Charitable Activities Section For Accounting Periods Beginning in:
For Split-Interest Trusts
Oregon Department of Justice
1515 SW 5th Avenue, Suite 410
Portland, OR 97201-5451
VOICE (971) 673-1880
TDD (503) 378-5938 2005
E-Mail: firstname.lastname@example.org FAX (971) 673-1882
Web site: http://www.doj.state.or.us
Section I. General Information
1. Cross Through Incorrect Items and Correct Here:
(See instructions for change of name or accounting period.)
City, State, Zip:
Phone: Fax: Amended
Period Beginning: / / Period Ending: / /
2. Did a certified public accountant audit your financial records? - If yes, attach a copy of the auditor’s report, financial statements,
accompanying notes and any schedules presented as supplementary information to the basic financial statements.
3. Has the trust or any officer, trustee, or executive personnel of the trust ever been involved in a voluntary agreement with any
district attorney or attorney general or a legal action in any court regarding the trust’s solicitation, administration, or management Yes No
practices? If yes, attach copies of the agreement and a written explanation.
4. During this reporting period, did the trust amend any trust documents OR did the trust receive a determination letter from the
Internal Revenue Service indicating a new or amended tax-exempt status? If yes, attach a copy of the amended document or Yes No
5. Is the trust ceasing operations and is this the final report? (If yes, see instructions.)
6. Provide contact information for the person responsible for retaining the trust’s records.
Name Position Phone Mailing Address
7. List of Officers, Directors, Trustees and Key Employees – List each person who held one of these positions at any time during the year even if they did
not receive any compensation from the organization. Attach additional sheets if necessary. If an IRS form is attached that includes substantially the
same information, the phrase “See IRS Form” may be entered in lieu of completing this section.
(A) Name, daytime phone number (B) Title & (C) (D) Contributions (E) Expense
& mailing address average weekly Compensation to benefit plans account & other
hours devoted to (If not paid, & deferred allowances
position enter $0) compensation
Form Continued on Reverse Side
Section II. Fee Calculation
8. Charitable Distribution ........................................................................................................... 8.
(Line 12 on Form 1041-A.)
9. Charitable Distribution Fee .................................................................................................................................................. 9.
(See chart below. Minimum fee is $10.)
Amount on Line 8 Charitable Distribution Fee
$0 - $24,999 $10
$25,000 - $49,999 $25
$50,000 - $99,999 $45
$100,000 - $249,999 $75
$250,000 - $499,999 $100
$500,000 - $749,999 $135
$750,000 - $999,999 $170
$1,000,000 or more $200
10. Net Assets at the End of the Reporting Period ........................................................................ 10.
(Line 45b on Form 1041-A or Line 46b on Form 5227.)
11. Net Assets Fee .................................................................................................................................................................... 11.
(Line 10 multiplied by .0001. If the fee is less than $5, write $0. Not to exceed $1,000. Round cents to the nearest whole dollar.)
12. Delinquency Penalty ........................................................................................................................................................... 12.
(If report is submitted after the due date, the delinquency penalty is $20.)
13. Total Amount Due ............................................................................................................................................................... 13.
(Add Lines 9, 11, and 12. Make check payable to the Oregon Department of Justice.)
14. Attach a copy of the trust’s federal tax returns and all supporting schedules and attachments.
Please Under penalties of perjury, I declare that I have examined this return, including all accompanying forms, schedules, and attachments, and to
the best of my knowledge and belief, it is true, correct, and complete.
_______________________________________ _____________________ _____________________
Signature of officer Date Title
_______________________________________ _____________________ _____________________
Preparer’s signature Date Phone
Preparer’s name Address
Charitable Activities Section, Oregon Department of Justice
2005 Form CT-12S Instructions
The Charitable Activities Section does not use
General the postmark date to determine whether an
organization has filed timely. Instead, filings are
Important Note - An extension request filed
with the IRS or the Oregon Department of
Instructions considered to have been made timely if they are
physically received 5 or less business days after
Revenue does NOT act as an extension with the
Charitable Activities Section unless a copy is
the due date. All filings received more than 5 submitted to the Charitable Activities Section by
days after the due date will be assessed a $20 the due date.
Purpose late charge.
