Subject: FW: Constituent Request From: "Murray, Chase" <Chase.Murray@mail.house.gov> Date: 5/10/2012 10:54 AM To : "'Peter M. Heimlich'" <pmh@medfraud.

info>

From: Murray, Chase Sent: Wednesday, May 09, 2012 5:27 PM To: 'sob8@cdc.gov' Subject: Constituent Request Ms. Berger, Attached are documents submitted to our office by Peter Heimlich, a constituent of Congressman Woodall. Mr. Heimlich has requested that our office ask on his behalf if a Mr. Douglas Browne, who works/has worked with the CDC, signed the accompanying documents. I look forward to your response, thank you for your help with this matter.

Chase Murray Legislative Assistant Congressman Rob Woodall 7th District of Georgia 202-226-2036

Attachments:

Heimlich.pdf

774 KB

forOffte?

PMT#

ffitVin^lILUN0IS
VA\Q 0^^

CHARITABLE ORGANIZATION ANNUAL REPORT

Attorney General LISA M A D I G A N State of Illinois Charitable Trust Bureau, 100 West Randolph CO# 3rd Floor, Chicago, Illinois 60601 Report for the Fiscal Period: Beginning^ & EndingiL
MO E Yes D No
01026498

FormAG990-1L Revised 1/03

AMT

INIT

/ 31

-L
/ 03

Check all items attached: E7J Copy of IRS Return *a*c/>*j 0 Auuited dinancial Statements ftyawsto Copy of Form IFC altX* n $15.00 Annual Report Filing Fee a w * * n $100.00 Late Report Filing Fee
MO DAY YR ,93

Federal ID # 3869459 Are contributions to the organization tax deductible?

LEGAL NAME ^ a v e ^ ^e Foundation MAIL ADDRESS "
5 0 w

DAY YR Year-end amounts

A)ASSETS A) $460309 B) $ 364,284
C

D)ate Organization if/as created: 0 2

/ uy

' Lawrence #300

B) LIABILITIES C ) N E T ASSETS

CITY, STATE Schiller Park, IL 50176 I. S U M M A R Y O FA L L R E V E N U E ITEMS D U R I N G T H E YEAR: D) PUBLIC SUPPORT. CONTRIBUTIONS & PROGRAM SERVICE REV, (GROSS AMTS.) E) GOVERNMENT GRANTS & MEMBERSHIP DUES F) OTHER REVENUES G) TOTAL REVENUE, INCOME AND CONTRIBUTIONS RECEIVED (ADD D,E. * F)

) $ 96.025

PERCENTAGE 88.B8 10.27 0,85 % % % 100% D)$

AMOUNT 324,331

E) $ 37,488 F ) $ 3,113 G)$ 364,932

II. SUMMARY OF ALL EXPENDITURES DURING THE YEAR:

H) 1) J> OPERATING CHARITABLE PROGRAM EXPENSE EDUCATION PROGRAM SERVICE EXPENSE TOTAL CHARITABLE PROGRAM SERVICE EXPENSE (ADD H & 1 1 $ 7S.77 76.77 % H ) $ 861,501

%
%

l)S
J) $ 861,501

Ji) JOINT COSTS ALLOCATED TO PROGRAM SERVICES (INCLUDED IN J): K) GRANTS TO OTHER CHARITABLE ORGANIZATIONS L) TOTAL CHARITABLE PROGRAM SERVICE EXPENDITURE (ADD J & K ) M) MANAGEMENT AND GENERAL EXPENSE N) FUNDRAISING EXPENSE O) T O T A L E X P E N D I T U R E S THIS PERIOD ( A D D L, M, & N)

%
76.77 8.25 14.98 % % % 100%

K)$ L ) $ 861,501
M ) $

92,611 168,086 1,122,198

N)5 )$

III. SUMMARY OF ALL PAID FUNDRAISER AND CONSULTANT ACTIVITIES:

(Attach Attorney General Report ot Individual Fundraising Campaign- Form IFC. One for each PFR.) PROFESSIONAL FUNDRAISERS: P) TOTAL AMOUNT RAISED BY PAID PROFESSIONAL FUNDRAISERS Q) TOTAL FUNDRAISERS FEES AND EXPENSES R) NET RECEIVED BY THE CHARITY (P MINUS Q=R) PROFESSIONAL FUNDRAISING CONSULTANTS: S) TOTAL AMOUNT PAID TO PROFESSIONAL FUNDRAISING CONSULTANTS 100% P) $ 0 Q)$ 0 R)$ 0

% %

S)$ o

IV. COMPENSATION TO THE (3) HIGHEST PAID PERSONS

T) NAME, TITLE: Carol Spizzim, CEO U) NAME TITLE: Dane Neal, National Program Coordinator

re-fT-fc W>g!g2^,yEBL'V
^ O t " 1 ATTORNt^ i f l M ^ V T)$ U) $ 71,250 49,638 40,385

,
V) NAME, TITLE: Linda Post, Accountant

VkAL
V)$

^TnUST

V. CHARITABLE PROGRAM DESCR\PT\OM:CHAHITABLE W) DESCRIPTION: Life Saving First Aid Training X) DESCRIPTION: Y) DESCRIPTION:

List on back side of instructions CODE PROGRAM (3 HIGHEST BY SEXFENIXDI CODE CATEGORIES

CHAWlABtfei

w># on
X)# Y)#

IF THE ANSWER TO ANY OF THE FOLLOWING IS YES, ATTACH A DETAILED EXPLANATION: 1. 2. WAS THE ORGANIZATION THE SUBJECT OF ANY COURT ACTION, FINE, PENALTY OR JUDGMENT? HAS THE ORGANIZATION OR A CURRENT DIRECTOR, TRUSTEE, OFFICER OR EMPLOYEE THEREOF, EVER BEEN CONVICTED BY ANY COURT OF ANY MIDSDEMEANOR INVOLVING THE MISUSE OR MISAPPROPRIATION OF FUNDS OR ANY FELONY?

0
.2. .4.

3.

DID THE ORGANIZATION MAKE A GRANT AWARD OR CONTRIBUTION TO ANY ORGANIZATION IN WHICH ANY OF ITS OFFICERS, DIRECTORS OR TRUSTEES OWNS AN INTEREST; OR WAS IT A PARTY TO ANY TRANSACTION IN WHICH ANY OF ITS OFFICERS, DIRECTORS OR TRUSTEES HAS A MATERIAL FINANCIAL INTEREST; OR DID ANY OFFICER, DIRECTOR OR TRUSTEE RECEIVE ANYTHING OF VALUE NOT REPORTED AS COMPENSATION? 3. HAS THE ORGANIZATION INVESTED IN ANY CORPORATE STOCK IN WHICH ANY OFFICER, DIRECTOR OR TRUSTEE OWNS MORE THAN 10% OF THE OUTSTANDING SHARES? IS ANY PROPERTY OF THE ORGANIZATION HELD IN THE NAME OF OR COMMINGLED WITH THE PROPERTY OF ANY OTHER PERSON OR ORGANIZATION?

5.

5.

