Raiser Statement Inspection Form PDF Details

A raiser statement inspection form is an important document for any nonprofit organization. This document helps to track the donations that have been made to the organization, and can be used as proof of donation for tax purposes. In order to ensure that your organization is using this form accurately and efficiently, it is important to understand the contents of the form and what information is required. This blog post will provide an overview of the raiser statement inspection form, including what information is included on the form and how it should be used. Stay tuned for future posts in which we will provide more detailed instructions on how to complete the raiser statement inspection form correctly.

You will discover more details concerning the raiser statement inspection form by looking through the table our team put together for you.

QuestionAnswer
Form NameRaiser Statement Inspection Form
Form Length4 pages
Fillable?No
Fillable fields0
Avg. time to fill out1 min
Other namesraiser chicago vehicle inspection form, New_York, PFR, 7-A

Form Preview Example

Form CHAR037

Professional Fund Raiser Interim /Closing Statem ent

 

New York State Department of Law (Office of the Attorney General)

Open to Public

 

 

Charities Bureau

 

 

The Capitol

Inspection

Article 7-A of the Executive Law

 

Albany, NY 12224

 

 

 

http://www.CharitiesNYS.com

 

 

 

 

 

 

Part A - Identification of Contracting Professional Fund Raiser(s)

1. Name of Contracting Professional Fund Raiser(s)

2. NYS PFR ID#

___ ___ - ___ ___ - ___ ___

___ ___ - ___ ___ - ___ ___

Part B - Identification of Contracting Charitable Organization(s)

1. Name of Contracting Charitable Organization(s)

2. NYS CHARITY ID#

___ ___ - ___ ___ - ___ ___

___ ___ - ___ ___ - ___ ___

Part C - Statement Information

1.Contract Period (Must coincide with the contract period set forth in the corresponding contract)

Start: __ __ / __ __ / __ __ __ __

End: __ __ / __ __ / __ __ __ __

2.Contract Year (if Multi-Year Contract)

Start: __ __ / __ __ / __ __ __ __

End: __ __ / __ __ / __ __ __ __

3.Campaign Dates Covered by Statement (Must be within the Contract Period or Contract Year)

Start: __ __ / __ __ / __ __ __ __

End: __ __ / __ __ / __ __ __ __

4.Original Filing ID of Corresponding Contract (Refer to this office’s Notice of Receipt of Contract sent to the PFR upon the filing of the original corresponding contract.)

 

 

 

 

 

 

5.

Type of Statement:

G Interim Statement

G Closing Statement

 

 

 

 

6.

Were services provided at any time other than during the Contract Period (C1) or, for multi-year contracts, the Contract Year (C2)? G Yes G No

 

 

 

 

 

 

Part D - Certification

We, an authorized representative of the Professional Fund Raiser and an authorized representative of the Charitable Organization, certify under the penalties for perjury, that we reviewed this Interim/Closing Statement, and to the best of our knowledge and belief, it is true, correct and complete in accordance with the laws of the State of New York applicable to this statement.

1. Professional Fund Raiser

PFR Representative

Signature

2. Charitable Organization

Charity Representative

Signature

Printed Name

Title

Date

Printed Name

Title

Date

FOR OFFICE

USE ONLY

DATE RECEIVED

CONTRACT FILING ID#

CHAR 037 FILING ID#

BEGINNING DATE

PFR ID#

END DATE

CHARITY ID#

NEXT CHAR037 DUE DATE

Page 1 of 3

Form CHAR037 (2010)

Part E - Activity and Conduct

1. Specify the methods of solicitation (Column A) and the types of contributions solicited (Column B). (Check all that apply.)

COLUMN A

 

COLUMN B

 

Telemarketing

G

Monetary Contributions

G

Direct Mail

G

Donation of New or Used Goods

G

Door to Door

G

Tickets to a Dinner/Gala/Other Special Event

G

Electronic Media (TV, Radio)

G

Ads in a Publication/Magazine

G

Print Media

G

Purchase of a Product

G

Internet

G

Grants

G

Email

G

Volunteers

G

Other (please describe):

G

Other (please describe):

G

2.Did this campaign involve the solicitation of persons in New York State only, the solicitation of persons in New York State and other states or the solicitation of persons only in other states?

