HARRY HUGHES, Governor

3873

(4)  The place where and the date when it was legally
established, the form of its organization, and a reference to any
determination of its tax-exempt status or change in its
tax-exempt status under the Internal Revenue Code. A copy of the
determination shall be filed with the statement;

(5)  The names and addresses of its officers,
directors, trustees, and principal salaried executive staff
officers;

(6)  Its balance sheet, income and expense statement,
and a financial report (including the kind and amount of its
gross income raised, costs and expenses incidental to the
fund-raising activities, and the allocation and disbursement of
gross income raised) prepared in accordance with generally
accepted accounting principles for its most recently fiscal year.

In the event that:

(i) The total amount of gross income received
equals or exceeds $100,000 an audit is required by an independent
certified public accountant according to the standards of
accounting and fiscal reporting for voluntary health and welfare
organizations;

(ii) The total amount of gross income received
is less than $100,000 the Secretary of State may require an audit
as required in subparagraph (i).

(iii) An audit required by subparagraph (i) or
(ii) above may exclude funds received from a governmental agency
if audit of such funds is otherwise provided by the governmental
agency.

(7)  Whether it intends to solicit contributions from
the public directly or have the solicitations made on its behalf
by others;

(8)  Whether it is authorized by any other
governmental authority to solicit contributions;

(9)  Whether it is or has ever been subject to an
order of any court or administrative agency restraining or
restricting its fund-raising activities, and, if so, such
information pertaining thereto as the Secretary of State may
require;

(10)  The purpose or purposes for which the
contributions to be solicited will be used;

(11)  The name or names under which it intends to
solicit contributions if different from that given pursuant to
paragraph (a)(1) of this section;