Did the address of the organization change during the year? Yes No

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1 2016 Tax Questionnaire 990 Not-For-Profit Thank you for completing this questionnaire completely and accurately. This is a very important step in completing your return. We recommend that you review last year s tax return to ensure you are providing us with complete information and have not missed items that were included on prior year returns. You can access your prior years tax returns and last year s questionnaire through the secure client portal. Legal Name of Not-for-Profit: Address of Organization: Did the address of the organization change during the year? Yes No Contact Person: Preferred address: Phone Number: CHECKLIST FOR INFORMATION TO PROVIDE Recommended method of delivery is via our secure portal - do not docus or information containing sensitive information Sent Item Sent Signed Form 990 Not For Profit engage letter. This signed and completed Questionnaire. For QuickBooks Online: Let us know when your file is complete and ready for us to work on. If you are using QuickBooks Online, verify info@cfcpas.com is set as your accounting firm. o o Click on the gear icon and select Manage Users. In the accounting firm section verify info@cfcpas.com is invited or select invite accountant and invite info@cfcpas.com. If you have a mid-month bank state or need to void/delete transactions please do not reconcile the bank account until all transactions/adjusts have been entered for December. For QuickBooks Desktop: Identify the QB Version (Year) you are using: Make sure all December bank states are reconciled and send us file transfer per the instructions at the end of the Questionnaire. Copy of bank states from month of year end. Receipts for assets purchased costing over 500 or 2,500 (see attached capitalization memo). Business credit card states for the last month of year end and month after year end with expense categories noted for each expense not in QuickBooks by last month of year end. Additional Information as needed per questions below Tax preparation will begin once all information is received. It is most efficient to send in all information at the same time. Client copies of completed tax returns will be available through our secure portal. If completing this form by hand, please complete using black or blue ink only NO RED INK OR PENCIL PLEASE. *If additional information is required in questions with an asterisk, space is provided at the end of the questionnaire. Docuation or details must be provided in order for us to begin preparing your return. Thank you!

2 General Information: YES NO 1. Did the organization make pays for services to unincorporated entities or attorneys for 600 or more? 1a. If #2 is Yes, was a Form 1099 issued for each qualifying pay? 1b. If #2 is Yes, what is the number reported on Box 3 of Form 1096? 2. Did the organization use form W-9 to obtain a tax identification number from any award or prize winner and send 1099 forms (ex. raffles)? 3. Did the organization have employees or paid officers? 3a. If yes, what is the number of employees reported on form W3? 4. Did the organization pay any employees or independent contractors more than 100,000? 5. Was there a liquidation, dissolution, termination, or substantial contraction during the year? 6. Did the organization maintain an escrow account or serve as an account custodian? 7. Did the organization sell more than 25% of its assets? Donations and Other Funds Received: YES NO 8. Were any non-cash donations received? If so, how was the value determined and recorded? 9. Did the organization receive donations from any individual or organization in excess of 5,000 or more than 2% of the total contributions to the entity? If yes, please provide the name of contributor, address and amount contributed: Name of Contributor: Address: Amt 10. If the organization is a charity, did the organization provide acknowledge letters to any individuals or organizations that donated more than 250 including non-cash donations? 10a If yes, did the acknowledge letters include the organization s full legal name, amount of the cash donation received or description of non-cash donation and a state that no goods or services were provided by the organization? 11. Did the organization receive any quid pro quo contributions in excess of 75? (A quid pro quo contribution exists when a donor receives goods or services in exchange for their donation.) If yes, did the organization notify the donor of the value of the goods or services provided?* 12. Did the organization receive donations of art, historical treasures, or other similar assets 13. Did the organization receive funds from any fundraising agencies (ex. United Way)? 14. Did the organization hold fundraising events? 15. Did the organization hold gaming events? 15a If yes, was more than 15,000 of gross income received from gaming activities? 16. Did the Section 501(c)(4), (5), or (6) organization receive membership dues or assesss? 17. Did the organization maintain any donor advised funds? 18. Did the organization receive or hold a conservation ease (including eases to preserve open space, the environ, historic land areas, and historic structures)? 19. Did the organization receive any income from a regularly carried on unrelated trade or business? 20. Did the organization maintain collections of works of art or historical treasures? Tax Return Compliance Questions: YES NO 21. Did the organization provide credit counseling, debt manage, credit repair, or debt negotiation services? 22. Did the organization, directly or through a related organization, hold assets in temporarily restricted endows, permanent endows, or quasi-endows? Page 2 of 5

