Form 990 Questionnaire
Please be sure to provide a complete questionnaire (we get a lot of incomplete questionnaires).
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 invoice.
Completing 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.
Send 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; 107 W Main St; Fulton OH 43321-9702; or fax to: 614-340-7909.
If you have questions, please call 614-743-2106.
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.
- Info about your organization:
Organization’s name / Federal ID number
Mailing address
Physical address
Check here if either address is different from last year
Organization’s phone / Organization’s web site
Organization is a / Corporation Trust Association
Date incorporated / State where incorporated
Principal officer's name / His/her SSN / His/her phone
Did your organization cease operations this year? / Yes No
Did your organization engage in significant program services this year not reported on any previous Form 990? (if yes, provide a complete explanation). / Yes No
Did your organization cease conducting or make significant changes to any program services? (if yes, provide a complete explanation). / Yes No
- This questionnaire covers the fiscal year ending: Month Year
- Check if: Initial return Final return Change of address Change of name
- Organization is tax-exempt under:
- This info was provided by:
E-mail:
- Who will sign the Form 990?
- Who has custody of the books?
Address:
- Has your organization filed Form 1023 or Form 1024 (application for IRS recognition of tax-exempt status)?
Yes, we have received an approval letter from the IRS
Yes, it has been submitted to the IRS, but we are awaiting final approval
No, our revenue is less than $5000/year; therefore, we are not required to file Form 1023 or Form 1024
No, we need MCG's assistance in preparing Form 1023 or Form 1024 (MCG will send another questionnaire to get the necessary info)
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:
- 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 sales are almost always considered UBI.
Yes—filing Form 990-T is required; please phone us immediately.
No
- 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)
Yes, we are required to file with the following state(s) and:
we want MCG to prepare it
we will prepare it ourselves.
If yes, ignore L, and complete the remainder of this questionnaire
No, we are exempt from having to file a year-end report with all states
- Complete this chart:
Gross Income (from all sources) / Total Expense / Total Program Service Expense** / Total Assets***
Current report year
First previous year
Second previous year
Average income *
* 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.
Was your organization’s averagegross 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?
Yes—complete the remainder of the questionnaire
No—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
Name / Position(s) (e.g., board member, President, etc.) (List all that apply) / Board Mbr / Officer / Former / Hours/Week This Org / Hours/Week Related Orgs / Annual Comp from This Org / Comp from Related Orgs / Benefits from This Org
1)
2)
3)
4)
5)
6)
7)
8)
9)
10)
- List any other person or entity (other than corporations)you paid $100,000 or more for services rendered during the report year
Name / Position / Address / Compensation / Benefits
1)
2)
3)
4)
5)
- In no more than 1-3 brief sentences each, describe your top program service accomplishment(s).
1)
2)
3)
4)
5)All other programs
Total expenses (this total must equal the Program Expense total in #35 below)
* 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 #35 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.
Question / Yes / No / Explanationor Other Response
- Last year's Form 990 was...
Not required to file
Required but not filed
Prepared elsewhere—send a copy of Form 990 for the last TWO years
- Check 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):
Educational Scientific
Literary Testing for public safety
Amateur sports
Prevention of cruelty to children or animals
- Are any board members or corporate officers related to one another (by blood, marriage, or significant business/financial dealings)?
- How many times did the board of directors meet?
- Were all board and committee meetings and decisions contemporaneously documented (i.e., did you keep minutes)?
- a. Number of voting board members
b.
- 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?
- 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)?
- Did any person or entity receive an economic benefit OR use any of the organization’s resources that was:
b. Not reasonable in nature or amount
c. Not properly reported for tax purposes / a.
Explain
b.
Explain
c.
Explain / a.
b.
c. / a.
b.
c.
- How manyof these tax forms did you issue for the report year?
From W2G
Form W2 (if greater than 0, check here if you filed all required employment tax returns )
- Did the organization have an interest in or signature authority over a financial account (of any type) in a foreign country?
- 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?
- Did the organization invest in, contribute assets to, or participate in a joint venture or similar arrangement with a taxable entity?
- Was the organization involved a partnership or other joint venture for which Schedule K-1 (Form 1065) was received?
- Did the organization lobby any legislative body (Congress, state legislature, city council, school board, etc)?
- 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?