Oregon law charges the Attorney General with
the duty and responsibility to represent the Record Keeping
public’s interest in connection with assets held Extensions for Filing and Please retain a copy of this report and all
for charitable purposes. The Attorney General Paying Fees supporting documentation for at least five years
after the due date.
carries out this responsibility by requiring
organizations holding such assets to register and A trust may apply for an extension of time to
file periodic financial reports. file. Extension requests must be received on or
before the due date of the report to avoid a Rounding and Blank Lines
Once submitted, this Form and all attachments delinquency penalty. The Charitable Activities Round all amounts on the report to the nearest
become a part of the public record. Any Section grants initial extension requests for up to whole dollar. Drop amounts under 50 cents and
interested person may examine or obtain a copy 90 days. An additional extension may be increase amounts from 50 to 99 cents to the next
of an annual report of a charitable organization requested, if necessary, for a maximum total whole dollar.
by contacting the Charitable Activities Section. extension period of 180 days. An extension to
file is also an extension to pay any associated Do not leave any line blank. Write “N/A,” “$0,”
fees. Therefore, estimated payments should not or “none” where appropriate.
Who Must File be included with extension requests.
All corporations and trusts registered with the
Charitable Activities Section of the Oregon Extensions may be requested through the Changes This Year
Department of Justice must annually file Form Department of Justice web site at The Charitable Activities Section’s policy on
CT-12, CT-12F, or CT-12S unless the Attorney http://www.doj.state.or.us/charigroup/howtoexte granting extensions of time to file has changed.
General has specifically exempted the nd.shtml. Follow the instructions carefully to The maximum initial extension period that a
organization from the reporting requirements. ensure that the Charitable Activities Section trust may request has been reduced from 180
receives your request. Please contact our office days to 90 days. See the preceding section of
if you have any questions about the on-line these instructions for complete information on
What Form to File extension process or are experiencing difficulties how to apply for an extension.
File Form CT-12 unless the organization is a with your on-line request.
corporation organized under the laws of a state
other than Oregon or the organization is a split- The trust may also submit a written extension How to Contact the
request so long as the Charitable Activities
interest trust with non-charitable beneficiaries.
Section receives the request on or before the due
File Form CT-12F if the organization is a date of the report. The trust should include the Section
corporation organized under the laws of a state reason why additional time is necessary in the To obtain blank forms, technical assistance or
other than Oregon. The Charitable Activities written request. Sending the Charitable information about a charitable organization,
Section does not accept multi-state annual report Activities Section a copy of the trust’s federal contact the Charitable Activities Section or visit
forms in lieu of a completed Form CT-12F. extension request on either Form 2758 or Form our web site at:
8868 is also sufficient to obtain an extension for
File Form CT-12S if the organization is a split- the period covered by the Form. The trust’s 4 or Charitable Activities Section
interest trust that holds assets for the benefit of 5-digit registration number should be noted on Oregon Department of Justice
both charitable and non-charitable beneficiaries. the top of all extension requests. If you would 1515 SW 5th Ave, Suite 410
like acknowledgement that your extension Portland, OR 97201-5451
If the organization does not fit within any of the request has been received, you should enclose an Phone: (971)673-1880
above categories, file Form CT-12. additional copy of the request and a self- TDD: (503)378-5938
addressed, stamped envelope. Fax: (971)673-1882
Due Date The Charitable Activities Section will not Web site: http://www.doj.state.or.us
The Form, all required attachments and provide formal notice that the trust’s extension
schedules, and payment of fees are due in the request has been approved. Instead, the trust
Charitable Activities Section’s office no later should assume that its extension request has Where to File
than 4 months and 15 days after the end of the been granted unless you hear otherwise from our Send completed Forms and any corresponding
organization’s fiscal year. If the due date falls on office. In the event your request is denied, to payment of fees to the above address. The
a weekend or legal holiday, the due date is the avoid a delinquency penalty, the annual report Charitable Activities Section does not accept the
next business day. must be submitted by the later of the due date or electronic filing of Forms.
within 10 days after the trust receives notice of
denial of the requested extension.
2. Independent Audit 7. Officers, Directors,
Check yes if the trust had an independent audit Trustees, and Other Key
of its financial records performed by a certified Employees
Line Instructions public accountant. Attach a copy of the
auditor’s report, the financial statements, the List each person who was an officer, director,
accompanying notes and any schedules trustee, or key employee (defined below) of the
trust at any time during the year even if they did
Section I. presented as supplementary information to
not receive any compensation from the trust.
the basic financial statements.