J
B E

6.

DID THE ORGANIZATION USE THE SERVICES OF A PROFESSIONAL FUNDRAISER? (ATTACH FORM IFC ) _ _ 6.

7a. DID THE ORGANIZATION ALLOCATE THE COST OF ANY SOLICITATION, MAILING, ADVERTISEMENT OR LITERATURE COSTS BETWEEN PROGRAM SERVICE AND FUNDRAISING EXPENSES?

B
ra

7b. IF "YES", ENTER (i) THE AGGREGATE AMOUNT OF THESE JOINT COSTS5 ;(ii) THE AMOUNT ALLOCATED TO PROGRAM SERVICES $ ; (iw) THE AMOUNT ALLOCATED TO MANAGEMENT AND GENERAL $ ; AND (iv) THE AMOUNT ALLOCATED TO FUNDRAISING $ 8. DID THE ORGANIZATION EXPEND ITS RESTRICTED FUNDS FOR PURPOSES OTHER THAN RESTRICTED PURPOSES? 9. HAS THE ORGANIZATION EVER BEEN REFUSED REGISTRATION OR HAD ITS REGISTRATION OR TAX EXEMPTION SUSPENDED OR REVOKED BY ANY GOVERNMENTAL AGENCY? 9.

8.

10. WAS THERE OR DO YOU HAVE ANY KNOWLEDGE OF ANY KICKBACK. BRIBE, OR ANY THEFT, DEFALCATION ^ W = MISAPPROPRIATION, COMMINGLING OR MISUSE OF ORGANIZATIONAL FUNDS? 10. | I l/l 11. LIST THE NAME, ADDRESS AND THE ACCOUNT # OF THE FINANCIAL INSTITUTIONS WHERE THE ORGANIZATION MAINTAINS ITS THREE LARGEST ACCOUNTS: Bank One, NA Illinois Market, P.O. Box 260180, Baton Rouge, LA 70826-0180, i

12 NAME AND TELEPHONE NUMBER OF CONTACT PERSON: Carol Sptaiffi (B47) 92B-9693 ALL ATTACHMENTS MUST ACCOMPANY THIS REPORT - SEE INSTRUCTIONS UNDER PENALTY OF PERJURY, I (WE) THE UNDERSIGNED DECLARE AND CERTIFY THAT I (WE) HAVE EXAMINED THIS ANNUAL REPORT AND THE ATTACHED DOCUMENTS, INCLUDING ALL THE SCHEDULES AND STATEMENTS AND THE FACTS THEREIN STATED ARE TRUE AND COMPLETE AND FILED WITH THE ILLINOIS ATTORNEY GENERAL FOR THE PURPOSE OF HAVING THE PEOPLE OF THE STATE OF ILLINOIS RELY THEREUPON. I HEREBY FURTHER AUTHORIZE AND AGREE TO SUBMIT MYSELF AND THE REGISTRANT HEREBY TO THE JURISDICTION OF THE STATE OF ILLINOIS. h

BE SURE TQ INCJ^UDE ALL FEES DUE: 1.') REPORTS AREDUE wfTHIN fx" " " MONTHS OF YOUR FISCAL YEAR END. 2.) FOR FEES DUE SEE INSTRUCTIONS. 3.) REPORTS THAT ARE LATE OR INCOMPLETE ARE SUBJECT TO A $100.00 PENALTY,

PRESIDENT oAVTRUSlfctt(PRINT TAME)

sh' fiGNATURE~T

f BATE'

TREASURER or TRUSTEE (PRINT NAME)

SIGNATURE

DATE

AZ-^-g E m PREPARER (PRINT NAME}

SIGNA'UKt

DATE

fprPKic*' r -.-lOnl' PMT

T ^ T ^ - p ^ ) 4 L J N O I S CHARITABLE ORGANIZATION ANNUAL REPORT PlenL )" ID / ' A t t o ttomey r n e y General L I S A M A D I G A N State o f Illinois Charitable Trust Bureau, 100 West Randolph 3rd Floor, Chicago, Illinois 60601 Report for the Fiscal Period: Beginning 01 / pi / 3P / 04
C Q

Form AG990-T] Revised I/O

&Ending___06 MO Federal ID # Yes No Are contributions to the organization tax deductible? L E G A L NAMESave A L i f e MAIL ADDRESS 9 9 5 0 CITY. STATE , . ZIP CODE
w n l

/ 04

nin^ftigs Check alf items attached: Q Copy of IRS Return M*.ch*j CS Audited Financial Statements p^wto Copy of Form IFC S 0 ' 1 O H5.00 Annual Report Filing Fe. 8 u ^</ D $100.00 Late Report Filing Fee
MO
DAY

YR

Date Organization was created: Year-end amounts

A)ASSETS A) $

Q2 /OQ / Q3

Foundation

- Lawrence S u i t e 300 _ . rark,

TT

1,403.584 333,61j_ 1,069;"973

AMOUNT

B) LIABILITIES C) N E T ASSETS

,.,,. iL bU17b

B)$ C)$

I. SUMMARY OF ALL REVENUE ITEMS DURING THE YEAR:

D) PUBLIC SUPPORT, CONTRIBUTIONS & PROGRAM SERVICE REV. {GROSS AMTS.) E) GOVERNMENT GRANTS & MEMBERSHIP DUES F) OTHER R E V E N U E S G) TOTAL REVENUE, INCOME AND CONTRIBUTIONS RECEIVED (ADD D.E. & F)

PERCENTAGE 10.04 *
QO-11 D) S E)$ F)$

115,844 ,000 (1,689! 1.154.155 151.664

:.i5'
100%

G)$
H)$

II. SUMMARY OF ALL EXPENDITURES DURING THE YEAR:

H) 0 J) OPERATING CHARITABLE PROGRAM EXPENSE EDUCATION PROGRAM SERVICE EXPENSE TOTAL CHARITABLE PROGRAM SERVICE EXPENSE (ADD H & I)

/ 84.16 %

i) $

84.16 %
J

J)$

151,664

Ji> JOINT COSTS ALLOCATED TO PROGRAM SERVICES (INCLUDED IN J ) : K> GRANTS T O OTHER CHARITABLE ORGANIZATIONS L) T O T A L C H A R I T A B L E PROGRAM SERVICE EXPENDITURE ( A D D J & K )

K)X

^16

L)$ M)$ N)$

151.664 21.328 7.215 180.207

M) MANAGEMENT A N D GENERAL EXPENSE N) FUNDRAISING EXPENSE

11.84 % 4.00 %
100 %

O) T O T A L E X P E N D I T U R E S THIS P E R I O D ( A D D L, M, & N)

o>$

III. SUMMARY OF ALL PAID FUNDRAISER AND CONSULTANT ACTIVITIES:

(Attach Attorney General Report of Individual Fundraising Campaign- Form IFC. One for each PFR ) PROFESSIONAL FUNDRAISERS: P) TOTAL AMOUNT RAISED BY PAID PROFESSIONAL FUNDRAISERS Q) TOTAL FUNDRAISERS FEES AND EXPENSES R) NET RECEIVED BY THE CHARITY (P MINUS Q=R) PROFESSIONAL FUNDRAISING CONSULTANTS: S) TOTAL AMOUNT PAID TO PROFESSIONAL FUNDRAISING CONSULTANTS

100 % % %

P) $
Q)$ R)$
arxJiaUgS

S) $

IV. COMPENSATION TO THE (3) HIGHEST PAID PERSONS DURING THE YEAR: T) NAME, TITLE: C a r o l S p i z z i r r i . U) NAME, TITLE:
Dane

CEO Coordinator

T)$
U)$

20.000 21,663

Neal.