New York State Only. . . . . . . . . . . . . . . . . . . . . .G (Complete only Columns I and II in Part F - Financial Report (page 3))

New York State and Other States . . . . . . . . . . . G. (Complete all Columns in Part F - Financial Report (page 3))

Other States Only.. . . . . . . . . . . . . . . . . . . . . . . G. (Do not complete Part F - Financial Report (page 3), but provide below an explanation as to why the corresponding contract was filed with the Charities Bureau.)

Explanation:

3.Within five days of receipt, were all contributions received from solicitation activity under this contract deposited in a bank account under the exclusive control of the charitable organization listed above?.................G Yes* G No* G Not Applicable (PFR had no access to contributions)

*If “Yes” or “No”, complete account information below:

Bank Name:

Bank Address:

Account Name:

4. Did the professional fund raiser subcontract any contractual services to an third party during the specified Contract Period or, if a multi-year contract, the Contract Year? . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . G Yes* G No

*If “Yes,” provide each subcontractor’s name, NY PFR ID#, address and telephone number.

Subcontractor Name & NYS PFR ID#

Subcontractor Address (Number and street, Room/Suite,

City or town, state or country and ZIP+ 4)

Subcontractor Phone Number

5. Has the professional fund raiser provided all contractual services and has the charitable organization received all contractual monetary payments

required by the contract?

G Yes G No*

*If “No,” provide an explanation:

Page 2 of 3

Form CHAR037 (2010)

Part F - Financial Report

If the campaign involved only the solicitation of persons in New York State, complete Columns I and II. If the campaign involved the solicitation of persons in New York State and other states, complete Columns I, II, III and IV.

New York

 

 

 

All States

Column I

Column II

 

Column III

Column IV

 

 

 

 

 

 

1.

GROSS REVENUE

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

a.

Monetary Contributions Solicited By PFR

 

$

 

 

 

$

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

b.

Advertisement Sales

 

$

 

 

 

$

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

c.

Entertainment Sales/Admission Charges

 

$

 

 

 

$

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

d.

Other Product Sales (Identify Product:

)

$

 

 

 

$

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

e.

Monetary Contributions Solicited By PFR Recruited Volunteers

 

$

 

 

 

$

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

f.

Other Revenue Source (Describe:

)

$

 

 

 

$

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

g.

Other Revenue Source (Describe:

)

$

 

 

 

$

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

h.

Other Revenue Source (Describe:

)

$

 

 

 

$

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

i.

. . . .TOTAL GROSS REVENUE (Add lines #1a through #1h)

 

 

$

 

 

 

$

 

2.

EXPENSES

 

 

 

 

 

 

 

 

a.

PFR’s Remuneration/Fee

 

$

 

 

 

$

 

 

b.

Salaries & Benefits For Professional Solicitors,

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Office Manager, Other PFR Employees

 

$

 

 

 

$

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

c.

Subcontractor’s Fee (Identify Subcontractor(s) in Part E4)

 

$

 

 

 

$

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

d.

Permits, Licenses, Registration Fees, Etc

 

$

 

 

 

$

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

e.

Office Rent, Office Utilities, Office Insurance

 

$

 

 

 

$

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

f.

Office Supplies, Other Office Expenses

 

$

 

 

 

$

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

g.

Computer/Data Processing Service Fees

 

$

 

 

 

$

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

h.

Telephone

 

$

 

 

 

$

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

i.

Printing

 

$

 

 

 

$

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

j.

Advertising

 

$

 

 

 

$

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

k.

List Rentals

 

$

 

 

 

$

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

l.

Postage & Shipping

 

$

 

 

 

$

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

m.

Show/Event Fee

 

$

 

 

 

$

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

n.

Show/Event Facilities Rental Fee & Insurance

 

$

 

 

 

$

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

o.

Cost of Merchandise For Resale

 

$

 

 

 

$

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

p.