Enter a zero in columns (C), (D), or (E) if no
compensation, contributions, expenses and other
General Information If instead of an audit, the trust had its financial
allowances were paid during the reporting year,
records either reviewed or compiled by a
certified public accountant there is no or deferred for payment to a future accounting
period. Give the daytime phone number and
1. Missing or Incorrect
requirement to submit a copy of the related
reports. However, the Charitable Activities preferred mailing address at which officers, etc.,
Information Section encourages voluntary submission of want the Department to contact them. Use an
review and compilation reports which will be attachment if there are more persons to list than
The Charitable Activities Section sends a Form there are lines available.
preprinted with name, address contact maintained in our files that are available for
information and registration number to all public inspection.
Show all forms of cash and noncash
registered trusts. If the trust has received one of compensation received by each listed officer,
these preprinted Forms, provide any missing or
corrected information. If the organization is 3. Disclosure Information etc., whether paid currently or deferred.
completing a blank Form, provide requested Check yes if the trust or any person involved A failure to fully complete this part can subject
information in this section. with the trust has entered into any agreement the trust to penalties for filing an incomplete
such as an assurance of voluntary compliance or Form.
Name Changes discontinuance with any district attorney or
attorney general; or if any present officer, The trust may also provide an attachment to
If applicable, write the trust’s new legal name. executive personnel, director, or trustee has ever
Attach a copy of the trust document that changed explain the entire compensation package for any
been enjoined from soliciting contributions, or person listed in this part.
the trust name. has been found (or proceedings pending) to have
been engaged in unlawful practices in the If an IRS form is attached that includes
Address and Phone Number solicitation of contributions or administration of substantially the same information, the phrase
charitable assets. Attach copies of agreements “See IRS Form” may be entered in lieu of
Changes and/or explanations. completing this section only if the daytime
If applicable, write the new address where mail
phone number and preferred mailing address of
for the trust should be directed in the future. If
applicable, write the new daytime phone number
and fax machine number for the trust.
4. Amendments to Trust
the officers, etc. are provided either in this
section or on the attached IRS form.
A "key employee" is any person having
Check yes if during the reporting period the trust
Accounting Year Changes amended the documents that created the trust or
responsibilities or powers similar to those of
If applicable, write the trust’s new or short officers, directors, or trustees. The term includes
if the IRS issued a tax-exempt status ruling for
reporting period. Preprinted forms will note the the chief management and administrative
subsequent accounting period to that reported in officials of a trust (such as executive director or
the prior year. If the trust has changed its fiscal chancellor) but does not include the heads of
Important Note—Attach signed and dated
year or is filing a final report for a period less separate departments or smaller units within a
copies of amended trust documents and/or IRS
than 12 months, the shortened period covered by trust.
the report must be noted here.
A chief financial officer and the officer in charge
Important Note—If the trust is filing a final
report, see the instructions for line 5 for
5. Final Report of administration or program operations are both
key employees if they have the authority to
dissolution requirements. Check yes if this is the final report for the trust. control the trust's activities, it's finances, or both.
The "heads of separate departments" reference
Important Note—If the trust is filing a The trust should contact the Charitable Activities applies to persons such as the head of the
shortened report due to a change in fiscal year, Section for specific instructions and radiology department or coronary care unit of a
see the instructions for line 11 for calculation of requirements relating to closing procedures. hospital or the head of the chemistry or history
prorated Net Assets fee. or English department at a college. These
A final report must reflect the financial persons are managers within their specific areas
transactions of the trust from the day after the but not for the trust as a whole and, therefore, are
Amended Reports close of its last accounting period to the date of not key employees.
If amending previously submitted information the disposition of all remaining assets, and it
for the same accounting period, check the must be filed within four months and 15 days Column (C)
amended report box. Either complete a blank after such termination. For each person listed, report salary, fees,
form that includes the amended information or bonuses and severance payments paid. Include
provide a copy of the previously submitted form payments of amounts reported or reportable as
that clearly shows what information is being 6. Who Keeps the Books? deferred compensation in any prior year.