N a t i o n a l Program Accountant

V) NAME, TITLE: Donna A c h s .

ATTORNEY GENERAL.v CHARITABLE TRUST

IF THE ANSWER TO ANY OF THE FOLLOWING IS YES, ATTACH A DETAILED EXPLANATION: 1. 2. WAS THE ORGANIZATION THE SUBJECT OF ANY COURT ACTION, FINE, PENALTY OR JUDGMENT? HAS THE ORGANIZATION OR A CURRENT DIRECTOR, TRUSTEE, OFFICER OR EMPLOYEE THEREOF, EVER BEEN CONVICTED BY ANY COURT OF ANY MIDSDEMEANOR INVOLVING THE MISUSE OR MISAPPROPRIATION OF FUNDS OR ANY FELONY?

YES

NO

2.

3.

DID THE ORGANIZATION MAKE A GRANT AWARD OR CONTRIBUTION TO ANY ORGANIZATION IN WHICH ANY OF ITS OFFICERS, DIRECTORS OR TRUSTEES OWNS AN INTEREST; OR WAS IT A PARTY TO ANY TRANSACTION IN WHICH ANY OF ITS OFFICERS, DIRECTORS OR TRUSTEES HAS A MATERIAL FINANCIAL INTEREST; OR DID ANY OFFICER. DIRECTOR OR TRUSTEE RECEIVE ANYTHING OF VALUE NOT REPORTED AS COMPENSATION? 3. HAS THE ORGANIZATION INVESTED IN ANY CORPORATE STOCK IN WHICH ANY OFFICER, DIRECTOR OR TRUSTEE OWNS MORE THAN 10% OF THE OUTSTANDING SHARES? IS ANY PROPERTY OF THE ORGANIZATION HELD IN THE NAME OF OR COMMINGLED WITH THE PROPERTY OF ANY OTHER PERSON OR ORGANIZATION? DID THE ORGANIZATION USE THE SERVICES OF A PROFESSIONAL FUNDRAISER?( ATTACH FORM IFC )

4.

5.

5. 6.

6.

7a. DID THE ORGANIZATION ALLOCATE THE COST OF ANY SOLICITATION. MAILING. ADVERTISEMENT OR LITERATURE COSTS BETWEEN PROGRAM SERVICE AND FUNDRAISING EXPENSES?
7

7b. IF "YES". ENTER (I) THE AGGREGATE AMOUNT OF THESE JOINT COSTS $ ;(ii) THE AMOUNT ALLOCATED TO PROGRAM SERVICES $ ; (iii) THE AMOUNT ALLOCATED TO MANAGEMENT AND GENERAL $ ; AND (iv) THE AMOUNT ALLOCATED TO FUNDRAISING $ 8. DID THE ORGANIZATION EXPEND ITS RESTRICTED FUNDS FOR PURPOSES OTHER THAN RESTRICTED PURPOSES? HAS THE ORGANIZATION EVER BEEN REFUSED REGISTRATION OR HAD ITS REGISTRATION OR TAX EXEMPTION S U S P E N D E D OR R E V O K E D BY ANY GOVERNMENTAL AGENCY? 9. X

8.

9.

10. WAS THERE OR DO YOU HAVE ANY KNOWLEDGE OF ANY KICKBACK, BRIBE, OR ANY THEFT. DEFALCATION MISAPPROPRIATION, COMMINGLING OR MISUSE OF ORGANIZATIONAL FUNDS? 10. 11. LIST THE NAME, ADDRESS AND THE ACCOUNT # OF THE FINANCIAL INSTITUTIONS WHERE THE ORGANIZATION MAINTAINS ITS THREE LARGEST ACCOUNTS:

Bank One. NA I l l i n o i s

kei

I. Box 2 6 0 1 8 0 . B a t o n R o u g e . LA 7 0 8 2 6 - 0 1 8 0

W a c h o v i a Bank N . A . , P . O . Box 5 0 0 1 5 , R o a n o k e , VA 2 4 0 4 0 - 7 3 5 0 12. NAME AND TELEPHONE NUMBER OF CONTACT PERSON: C a r o l S p i z z i r r i

ALL ATTACHMENTS MUST ACCOMPANY THIS REPORT - SEE INSTRUCTIONS UNDER PENALTY OF PERJURY. 1 (WE) THE UNDERSIGNED DECLARE AND CERTIFY THAT I IWE) HAVE EXAMINED THIS ANNUAL REPORT AND THE ATTACHED DOCUMENTS. INCLUDING ALL THE SCHEDULES AND STATEMENTS AND THE FACTS THEREIN STATED A R E TRUE AND COMPLETE A N D FILED WITH THE ILLINOIS ATTORNEY GENERAL FOR THE PURPOSE OF HAVING THE PEOPLE OF THE STATE OF ILLINOIS RELY THEREUPON, t HEREBY FURTHER AUTHORIZE AND AGREE TO SUBMIT MYSELF AND THE REGISTRANT HEREBY TO THE JURISDICTION OF THE STATE OF ILLINOIS.

(847) 928-9683

BE SURE TO INCLUDE ALL FEES DUE: 1.) REPORTS ARE DUE WITHIN SIX MONTHS OF YOUR FISCAL YEAR END. 2.) FOR FEES DUE SEE INSTRUCTIONS. 3.) REPORTS THAT ARE LATE OR INCOMPLETE ARE SUBJECT TO A $100.00 PENALTY.

PRESIDENT or TRUSTEE (PRWT NAME)

TREASURER or TRUSTEE (PRINT NAM

PREPARER (PRINT NAM~

SIGNATURE

DATE

For O f f l o U i e Only

PMT#

ILLINOIS CHARITABLE ORGANIZATION ANNUAL REPORT

Attorney General U S A M A D I G A N State o f Illinois Charitable Trust Bureau, 100 West Randolph 11th Floor, Chicago, Illinois 60601 CO # 01026498 Report for the Fiscal Period:

Form AG990-IL Revised 3/05

AMT

INIT

Beginning o?
& E n d i n g . 06
MO

/ o*
/ 30
DAY

/
/ 05

Check all items attached: H Copy of IRS Return & Audited Financial Statements ay**,*, n Copy of Form IFC S^0" El $15.00 Annual Report Filing Fee Bum.uFiiim 100.00 Late Report Filing Fee
MO DAY YR

Federal ID # I Are contributions to the organization tax deductible? LEGAL NAME MAIL ADDRESS CITY, STATE ZIP CODE "950 W- Lawrnce', Sutte 30