Other Expense (Describe:

)

$

 

 

 

$

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

q.

Other Expense (Describe:

)

$

 

 

 

$

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

r.

Other Expense (Describe:

)

$

 

 

 

$

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

s.

Other Expense (Describe:

)

$

 

 

 

$

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

t.

. . . . . . . . .TOTAL EXPENSES (Add lines #2a through #2s)

 

 

$(

)

 

 

$(

)

 

 

 

 

 

 

 

 

 

 

 

 

 

 

3.

NET AMOUNT RETAINED BY THE CHARITY

 

 

 

 

 

 

 

 

 

(Subtract line #2t from line #1i)

 

 

$

 

 

 

$

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

4.

AD D ITIO N AL GU AR AN TEED M O N IES PAID TO TH E C H AR ITY

 

$

 

 

 

$

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

5.

MISCELLANEOUS

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

a.

Uncollected Pledges as of the Date of this Report

 

$

 

 

 

$

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

b.

In-Kind (Non-Cash) Donations (Describe:

 

)

$

 

 

 

$

 

 

c.

Professional Fund Raiser’s Profit/Loss (Optional)

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

(not the same as line #2a)

 

$

 

 

 

$

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Page 3 of 3

Form CHAR037 (2010)

New York State Departm ent of Law (Office of the Attorney General) Charities Bureau

Instructions for Form CHAR037 (Professional Fund Raiser Interim/Closing Statement)

and Summary of Filing Requirements for Professional Fund Raiser Interim/Closing Statements

http://www.CharitiesNYS.com

Important Notice: These Instructions and Summary are intended to provide assistance in completing Form CHAR037. Also included is information on the filing requirements relating to Professional Fund Raiser Interim/Closing Statements. For additional information on registration and filing requirements pursuant to the Executive Law, registrants and potential registrants are encouraged to familiarize themselves with §171-a through §177 of Article 7-A of the Executive Law and NYCRR Title 13, Chapter V, Parts 90 - 99.

I.General Instructions in Completing Form CHAR037

A.Type or print in ink the responses to all items on pages 1 - 3 of Form CHAR037. Enter "NA" for any item that is not applicable.

B.In all instances "PFR Representative" or an “authorized representative of the Professional Fund Raiser” shall mean an owner, partner, director, officer, manager or key employee of the contracting PFR.

C.In all instances "Charity Representative" or an “authorized representative of the Charitable Organization” shall mean an officer, director or key employee of the contracting Charity.

D.The Financial Report (Part F, page 3) must report, on an accrual basis, all revenues received by or on behalf of the charitable organization(s) and all expenses incurred by the professional fund raiser(s) and the charitable organization(s) as a result of services provided during the specified contract period or contract year (if a multi-year contract). Include additional itemized income sources and itemized expenses on a separate attachment, using the same schedule format as the Financial Report.

II.PFR and Charity Certification

An authorized representative of the Professional Fund Raiser and an authorized representative of the Charitable Organization must certify to all statements made in Form CHAR037. The signatures on Form CHAR037, Part D must be accompanied by each signatory’s printed name, title and the date signed.

III.Amendments to Form CHAR037

A Professional Fund Raiser should file an amended CHAR037 whenever there is a material change to the information provided on a previously filed interim/closing statement, including changes in revenue and expense figures. All Parts (A - F) on an amended Form CHAR037 must be completed. Additionally, the word “AMENDED” must be placed at the top of page 1, Form CHAR037.

IV.

Form CHAR037 Due Dates

 

A closing statement is due within 90 days after the termination of a contract. For a contract whose term is longer than one year,

 

an interim statement must be filed within 15 months of the execution of the contract and annually thereafter.

V.Mailing Instructions

All completed Form CHAR037 should be mailed to the following address:

New York State Department of Law (Office of the Attorney General)

Charities Bureau

The Capitol

Albany, NY 12224

VI.

Additional Charities Bureau Contact Information

 

Telephone:

(518) 486-9797

 

E-mail:

Charities.Fundraising@ag.ny.gov

-i-

Instructions for Form CHAR037/CHAR037 Summary (2010)

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