amended. Submit any additional fee due with the Indicate the person to be contacted if the trust's
amended report. The Charitable Activities books need to be accessed for information or Column (D)
Section will mail any refund within 60 days from review. Either a business or personal phone Include in this column all forms of deferred
the receipt of an amended report. A $25 refund number and mailing address are acceptable. compensation and future severance payments
processing fee may be assessed. (whether or not funded; whether or not vested;
and whether or not the deferred compensation
plan is a qualified plan under section 401(a)). 1,000,000 or more 200 11 should be prorated by the number of months
Include also payments to welfare benefit plans covered by the report. To determine the prorated
on behalf of the officers, etc. Such plans provide The maximum amount subject to the charitable amount, divide the amount determined above by
benefits such as medical, dental, life insurance, distribution fee is $1,000,000. The maximum 12 and multiply by the number of months
severance pay, disability, etc. Reasonable charitable distribution fee is $200. The minimum covered by the short report. No similar proration
estimates may be used if precise cost figures are charitable distribution fee is $10. should be made if the short report is due to the
not readily available. initial or final reporting period.
Unless the amounts were reported in column (C), 10. Net Assets at the End of
report as deferred compensation in column (D), the Reporting Period 12. Delinquency Penalty
salaries and other compensation earned during
The Charitable Activities Section has adopted If the report is not filed or the fee is not paid by
the period covered by the Form, but not yet paid
the definition for “Net Assets” used by the the due date (or the extended due date), an initial
by the date the trust files its Form.
Internal Revenue Service. If the trust completed penalty charge in the amount of $20 will be due.
one of the following IRS Forms for this Additional penalties will be assessed until
reporting period, the Net Assets figure should compliance occurs.
Enter both taxable and nontaxable fringe benefits
(other than de minimis fringe benefits described come from the line number listed:
IRS Form 1041-A, Part IV, line 45b
in section 132(3) of the Internal Revenue Code).
Include expense allowances or reimbursements IRS Form 5227, Part IV, line 46b 13. Total Amount Due
that the recipients must report as income on their Add lines 9, 11, and 12. This is the total amount
separate income tax returns. Examples include If the trust was not required to complete one of due. Make check or money order payable to the
amounts for which the recipient did not account these IRS Forms a summary of what constitutes “Oregon Department of Justice”. Do not send
to the trust or allowances that were more than Net Assets is provided within these instructions. cash. Mail payment together with the report to:
the payee spent on serving the trust. Include A more detailed definition can be found in the
payments made under indemnification IRS instructions for the listed Forms. Charitable Activities Section
arrangements, the value of the personal use of Oregon Department of Justice
Net Assets refer to the trust’s assets minus 1515 SW 5th Avenue, Suite 410
housing, automobiles, or other assets owned or
liabilities. Portland, Oregon 97201-5451
leased by the trust (or provided for the trust’s use
without charge), as well as any other taxable and “Assets” are items of value to the trust, such as
nontaxable fringe benefits. cash, receivables less any allowance for doubtful Important Note—Indicate on the check the
accounts, inventory, prepaid expenses, trust’s 4 or 5-digit Oregon Department of Justice
investments, land, buildings & equipment less registration number. The registration number is
Section II. any accumulated depreciation if the trust records located on line 1 of the preprinted Form CT-12S
depreciation. or can be obtained by contacting the Charitable
“Liabilities” are the amount of debts and
obligations owed by the trust, such as accounts
8. Charitable Distribution payable, accrued expenses, deferred revenue, 14. IRS Forms, Schedules,
loans, and mortgages. and Attachments
The charitable distribution represents the total
amount paid to charitable organizations. If an All trusts must attach a complete copy of all
Important Note— If the trust disposed of all or
IRS Form 1041-A was filed, this amount should Forms, supporting schedules, and attachments
substantially all of the trust’s assets during this
come from Line 12. If no IRS Form 1041-A was filed with the IRS. This may include IRS Form
reporting period, attach a letter listing a
filed, the amount will need to be calculated. 1041-A and/or IRS Form 5227.
description of the asset and the name, address,
phone number, and contact person of each entity
9. Charitable Distribution Fee
which received the trust’s assets, unless the Signature Block
assets were transferred in the usual and regular
To make the return complete, a receiver, trustee,
Use the charitable distribution figure from line 8 course of business.
or assignee must sign any return he or she files
to calculate the charitable distribution fee for the trust. Signature stamps and labels are not
according to the following schedule.
11. Net Assets Fee acceptable.
Charitable Distribution Fee Schedule Multiply the amount subject to a Net Assets fee In the paid preparer’s information section,
from line 10 by .0001 and enter this figure on include the name, daytime phone number, and
Amount on Line 8 Distribution Fee line 11. Round to the nearest whole dollar. If the address of any person who was paid by the trust
$ 0 - $ 24,999 $ 10 result is less than $5 enter $0. If the result is to complete this report.