B Yes D N O

Date Organization was created: 02

/ 09

/ 93

Save A Life Foundation

Year-end amounts
A)ASSETS B) LIABILITIES C) NET ASSETS

A)$ 1643498 B)S 669348

c

Schiller Park, IL 60176

)$

974150
AMOUNT

I. SUMMARY OF ALL REVENUE ITEMS DURING THE YEAR:

D) PUBLIC SUPPORT. CONTRIBUTIONS & PROGRAM SERVICE REV. (GROSS AMTS.] E) GOVERNMENT GRANTS & MEMBERSHIP DUES F) OTHER REVENUES G) TOTAL REVENUE, INCOME AND CONTRIBUTIONS RECEIVED (ADD D,E, & F) II. SUMMARY OF ALL EXPENDITURES DURING THE YEAR: H) I) J) OPERATING CHARITABLE PROGRAM EXPENSE EDUCATION PROGRAM SERVICE EXPENSE TOTAL CHARITABLE PROGRAM SERVICE EXPENSE (ADO H & I) $

PERCENTAGE

D ) $ 533339 E)$ 1196000

F ) $ 2801 100% G ) $ 1732140

H ) $ 1713050 l)$ J ) $ 1713050

J1) JOINT COSTS ALLOCATED TO PROGRAM SERVICES (INCLUDED IN J): K) GRANTS TO OTHER CHARITABLE ORGANIZATIONS L) TOTAL CHARITABLE PROGRAM SERVICE E X P f D f B ( f p W E J M) MANAGEMENT AND GENERAL EXPENSE N) FUNDRAISING EXPENSE

% Q

K)$ L ) $ 1713050 M ) $ 80431

3 JAN - 2000/^2^ ' ,Mrl 9

N ) $ 34482 100%

O) TOTAL EXPENDITURES THIS PERIOD (ADO l _ W R N E Y G E N E R A L

>* 1827963

III. SUMMARY OF ALL PAID FUNDRAISER AND^C^lJl^lf^C^TviTIES:

(Attach Attorney General Report of Individual Fundraising Campaign- Form IFC. One for each PFR.; PROFESSIONAL FUNDRAISERS: P) TOTAL AMOUNT RAISED BY PAID PROFESSIONAL FUNDRAISERS Q) TOTAL FUNDRAISERS FEES AND EXPENSES R) NET RECEIVED BY THE CHARITY (P MINUS Q=R) PROFESSIONAL FUNDRAISING CONSULTANTS: S) TOTAL AMOUNT PAID TO PROFESSIONAL FUNDRAISING CONSULTANTS IV. COMPENSATION TO THE (3) HIGHEST PAID PERSONS DURING THE YEAR: T) NAME, TITLE: Carol Spizzirri, President/Founder U) NAME, TITLE: Dane Neal, National Policy Director V) NAME, TITLE: Ciprina Spizzirri, National Communication Director % 100% P) $ Q)$ R)$
'H-M^U-

S)$

T)S 120000
U ) $ 54381 V ) $ 35446

List on back side of instructions V. CHARITABLE PROGRAM DESCRIPTION CCHARKABLE PROGRAM VHKHEST BY, EXPEHDEO, CODE CATEGORY* CODE W) DESCRIPTION: Life Saving First A i d Training X) DESCRIPTION: Y) DESCRIPTION: W)#0U X)# Y)#

IF THE ANSWER TO ANY OF THE FOLLOWING IS YES, ATTACH A DETAILED EXPLANATION: 1. 2. WAS THE ORGANIZATION THE SUBJECT OF ANY COURT ACTION, FINE, PENALTY OR JUDGMENT? HAS THE ORGANIZATION OR A CURRENT DIRECTOR, TRUSTEE, OFFICER OR EMPLOYEE THEREOF, EVER BEEN CONVICTED BY ANY COURT OF ANY MIDSDEMEANOR INVOLVING THE MISUSE OR MISAPPROPRIATION OF FUNDS OR ANY FELONY? 1.

YES NO

2.

3.

DID THE ORGANIZATION MAKE A GRANT AWARD OR CONTRIBUTION TO ANY ORGANIZATION IN WHICH ANY OF ITS OFFICERS, DIRECTORS OR TRUSTEES OWNS AN INTEREST; OR WAS IT A PARTY TO ANY TRANSACTION IN WHICH ANY OF ITS OFFICERS, DIRECTORS OR TRUSTEES HAS A MATERIAL FINANCIAL INTEREST; OR DID ANY OFFICER, DIRECTOR OR TRUSTEE RECEIVE ANYTHING OF VALUE NOT REPORTED AS COMPENSATION?._ . _. 3. HAS THE ORGANIZATION INVESTED IN ANY CORPORATE STOCK IN WHICH ANY OFFICER, DIRECTOR OR TRUSTEE OWNS MORE THAN 10% OF THE OUTSTANDING SHARES? .4. IS ANY PROPERTY OF THE ORGANIZATION HELD IN THE NAME OF OR COMMINGLED WITH THE PROPERTY OF ANY OTHER PERSON OR ORGANIZATION? DID THE ORGANIZATION USE THE SERVICES OF A PROFESSIONAL FUNDRAISER?( ATTACH FORM IFC )

5.

5. 6.

6.

7a. DID THE ORGANIZATION ALLOCATE THE COST OF ANY SOLICITATION, MAILING, ADVERTISEMENT OR LITERATURE COSTS BETWEEN PROGRAM SERVICE AND FUNDRAISING EXPENSES? 7

7b. IF "YES", ENTER (i) THE AGGREGATE AMOUNT OF THESE JOINT COSTS $ ;(ii) THE AMOUNT ALLOCATED TO PROGRAM SERVICES $ ; (iii) THE AMOUNT ALLOCATED TO MANAGEMENT AND GENERAL S ; AND (iv) THE AMOUNT ALLOCATED TO FUNDRAISING $ 8. DID THE ORGANIZATION EXPEND ITS RESTRICTED FUNDS FOR PURPOSES OTHER THAN RESTRICTED PURPOSES? HAS THE ORGANIZATION EVER BEEN REFUSED REGISTRATION OR HAD ITS REGISTRATION OR TAX EXEMPTION SUSPENDED OR REVOKED BY ANY GOVERNMENTAL AGENCY? 9.

8.

9.