3 Tax Return Compliance Questions Cont d: YES NO 23. Did the 501 (c)(3), (4), or (29) organization engage in excess benefit transactions with persons in a position to exercise substantial influence over the affairs of the organization or become aware of previous transactions? 24. Did the organization hold any receivables or payables to any current or former officers, directors, trustees, key employees, highest compensated employees or persons in a position to exercise substantial influence over the affairs of the organization? 25. Did the organization provide a grant or other assistance to an officer, director, trustee, key employee, substantial contributor, grant selection committee member, or to an individual or entity related to these persons? 26. Did the organization engage in business transactions with a current or former officer, director, trustee, key employee, or a family member or related entity of such? 27. Did the 501(c)(3) organization make any transfers to an exempt non-charitable organization that is related as a parent, a subsidiary, brother/sister, or supported/supporting? 28. Did the organization own 100% of an organization not treated as a separate entity for federal tax purposes? 29. Is any related organization a controlled entity of the organization? 30. Were any old un-cleared checks written off during the last fiscal year? 31. Has the organization made or received any interest free or below market rate loans? 32. Has the organization been examined or received a notice from the IRS or any other tax authority? 33. Does the organization own greater than 50% interest in any taxable corporation, partnership, or LLC? 34. Did the organization engage in new activities during the fiscal year? If yes, please provide description.* 35. Has the organization revised its organizing or governing docus? 36. Was there a liquidation, dissolution, termination, or substantial contraction during the year? 37. Did the organization pay any direct or indirect political expenses? 38. Did the organization engage in direct or indirect political campaign activities on behalf of or in opposition to candidates for public office? 39. Did the organization engage in lobbying activities? 40. Did the organization borrow from or make loans to any officer, director, trustee, or key employee? 41. Did the organization pay any excise taxes during the year? 42. Was the organization party to a prohibited tax shelter transaction at any time during the year? 43. Did the organization, directly or through a related organization, hold assets in temporarily restricted endows, permanent endows, or quasi-endows? 44. Has the organization denied copies of Forms 990 and 1023 to anyone who requested a copy? If yes, please provide details.* Foreign Information: YES NO 45. Does the organization have any funds in a foreign bank account? 46. Does the organization have signature authority over a foreign bank account? 47. Does the organization maintain an office, employees, or agents outside of the United States at any time during the year? 48. Did the organization provide grants or other assistance to or any entity located outside the United States? 49. Did the organization provide grants or other assistance to or for foreign individuals? 50. Did the organization generate revenues or expenses from activities outside the United States or have foreign invests? 51. Did the organization have more than 5,000 of grants or assistance to any organization or entity located outside the United States? Page 3 of 5

4 Illinois Form AG990 Questions: YES NO 52. Was the organization the subject of any court actions, fine, penalty, or judg? 53. Has the organization or a current director, trustee, officer, or employee thereof ever been convicted by any court of any misdemeanor or felony involving the misuse or misappropriation of funds or any felony? 54. 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? 55. Has the organization invested in any corporate stock in which any officer, director, or trustee owns more than 10% of the outstanding shares? 56. Is any property of the organization held in the name of or commingled with the property of any other person or organization? 57. Did the organization use the services of a professional fundraiser? 58. Did the organization allocate the cost of any solicitation, mailing, advertise, or literature costs between program service and fundraising expenses? 59. Did the organization expend its restricted funds for purposes other than restricted purposes? 60. Has the organization ever been refused registration, or had its registration or tax exempt status revoked? 61. Was there, or do you have any knowledge of any kickback, bribe, theft, defalcation, misappropriation, commingling, or misuse of organizational funds? 62. Must provide the Name, Title and total compensation paid to the three highest paid persons during the fiscal year. Name of Contributor: Title: Amount If the organization is classified as a private foundation, please answer the following: YES NO 63. Please provide a list of officers, directors, trustees, and key employees. For each, please provide average hours worked compensation and health benefits. 64. Did the foundation comply with the public inspection requires for its annual returns and exemption application? 65. Did the foundation directly or indirectly pay premiums during the year on a life insurance, annuity or endow contract? 66. Did the foundation engage in the sale or exchange, or leasing of property with a person who was 67. Did the foundation borrow money from, lend money to, or otherwise extend credit to (or accept it from) a person who was in a position to exercise substantial influence over the affairs of the foundation? 68. Did the foundation furnish goods, services, or facilities to (or accept them from) a person who was 69. Did the foundation pay compensation to, or pay or reimburse the expense of, a person who was 70. Did the foundation transfer any income or assets to a person who was in a position to exercise substantial influence over the affairs of the foundation? 71. Did the foundation pay money or property to a govern official? 72. Do any foundation officers, directors, trustee, or key employees have any relationship with any of the organizations the foundation contributes funds to? 73. Does the foundation only make contributions to preselected charitable organizations, and never accept unsolicited requests for funds? 74. Did the foundation pay premiums, directly or indirectly, on any life insurance, annuity, or endow contract? Page 4 of 5

5 *Please remember if you answered yes to any of the questions above to provide us with the docuation or details. Thank you! Authorized Signature: Print Name: Date: Title: If you used the fillable version of this form just save it to your desktop and upload to your portal. This form and all others forms and docus may be scanned and uploaded to your secure portal. They will be saved there for your convenience. Do not any information that contains social security numbers or other sensitive information. Please drop off the docus, mail with a tracking option or use your secure portal. Please remember if you answered yes to any of the questions above that all docuation or details (in the order they are listed on this questionnaire) must be provided to us before the preparation of your return will begin. Question # Notes: Details or Addl Docuation Sent TO SAVE A BACKUP Save a regular backup of your Quickbooks file (not an accountant s copy) to a location you can find it again (ex. desktop). In QuickBooks go to: File Backup Company Create Local Backup - The file should have a *.QBB filename extension. TO UPLOAD YOUR FILE TO YOUR SECURE PORTAL Go to our website Go to the Client Center: Enter your login and password, and click Login. Click the File Exchange link, click the folder with your Company name, and click Upload. Click Select Files, and browse to the QuickBooks backup file you created, select open, and click Upload. For additional help you may click on Using File Exchange in the Client Center for a step by step how to video. Page 5 of 5