????Value of item given FORMTEXT ?????Description FORMTEXT ?????Date FORMTEXT ?????2 Name FORMTEXT ?????Address FORMTEXT ?????Value of item given FORMTEXT ?????Description FORMTEXT ?????Date FORMTEXT ?????3 Name FORMTEXT ?????Address FORMTEXT ?????Value of item given FORMTEXT ?????Description FORMTEXT ?????Date FORMTEXT ?????4 Name FORMTEXT ?????Address FORMTEXT ?????Value of item given FORMTEXT ?????Description FORMTEXT ?????Date FORMTEXT ?????5 Name FORMTEXT ?????Address FORMTEXT ?????Value of item given FORMTEXT ?????Description FORMTEXT ?????Date FORMTEXT ?????Explanations (use this section to provide explanations for any item(s) recorded in this questionnaire)QuestionExplanation FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ?????Send the completed questionnaire together with the requested material to MCG: (Please send documents that contain sensitive info via our secure web portal; do not send via e-mail) MCG’s web portal Forgot your password? Click the ‘Lost Password’ link. Don’t have an MCG web portal account? Use the Guest Exchange feature.Or mail to MCG; PO Box 81, Chesterville OH 43317-0081 Or fax to: 614-340-7909. If you have questions, please call 614-707-7500 ................
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