10. WAS THERE OR DO YOU HAVE ANY KNOWLEDGE OF ANY KICKBACK, BRIBE, OR ANY THEFT, DEFALCATION MISAPPROPRIATION, COMMINGLING OR MISUSE OF ORGANIZATIONAL FUNDS? 10. 11. LIST THE NAME AND ADDRESS OF THE FINANCIAL INSTITUTIONS WHERE THE ORGANIZATION MAINTAINS ITS THREE LARGEST ACCOUNTS:

Bank One N.A., P.O. Box 260180, Baton Rouge, LA 70826-0180 Wachovia Bank N.A. P.O. Box 50015, Roanoke, VA 24040-7350
12. NAME AND TELEPHONE NUMBER OF CONTACT PERSON: Carol Spizzirri (847) 928-9683 ALL ATTACHMENTS MUST ACCOMPANY THIS REPORT - SEE INSTRUCTIONS UNDER PENALTY OF PERJURY, I (WE) THE UNDERSIGNED DECLARE AND CERTIFY THAT I (WE) HAVE EXAMINED THIS ANNUAL REPORT AND THE ATTACHED DOCUMENTS, INCLUDING ALL THE SCHEDULES AND STATEMENTS AND THE FACTS THEREIN STATED ARE TRUE AND COMPLETE AND FILED WITH THE ILLINOIS ATTORNEY GENERAL FOR THE PURPOSE OF HAVING THE PEOPLE OF THE STATE OF ILLINOIS RELY THEREUPON. I HEREBY FURTHER AUTHORIZE AND AGREE TO SUBMIT MYSELF AND THEKEGISJRANT HEREBY TO THE JURISDICTION OF THE STATE OF ILLINOIS. rt.^) J " CCi<^ \2f3lr^ $i.a BE SURE TO INCLUDE ALL FEES DUE: 1.) REPORTS ARE DUE WITHIN SIX MONTHS OF YOUR FISCAL YEAR END. 2.) FOR FEES DUE SEE INSTRUCTIONS. 3.) REPORTS THAT ARE LATE OR INCOMPLETE ARE"SUBJECT TO A $100.00 PENALTY. Jrtuh)i>ifl<L

jjt/o lJJJt/ 0J
DATE

lETKiTiJdJlJJfliMIWJiJJH!

NAME)

SIGNATURE

T NAME) TREASURER or TRUSTEE (PRINT

SIGNATURE

(DATE

RINT NAME)

SIGNATURE

DATE

A*t**^fe~-r>i~i

FOfOfflc U n O n i

ILLINOIS CHARITABLE ORGANIZATION ANNUAL REPORT

Attorney General LISA MADIGAN State of Illinois Charitable Trust Bureau, 100 West Randolph 11th Floor, Chicago, Illinois 60601 CO l 0 1 0 2 6 4 9 8
Check ail items

Fo

G< T ?;li Kev,sed 3 05

'

attached:

Report for the Fiscal Period: Beginning^ 0 7

Federal ID #| Are contributions to the organization tax deductible?
n7

z > copy of IRS Return

*.. 5E a*** H D E! n Audited Financial Statements Copy of Form IFC $15.00 Annual Report Filing Fee $100.00 Late Report Filing Fee
MO DAY YR

0. Q 1

05

in

Ol HA yn

& Ending^ ^
0

MO

DAY

Yes No

Date Organization was created: 02

/ 09

/ 93

I.

S U M M A R Y OF A L L REVENUE ITEMS DURING THE YEAR: O) PUBLIC SUPPORT, CONTRIBUTIONS & PROGRAM SERVICE REV. (GROSS AMTS.) E) GOVERNMENT GRANTS & MEMBERSHIP DUES F)OTHER REVENUES G) TOTAL REVENUE. INCOME AND CONTRIBUTIONS RECEIVED (ADD D,E, & F)

PERCENTAGE

AMOUNT

21.30 78.59 .11

100%

D)$ 189,738 E)$ 700,000 F)$ 956 G) $ 890,694 H) $ 1,005,527

l)$

II. SUMMARY OF ALL EXPENDITURES DURING THE YEAR:

H) OPERATING CHARITABLE PROGRAM EXPENSE I) J) EDUCATION PROGRAM SERVICE EXPENSE TOTAL CHARITABLE PROGRAM SERVICE EXPENSE (ADD H 4 I) $_

94.75

<%

94.75

j ) $ 1,005,527

Ji) JOINT COSTS ALLOCATED TO PROGRAM SERVICES (INCLUDED IN J): K) GRANTS TO OTHER CHARITABLE ORGANIZATIONS L) TOTAL CHARITABLE PROGRAM SERVICE EXPENDITURE (ADD J & K) M) MANAGEMENT AND GENERAL EXPENSE N) FUNDRAISING EXPENSE O) TOTAL EXPENDITURES THIS PERIOD (ADD L, M, & N)

% 5.25 % %
100%

K)$ L)S

M)S 55,716
N)$ 0 0)$ 1,061,243

III. SUMMARY OF ALL PAID FUNDRAISER AND CONSULTANT ACTIVITIES:

(Attach Attorney General Report of Individual Fundraising Campaign- Form IFC. One for each PFR.) PROFESSIONAL FUNDRAISERS: P) TOTAL AMOUNT RAISED BY PAID PROFESSIONAL FUNDRAISERS Q) TOTAL FUNDRAISERS FEES AND EXPENSES R) NET RECEIVED BY THE CHARITY (P MINUS Q=R) PROFESSIONAL FUNDRAISWO CONSW.TANTS: S) TOTAL AMOUNT PAID TO PROFESSIONAL FUNDRAISING CONSULTANTS 100% P)$
Q)$

% %

R)$ S)$

IV. COMPENSATION TO THE (3) HIGHEST PAID PERSONS DURING THE YEAR: T) NAME, TITLE: Carol Spizzirri, President/Founder U) NAME, TITLE: Dane Neal, National Policy Director V) NAME. TITLE: Robert Barnes, Director

m$MMiM*h^m<i
T ) $ 130,000

U) $ 63,500 V) S 55,000

. p s t o n ^ s ^ i n ^ o n s V . C H A R I T A B L E P R O G R A M DESCR\PT\ON:cHARmBLE PROGRAM (JH/GHEST BY $ EXPENDED, ooKCATEGomes W) DESCRIPTION: Life Saving First A i d Training X) DESCRIPTION: Y) DESCRIPTION:

W)# 0J1
X)d Y)#

IF THE ANSWER TO ANY OF THE FOLLOWING IS YES, ATTACH A DETAILED EXPLANATION: 1. 2. WAS THE ORGANIZATION THE SUBJECT OF ANY COURT ACTION. FINE. PENALTY OR JUDGMENT? HAS THE ORGANIZATION OR A CURRENT DIRECTOR. TRUSTEE, OFFICER OR EMPLOYEE THEREOF. EVER BEEN CONVICTED BY ANY COURT OF ANY MIDSDEMEANOR INVOLVING THE MISUSE OR MISAPPROPRIATION OF FUNDS OR ANY FELONY?

YES NO

2.

3.

DID THE ORGANIZATION MAKE A GRANT AWARD OR CONTRIBUTION TO ANY ORGANIZATION IN WHICH ANY OF ITS OFFICERS, DIRECTORS OR TRUSTEES OWNS AN INTEREST; OR WAS IT A PARTY TO ANY TRANSACTION IN WHICH ANY OF ITS OFFICERS. DIRECTORS OR TRUSTEES HAS A MATERIAL FINANCIAL INTEREST; OR DID ANY OFFICER, DIRECTOR OR TRUSTEE RECEIVE ANYTHING OF VALUE NOT REPORTED AS COMPENSATION? 3. HAS THE ORGANIZATION INVESTED IN ANY CORPORATE STOCK IN WHICH ANY OFFICER. DIRECTOR OR TRUSTEE OWNS MORE THAN 10% OF THE OUTSTANDING SHARES? IS ANY PROPERTY OF THE ORGANIZATION HELD IN THE NAME OF OR COMMINGLED WITH THE PROPERTY OF ANY OTHER PERSON OR ORGANIZATION? DID THE ORGANIZATION USE THE SERVICES OF A PROFESSIONAL FUNDRAISER?{ATTACH FORM IFC )_

.4.