25,000 - 49,999 25 more than $1,000 enter $1,000.
50,000 - 99,999 45
100,000 - 249,999 75 Important Note—If the trust is filing a short
250,000 - 499,999 100 report of less than one year due to a change in
500,000 - 749,999 135 accounting periods, the amount entered on line
750,000 - 999,999 170
Contact the Following Agencies for Assistance
Portland, Oregon 97201-5451
Charitable Activities phone: (971)673-1880
Section TDD: (503)378-5938
fax: (971)673-1882 Questions about annual reports for
Oregon Department of Justice
e-mail: email@example.com charitable organizations-Forms CT-12,
1515 SW 5th Avenue, Suite 410
web site: http://www.doj.state.or.us CT-12F, and CT-12S
Registration of charitable corporations or 1024, Application for Recognition of Revocation of Dissolution
trusts Exemption Under §501(a)
Merging nonprofit organizations 1041, U.S. Income Tax Return for Publications
Dissolving nonprofit organizations Estates and Trusts
Reporting illegal activity by nonprofit 1041-A, U.S. Information Return - Trust Oregon Business Guide
organizations Accumulation of Charitable Amounts
Serving as a board member of a nonprofit 1128, Application to Adopt, Change, or
organization Retain a Tax Year
Information about charitable 2758, Application for Extension of Time Oregon Department
organizations and copies of annual To File Certain Excise, Income, of Revenue
reports Information, and Other Returns
4720, Return of Certain Excise Taxes on Revenue Building
Charities and Other Persons 955 Center St. NE
5227, Split-Interest Trust Return Salem, OR 97301
RF-C, Registration Form for Charitable 5768, Election/Revocation of Election by phone: (503)378-4988 and (800)356-4222
Corporations an Eligible Section 501(c)(3) TTY: (503) 945-8617 and (800)886-7204
RF-T, Registration Form for Trusts Organization to Make Expenditures to web site: http://www.oregon.gov/DOR
CT-12, Annual Report Form for Influence Legislation
Domestic Operating Charities 8822, Change of Address Issues
CT-12F, Annual Report Form for 8868, Application for Extension of Time
Foreign Charities to File an Exempt Organization Return State taxation and filing
CT-12S, Annual Report Form for requirements
Domestic Trusts with Non-Charitable
20, Oregon Corporation Excise Tax
Pub. 526, Charitable Contributions
Publications Pub. 538, Accounting Periods and
41, Oregon Fiduciary Income Tax
Oregon Wise Giving Guide Pub. 557, Tax-Exempt Status for Your
Oregon Business Giving Guide Organization
A Guide to Non-Profit Board Service in Pub. 578, Tax Information for Private
Oregon Foundations and Foundation Managers State of Oregon
Pub. 583, Starting a Business and
Oregon Revised Statutes Keeping Records web site: http://www.oregon.gov
Pub. 598, Tax on Unrelated Business
Chapter #65, Nonprofit Corporations
Income of Exempt Organizations
Chapter #128, Trusts; Charitable
Pub. 3079, Gaming Publication for Tax-
Chapter #464, Games
Chapter #646, Trade Practices &
Antitrust Regulations Corporation Division
Oregon Administrative Rules Public Service Building
Chapter #137-010-005 et seq. 255 Capitol Street NE, Suite 151
Salem, OR 97310-1327
Internal Revenue Service TTY: (503)986-2328
phone: (877)829-5500 http://www.filinginoregon.com
web site: http://www.irs.gov
Issues Forming a new corporation
Obtaining state and federal tax
Obtaining federal tax-exempt status
Completing federal tax forms
Merging nonprofit corporations
Dissolving nonprofit corporations
Forms Amending articles of incorporation
990, Return of Organization Exempt Obtaining copies of filed articles of
From Income Tax incorporation and amendments
990-EZ, Short Form - Return of
Organization Exempt From Income Tax Forms
Schedule A, for Form 990 and 990-EZ
Articles of Incorporation
990-PF, Return of Private Foundation
Assumed Business Name Registration
990-T, Exempt Organization Business
Income Tax Return Articles of Amendment
1023, Application for Recognition of Restated Articles
Exemption Under §501(c)(3) Articles of Dissolution