Question / Yes / No / Explanation and/or Response
- Do you have a written conflict of interest policy?(Note: this is sometimes incorporated into your constitution or bylaws)
- Do you have a written whistle blower policy?(Note: this is sometimes incorporated into your constitution or bylaws)
- Do you have a written document retention and destruction policy? (Note: this is sometimes incorporated into your constitution or bylaws)
- Are officers, directors and key employees required to annually report any interests that could result in a conflict of interest?
- 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?
- 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.
- Did you solicit any donations that were not tax deductible?
- Did you receive one or more paymentsof more than $75 made partly as a contribution and partly in exchange for goods or services provided to the payer?
- 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'.
- a. Did you receive a donation of an airplane, boat or car?
Explain
b. / a.
b. / a.
- 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?
Explain
b. / a.
b. / a.
- Were any changes made to beginning net assets (other than recording current year net income)?
Financial Data
We were an MCG'AdMinistry client at the end of the report year: you do not need to completethe Items in red. Responses to all other questionsare still required.
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: Accrual Cash Modified cash
- Income 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 Categories / Report Year / Portion received from 501C3 Entities / First Previous Year / Second Previous Year
Federal campaigns
Membership dues
Fundraising events; if the amount is $15,00 or more please provide below a description and income/expense report for each event
Direct expenses for fundraising events
Income from related organizations
Government grants
All other donations, gifts, & grants
Value of donated high-end professional services not included above *
Value of other non-cash donations received *
Program fees:
Program fees:
Program fees:
Program fees:
Interest & other investment income
Royalty income
Gross rental income
Less: rental expenses
Was the rental property subject to a mortgage / Yes No
Was the property rented exclusively to one or more tax-exempt entities? / Yes No
Gross proceeds from sales of assets other than inventory
Less: costs basis of assets sold
Sales of inventory items
Cost of inventory items purchased (whether sold or still in inventory)
Total Income
* 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(prior year data needed only if MCG did not prepare your Form 990 last 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 greater / Required if MCG did not prep Form 990 last year
Expense Categories / Annual Total / Program Services / Management & General / Fund Raising / 1stPrev Year / 2ndPrev Year
Grants paid from donor advised funds
Other grants paid; if > $5000 provide a list of recipients, addresses & amounts
Assistance to individuals; if > $5000 provide a list of recipients, addresses & amounts
Benefits paid to or for members
Compensation: current officers & directors
Compensation: former officers & directors
Compensation: all others
Pension plan contributions
Other employee benefits
Payroll taxes paid by employer
Management fees
Legal fees
Accounting fees
Lobbying fees
Professional fundraising fees
Investment management fees
Other professional fees
Advertising & promotion
Office expenses
Information technology
Royalties paid
Occupancy costs (rent/util/insurance/etc)
Travel
Conferences, conventions & meetings
Interest expense
Payments to affiliates
Depreciation & depletion*
Insurance
Value of non-cash donations received
Value of donated professional services*
Other:
Other:
Other:
Other:
Other:
Other:
Program Services Total / This total must equal the expense total in #3on page 3
* Include only if you use the accrual basis of accounting
- Balance 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 only / Beginning of Year / End of Year / Liabilities
* accrual-based accounting only / Beginning of Year / End of Year
Checking accounts & cash on hand / * Accounts payable
Savings accounts / * Grants payable
Amounts receivable from directors, officers and key employees / Loans payable to officers, directors, and key employees
* Other accounts receivable / * Deferred revenue
* Other notes and loans receivable / * Tax-exempt bond liability
* Inventories / * Mortgages/other notes payable
* Pre-paid expenses / * Other liability:
* Fixed assets other than real estate / * Other liability:
* Accumulated depreciation / Net Assets
* Real estate / Complete this section if you follow SFAS 117
* Accumulated depreciation / Unrestricted net assets
*Other asset: / Temporarily restricted net assets
*Other asset: / Permanently restricted net assets
*Other asset: / Complete this section if you do not follow SFAS 117
*Other asset: / Capital stock/trust principal
*Other asset: / Paid-in or capital surplus
*Other asset: / Retained earnings
*Other asset: / Total net assets/fund balance
Beginning total net assets/equity / +
Total income (question #33 above) / +
Total expenses (question #35 above) / -
Ending total net assets/equity / =
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.