5.

. 5. 6.

6.

7a. DID THE ORGANIZATION ALLOCATE THE COST OF ANY SOLICITATION, MAILING, ADVERTISEMENT OR LITERATURE COSTS BETWEEN PROGRAM SERVICE AND FUNDRAISING EXPENSES?

7.

7b. IF "YES". ENTER (i) THE AGGREGATE AMOUNT OF THESE JOINT COSTS $ :() THE AMOUNT ALLOCATED TO PROGRAM SERVICES $ ; (iii) THE AMOUNT ALLOCATED TO MANAGEMENT AND GENERAL $ ; AND (iv) THE AMOUNT ALLOCATED TO FUNDRAISING 8. DID THE ORGANIZATION EXPEND ITS RESTRICTED FUNDS FOR PURPOSES OTHER THAN RESTRICTED PURPOSES? HAS THE ORGANIZATION EVER BEEN REFUSED REGISTRATION OR HAD ITS REGISTRATION OR TAX EXEMPTION SUSPENDED OR REVOKED BY ANY GOVERNMENTAL AGENCY? 9.

8.

9.

10. WAS THERE OR DO YOU HAVE ANY KNOWLEDGE OF ANY KICKBACK. BRIBE, OR ANY THEFT, DEFALCATION MISAPPROPRIATION, COMMINGLING OR MISUSE OF ORGANIZATIONAL FUNDS? 10. 11. LIST THE NAME AND ADDRESS OF THE FINANCIAL INSTITUTIONS WHERE THE ORGANIZATION MAINTAINS ITS THREE LARGEST ACCOUNTS:

Bank One N.A., P.O. Box 2601SO, Baton Rouge, LA 70826-0180 TCF National Bank, 500 W, Joliet Rd., Willowbrook, IL 60527
12. NAME AND TELEPHONE NUMBER OF CONTACT PERSON: Carol Spizzirri (847) 928-9683

ALL ATTACHMENTS MUST ACCOMPANY THIS REPORT SEE INSTRUCTIONS UNDER PENALTY OF PERJURY, I (WE) THE UNDERSIGNED DECLARE AND CERTIFY THAT I (WE) HAVE EXAMINED THIS ANNUAL REPORT AND THE ATTACHED DOCUMENTS. INCLUDING ALL THE SCHEDULES AND STATEMENTS AND THE FACTS THEREIN STATED ARE TRUE AND COMPLETE AND FILED WITH THE ILLINOIS ATTORNEY GENERAL FOR THE PURPOSE OF HAVING THE PEOPLE OF THE STATE OF ILLINOIS RELY THEREUPON. I HEREBY FURTHER AUTHORIZE AND AGREE TO SUBMIT MYSELF AND THE REGISTRANT HEREBY TO THE JURISDICTION OF THE STATE OF ILLINOIS.

i*.e\
PRESIDENT or TRUSTEE (PRINT NAME)

MONTHS OF YOUR FISCAL YEAR END. 2.) FOR FEES DUE SEE INSTRUCTIONS. 3.) REPORTS THAT ARE LATE OR INCOMPLETE ARE SUBJECT TO A $100.00 PENALTY.

,\st>l*A* TREASURER or TRUSTEE (PRINT NAME)

PREPARER (PRINT NAME)

SIGNATURE

DATE

For Office Use Only

Illinois Charitable Organization Annual Report

Attorney Genera! Lisa Madigan State of Illinois Charitable Trust Bureau, 100 West Randolph 11th Floor, Chicago, Illinois 60601
Report for the Fiscal Period: Beginning 7/01/06 &Endinq~67T0/07
MO DAY YR

Form AG990-IL Revised 3/05 ID-I U

CO#
Check all items

01026498
attached:

KhkeCheett

Copy of IRS Return Audited Financial Statements Copy of Form IFC 515.00 An rti/al Report Filing Fee 5100.00 Late Report Filing Fee

Federal ID # Are contributions to the organization tax deductible? |X| Yes | ~ | No Year-end amounts A ASSETS LIABILITIES NET ASSETS

Date Organization was created:

LEGAL

N * SAVE A LIFE FOUNDATION

ADDRESS 9950 LAWRENCE # 3 0 0 -

R E C E I V E D
O
J

2/09/1993 A$ B$

MO

DAY

YR

449,823. 191,214. 258,608.

AMOUNT

CITY, STATE
I

ZIP CODE SCHILLER PARK, IL 60176

MAY l 6 2008

B C

c$

Attorney General
SUMMARY OF A L L REVENUE ITEMS DURING THE Y ^ R 1 - * 1 ' ^ D PUBLIC SUPPORT, CONTRIBUTIONS AND PROGRAM SERVICE REVENUE ^
PERCENTAGE

22.81%
75.63%

D$ E$ F$ G$ H$ 1$ J$

211,116.
700,000.

F OTHERREVENUES
G II

See..Statement.1

1.56% 100% 90.46%

%

TOTAL REVENUE, INCOME AND CONTRIBUTIONS RECEIVED (ADD D, E, AND F) S U M M A R Y OF A L L EXPENDITURES DURING THE YEAR:

14,429. 925,545. 1,330,239. 1,330,239.

90.46%
J l JOINT COSTS ALLOCATED TO PROGRAM SERVICES (INCLUDED IN J) $

1
K$
L$ M$

%
L TOTAL CHARD"ABLE PROGRAM SERVICE EXPENDrTURE (ADD J AND K)

90.46%
9.54%

1,330,239. 140,299. 1,470,538.

N O III

FUNDRAISING EXPENSE TOTAL EXPENDITURES THIS PERIOD (ADD L, M, AND N) S U M M A R Y OF A L L PAID FUNDRAISER A N D CONSULTANT ACTIVITIES: (Attach Attorney General Report of Individual Fundraising Campaign - Form IFC. One for eacJh PFR.) PROFESSIONAL FUNDRAISERS:

100%

N$ 0$

^^^^^^^^^^^^^^^^^^^^^^^^^^^^^^^^^^^^^^^^^^^^^^H

P Q R

TOTAL AMOUNT RAISED BY PAID PROFESSIONAL FUNDRAISERS TOTAL FUNDRAISERS FEES AND EXPENSES NET RECEIVED BY THE CHARITY (P MINUS Q=R) PROFESSIONAL FUNDRAISING CONSULTANTS:

100%
% %

P$ Q$ R$ S$

S IV T

TOTAL AMOUNT PAID TO PROFESSIONAL FUNDRAISING CONSULTANTS C O M P E N S A T I O N T O T H E (3) HIGHEST PAID P E R S O N S D U R I N G T H E Y E A R : NAME. TITLE: CAROL S P I Z Z I R R I , PRESIDENT/FOUND

Hl^H^H
T$

130,000.
63,520.

U NAME, TITLE: DANE NEAL, DIRECTOR V NAME, TITLE: VINCENT DAVIS, DIRECTOR
V C H A R I T A B L E P R O G R A M D E S C R I P T I O N : CHARITABLE PROGRAM (3 HIGHEST BY $ EXPENDED) CODE CA TEGORIES

u$ v$
W# X# Y#
ILVA0212L 0/V16TO

50,000. See instructions for list CODE

W DESCRIPTION: LIFE SAVING FIRST AID TRAINING

X Y DESCRIPTION: DESCRIPTION:

011

SAVE A LIFE FOUNDATION

IF THE ANSWER TO ANY OF THE FOLLOWING IS YES, ATTACH A DETAILED EXPLANATION: 1 2 WAS THE ORGANIZATION THE SUBJECT OF ANY COURT ACTION, FINE, PENALTY OR JUDGMENT? HAS THE ORGANIZATION OR A CURRENT DIRECTOR, TRUSTEE, OFFICER OR EMPLOYEE THEREOF, EVER BEEN CONVICTED BY ANY COURT OF ANY MISDEMEANOR INVOLVING THE MISUSE OR MISAPPROPRIATION OF FUNDS OR ANY FELONY?, DID THE ORGANIZATION MAKE A GRANT AWARD OR CONTRIBUTION TO ANY ORGANIZATION IN WHICH ANY OF ITS OFFICERS, DIRECTORS OR TRUSTEES OWNS AN INTEREST; OR WAS IT A PARTY TO ANY TRANSACTION IN WHICH ANY OF ITS OFFICERS, DIRECTORS OR TRUSTEES HAS A MATERIAL FINANCIAL INTEREST; OR DID ANY OFFICER, DIRECTOR OR TRUSTEE RECEIVE ANYTHING OF VALUE NOT REPORTED AS COMPENSATION? HAS THE ORGANIZATION INVESTED IN ANY CORPORATE STOCK IN WHICH ANY OFFICER, DIRECTOR OR TRUSTEE OWNS MORE THAN 10% OF THE OUTSTANDING SHARES? IS ANY PROPERTY OF THE ORGANIZATION HELD IN THE NAME OF OR COMMINGLED WITH THE PROPERTY OF ANY OTHER PERSON OR ORGANIZATION? DID THE ORGANIZATION USE THE SERVICES OF A PROFESSIONAL FUNDRAISER? (ATTACH FORM IFC ) 1

Page 2

YES NO

X
I X

3 4 5 6

4 5 6

_x_
X

7a DID THE ORGANIZATION ALLOCATE THE COST OF ANY SOLICITATION, MAILING, ADVERTISEMENT OR LITERATURE COSTS BETWEEN PROGRAM SERVICE AND FUNDRAISING EXPENSES? 7b IF 'YES', ENTER (.) THE AGGREGATE AMOUNT OF THESE JOINT COSTS $ ; (ii) THE AMOUNT ALLOCATED TO PROGRAM SERVICES $ ; (ii) THE AMOUNT ALLOCATED TO MANAGEMENT AND GENERAL $ ; AND (iv) THE AMOUNT ALLOCATED TO FUNDRAISING $ 8 9 10 11 DID THE ORGANIZATION EXPEND ITS RESTRICTED FUNDS FOR PURPOSES OTHER THAN RESTRICTED PURPOSES? HAS THE ORGANIZATION EVER BEEN REFUSED REGISTRATION OR HAD ITS REGISTRATION OR TAX EXEMPTION SUSPENDED OR REVOKED BY ANY GOVERNMENTAL AGENCY? WAS THERE OR DO YOU HAVE ANY KNOWLEDGE OF ANY KICKBACK, BRIBE, OR ANY THEFT, DEFALCATION MISAPPROPRIATION, COMMINGLING OR MISUSE OF ORGANIZATIONAL FUNDS?.

8 9 10

LIST THE NAME AND ADDRESS OF THE FINANCIAL INSTITUTIONS WHERE THE ORGANIZATION MAINTAINS ITS THREE LARGEST ACCOUNTS:

See Statement 2

ALL ATTACHMENTS MUST ACCOMPANY THIS REPORT - SEE INSTRUCTIONS UNDER PENALTY OF PERJURY, I (WE) THE UNDERSIGNED DECLARE AND CERTIFY THAT I (WE) HAVE EXAMINED THIS ANNUAL REPORT AND THE ATTACHED DOCUMENTS, INCLUDING ALL THE SCHEDULES AND STATEMENTS AND THE FACTS THEREIN STATED ARE TRUE AND COMPLETE AND FILED WITH THE ILLINOIS ATTORNEY GENERAL FOR THE PURPOSE OF HAVING THE PEOPLE OF THE STATE OF ILLINOIS RELY THEREUPON. I HEREBY- FURTHER AUTHORIZE AND AGREE TO SUBMIT MYSELF AND THE REGISTRANT HEREBY TO THE JURISDICTION OF THE STA

BE SURE TO INCLUDE ALL FEES DUE: 1 2 3 REPORTS ARE DUE WITHIN SIX MONTHS OF YOUR FISCAL YEAR END. FOR FEES DUE SEE INSTRUCTIONS. REPORTS THAT ARE LATE OR INCOMPLETE ARE SUBJECT TO A $100.00 PENALTY.

PREPARE R (Pfiiw NAME)

SIGNAT

CBIZ ACCTG., TAX & ADVISORY SERVICES, LL One South Wacker Dr., Ste 1800 Chicago, IL 60606-4630

1LVA0212L 08/16/05

ILLINOIS CHARITABLE ORGANIZATION ANNUAL REPORT

Attorney General L I S A M A D I G A N State of Illinois
Chantabie Trust Bureau, 100 West Randolph 11th Floor, Chicago, Illinois 60601
R p n n f t w ^ c i o ^ i B ^ r (T

Fom)AG990-IL Revised 3/05

r\\**j>ixr>& CO# (J \Q Q.&Lf\)/)

Check aft ttmma attached:

Report for the Frscal Penod: f joggf ms R*m B eoinninn it , 1 , i * " *#om** u Audited Financial Statements Beginning^ eeainnma * / -j , \W>_ j ^ %* $15.00 C o p y of FormReport IFC Filing Fee S X " a Annuaf & Ending,^ / ? P J > ( * ? < BUWF** n $100.00Late ReportFiBngFee
fd era l( D# _ a contributions to the organization tax deductible? LEGAL NAME
MAIL
fl

MO

"DAY -WI

MO Date Organization W ^ create*

OAY

f j Y i N

**

^L

SAVE A LIFE FOUNDATION ^ f a c p C I U C n Attorney G e n e r a l Of i7479 W Dartmqor IL Dr 60030

A.DDRESS rv, STATE ZIP CODE

JUN 1 0 2010

Grayslake,

Charitable Trust

SUMMARY OF ALL REVENUE HEMS DURING THE YEAR D) PUBLIC SUPPORT. CONTRIBUTIONSftPROGRAM SERVICE REV. (GROSS AMTS.)) E) GOVERNMENT GRANTS 4 MEMBERSHIP nuES F , OTHER REVENUES G) TOTAL REVENUE, INCOME AND CONTRIBUTIONS RECEIVED (ADD D,E, & F) SUMMARY OF ALL EXPENDITURES DURING THE YEAR: H) I) J) OPERATING CHARITABLE PROGRAM EXPENSE EDUCATION PROGRAM SERVICE EXPENSE TOTAL CHARITABLE PROGRAM SERVICE EXPENSE (ADD H At )

J i ) JOINT COSTS ALLOCATED TO PROGRAM SERVICES (INCLUDED IN J): K) GRANTS TO OTHER CHARITABLE ORGANIZATIONS L! TOTAL CHARITABLE PROGRAM SERVICE EXPENDITURE {ADD J 4 K) GENERAL EXPENSE

M) MANAGEMENT AND

ti] FUNDRAISING EXPENSE O I TOTAL EXPENDITURES THIS PERIOD (ADD L, M, N) SUMMARY OF ALL PAID FUNDRAISER AND CONSULTANT ACTIVITIES: mttBCh Afioffny G9frai Report of hdivfcJuai Fundrsisrng Campaign- For* 1FC. Owfor each PFR. PROFESSIONAL FUNDRAISERS: P) TOTAL AMOUNT RAISED BY PAID PROFESSIONAL FUNDRAISERS G} TOTAL FUNDRAISERS FEES ANO EXPENSES *) NET 4eCElVED BY THE CHARITY {P MINUS Q=R) PROFESSIONAL FUNDRAISING CONSULTANTS; 3) TOTAL AMOUNT PAID TO PROFESSIONAL FUNDRAISING CONSULTANTS :OMPENSAT)ON TO THE (3) HIGHEST PAID PERSONS DURING THE YEAR; r; NAME. TITLE
1) N A M E , T I T L 6

'**

') NAME, TITLE W R I T A B L E PROGRAM D E S C R I P T 1 0 N : w m o * p B W Br t Exp&aeo) cooe CA TEGORES List on b a i * side of Instructions CODE

ANSWER TO ANY OF THE FOLLOWING 13 YES, An/SnTDErwiiD^PLAKATlON:

WAS THE ORGANIZATION THE SUBJECT OF ANY COURT ACTION. FINE. PENALTY OR JUDGMENT? I, HAS THE ORGANIZATION OR A CURRENT DIRECTOR. TRUSTEE, OFFICER OR EMPLOYEE THEREOF EVER BEEN CONVICTED BY ANY COURT OF ANY MIDSDEMEANOR INVOLVING THE MISUSE OR MISAPPROPRIATION OF FUNDS OR ANY FELONY?

YES/W

2.

).

D10 THE ORGANIZATION MAKE A GRANT AWARD OR CONTRIBUTION TO ANY ORGANIZATION IN WHICH ANY OF ITS OFFICERS DIRECTORS OR TRUSTEES OWNS AN INTEREST; OR WAS IT A PARTY TO ANY TRANSACTION IN WHICH ANY OF ITS OFFICERS, DIRECTORS OR TRUSTEES HAS A MATERIAL FINANCIAL INTEREST; OR DID ANY OFFICER, DIRECTOR OR TRUSTEE RECEIVE ANYTHING OF VALUE NOT REPORTED AS COMPENSATION? 3 1 HAS THE ORGANIZATION INVESTED IN ANY CORPORATE STOCK IN WHICH ANY OFFICER, DIRECTOR OR TRUSTEE OWNS MORE THAN 10% OF THE OUTSTANDING SHARES? IS ANY PROPERTY OF THE ORGANIZATION HELD IN THE NAME OF OR COMMINGLED WITH THE PROPERTY OF ANY OTHER PERSONOR ORGANIZATION? DID THE ORGANIZATION USE THE SERVICES OF A PROFESSIONAL FUNDRAISER?(ATTACH FORM IFC) DID THE ORGANIZATION ALLOCATE THE COST OF ANY SOLICITATION, MAILING. ADVERTISEMENT OR LITERATURE COSTS BETWEEN PROGRAM SERVICE AND FUNDRAlSlNG EXPENSES?

4.

5. 6.

7.

IF T c S " , ENTER <i) THE AGGREGATE AMOUNT OF THESE JOINT COSTS | ;(B) THE AMOUNT ALLOCATED TO PROGRAM SERVICES $ : (Hi) THE AMOUNT ALLOCATED TO MANAGEMENT AND GENERAL S ; AND (iv THE AMOUNT ALLOCATED TO FUNDRAISiNG DID THE ORGANIZATION EXPEND ITS RESTRICTED FUNDS FOR PURPOSES OTHER THAN RESTRICTED PURPOSES? HAS THE ORGANIZATION EVER BEEN REFUSED REGISTRATION OR HAD ITS REGISTRATION OR TAX EXEMPTION SUSPENDED OR REVOKED BY ANY GOVERNMENTAL AGENCY? 9.
fi

WAS THERE OR DO YOU HAVE ANY KNOWLEDGE OF ANY KICKBACK, BRIBE, OR ANY THEFT. DEFALCATION MISAPPROPRIATION. COMMINGLING OR MISUSE OF ORGANiZATiONAL FUNDS? 10. LIST THE NAME AND ADDRESS OF THE FINANCIAL INSTITUTIONS WHERE THE ORGANIZATION MAINTAINS ITS THREE LARGEST ACCOUNTS:

NAME AND TELEPHONE NUMBER OF CONTACT PERSON: ATTACHMENTS MUST ACCOMPANY THIS REPORT - SEE INSTRUCTIONS : PENALLY OF PERJURY. I (WE) THE UNDERSIGNED DECLARE AND CERTIFY THAT I (WE) HAVE EXAMINED THIS ANNUAL REPORT HE ATTACHED DOCUMENTS, INCLUDING ALL THE SCHEDULES AND STATEMENTS AND THE FACTS THEREIN STATED ARE \HD COMPLETE AND FILED WITH THE ILLINOIS ATTORNEY GENERAL FOR THE PURPOSE OF HAVING THE PEOPLE OF THE
OF ILLINOIS: R Pl' Y T H E R E U P O N I HEREBY FURTHER AUTHORIZE AMD A fi R FF TO SUBMIT MYSFI F AMD T MF RERIOTRAMT

Y TO TH ^RM r fiTOT*N&AT E OF ILLINOIS

"= u *

MI3CLr

*""

m e W

"

w n

tifwaul
? TO iMCLUPeALL FEES PU.fr RTSAKE DUE WITHIN SIXTHS drfYOUR FISCAL Y&l&SND. *Pl_ET ARE SUBJECT TO A

CAROL SPI2ZXRRI RESIDENT or TRUSTEE PRINT NAME)

TRJASURER or TRUSTEE (PRINT NAME)

afr/jtef
SIGNATURE