·
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Attorney General.Tom. ~.iller G7 Y fl 23 M~ 10: 16
Consumer ProtectIOn DIvIsIOn
Hoover State Office Building l:w , iS U ; ~lR PI\ OT C: CT i O .~ 01j .
1305 E. \Valnut, Des Moines, Iowa 50319
515-281-5926
E-Illail: consumel·@ag.state.ia.us
PLEASE NOTE IMPORTANT OPEN RECORDS INFORMATION TOWARDS THE END OF THIS FORM.
2. Identify the charitable organization fiJI' which you will be soliciting money within the
State of lo\va during this registration period. (If more than one charitable organization,
file a separate Financial Information Disclosure form for each .)
C. Name, title, address and telephone number of the contact persoll(s) for the
charitable org,ll1i zation:
Page I of 5
210 Walnut Street, Room 1045 Des Moines
/-/(9- ~1701--
3. Beginning and ending solicitation dates J thropgh ON GOING
4. Is the contract between the professional fund-raiser and the charitable organization on tile
with the office of the 100\'a Attorney General?
6. r~ill be contacted by telephone and mail, how will the initial contact be made'?
Telephonv Mail
7. IfsoJiciting will be conclucted by telephone, provide the following regarding the location
from which calls v"ill be made. (If more th an two locations, continue on a separate sheet) :
Please see attachment
Room I
Room 2
a. Address of telephone roOI11 (Include street, city and state):_ _ _ _ _ _ _ _ _ _ __
X. Will the solicitation campaign involve the sale of goods or services? Yes G)
Page 2 of 5
If yes, check one or more of the t()llowing that apply:
10. !fcontributions will be made by mail, identify all addresses to which the mail will be sent.
Ifany of the addresses are dinerent than the addresses listed in response to question 2B,
please state: (I) whether the address is that ofa post office box, commercial mail service,
bank of the professional timd-r;liser or the address of a charitable organization; (2) the
identity of the individual or entity responsible for collecting mail containing contributions.
Donations are mailed to a PMB Box (like a UPS store or a Pack & Mail)
processing. The PMB Box has not yet been set lip
I I. State which of the f()llowing has the authority to withdraw the funds hOI11 any banking
account (check all that apply):
12. State whether contributions to the charitable organization are tax deductible:
~
GJ No
13. On an attached sheet, describe the charitable program for which the solicitation campaign is
being carried out.
Page 3 of 5
FII\ANCIAL JNFORMATION
State the following information and indicate the applicable time period and dates (either the last
completed fiscal year or the previous twelve months):
(I
b. Itemize the sOllrce(s), and dollar amollnts per source, of all funds collected on
behalf of the charitable organization: (contributions or donations; payments for
tickets to events, govel"lll11ent grants, private charities, foundations, etc.):
(I
(2) Total not given to charitable organization but expended on behalf of the
charitable organization: Itemize by dollar amount based on the following anci any
(I
(3) State the total dollar amount billed to the charitable organizatiOl1 by the
professional commercial fund-raiser and itemize each such billing by purpose and
amount:
(I
Page 4 of 5
Note: All information and documentation provided as part of this registration, including this
form are public records and all or some may be open to public inspection pursuant to the
Iowa public recorcls law, Iowa Cocle chapter 22, and the iowa Attorney General's
Administrative Rules relating to public records, 61 lAC chapter 2.
I\ote: Any changes or additions to the information provided in this notice must oe reported
immediately.
SIGI\ATURE:
State of Michigan )
) SS.
County of Oakland )
I,R. William. Burland, being tirst duly sworn on oath, depose and state that I am a
managing agent of the pl"Ofession:lI fund-raiser; that T have read the contents of this Charitable
Organization Financial Disclosme Form; that I know the contents thereof; and that each
---ti< -~
./
(4~JAQ~//
Otaryulic' , - - -- ---
CATHLEEN D. ANDARY
County of Macomb
Page 5 of 5
Stalement of Purpose Pane
:::> 1 of 1
Reminder: AOL will never ask you to send us your password or credit card number in an email. This message has been scanned for known viruses.
Attachments:
smime .p7s (6K)
641-777-7844
MI48034
MI48124
Banks
Flagstar Bank
5151 Corporate Dr.
Troy, MI
Account U 583585445
AGREEMENT
FOR AND IN CONSIDERATION of the covenants and agreements contained herein, the undersigned,
organization (hereinafter referred to as "VVIA "), enter into this contractual agreement as follows:
1. PURPOSE: The parties hereto agree and covenant that the purposes of this
Agreement are as follows:
C· \\"') }
~~, ', Agreement and any extension thereof, not to retain or use the services of any
other telemarketing flnns except those which are arranged by or through ACS.
In addition thereto, VVIA agrees that it will not conduct its own telemarketing
::;. i I
program(s), or do so in conjunction with any other person or entity, without the
f) ......- ,
express written consent of ACS, who shaH have the right to withhold approval at
its sole discretion.
c) For ACS to solicit contributions for VVIA for fulfillment of VVIA's charitable
purpose(s) in the State ofIOWA.
a) ACS agrees to make telephone calls from its facilities, from lists of names and
corresponding phone numbers; such lists are to be provided by ACS. ACS
agrees to provide a work force that is properly trained and supervised for the
purposes of this Agreement. Said Facilities and work force may be
subcontracted by ACS .
c) To engage in no activities in the name ofVVIA without its consent, and at all
times to conduct business with due regard to the name and reputation of VVIA.
d) To use its best efforts in locating and referring qualified telemarketing firms to
VVIA with the goal of creating national coverage for telemarketing campaigns.
Said telemarketing fums shall submit reference background fonns, be properly
registered and bonded to comply with the appropriate state law(s) in
geographical jurisdiction, and must be approved in writing by VVIA, which
approval shall not be unreasonably withheld or delayed.
e) To receive and review the sales records of the independent telemarketing finns
and create infonnation, the fonn and substance of which shall be mutually
agreed to by and between both parties herein, setting forth program service
infonnation to be distributed.
2
f) To provide storage of information.
g) To ensure that all licenses, filing, permits and registrations, as may be required
by governmental agencies are filed in a timely fashion, pursuant to ACS's
portion of this Agreement.
i) To hold ACS hannless from any potential law suit filed against
3
6.
COMPENSATION: All contracts arranged or provided by ACS shall set forth
acknowledge and agree that ACS shall be entitled to a fee for its services as provided
herein . Such funds shall come from collections and shall not exceed the agreed upon
percentage listed in exhibit "A" . Said amount shall represent the entire compensation
due ACS for its services, and shall be paid by VVTA to ACS on a basis set forth from
time to time by ACS, and not more than two (2) times per week. Funds will be wired
or sent by overnight mail service with next morning delivery, within twenty four (24)
hours of VVIA's receipt of deposit information from ACS.
9. HOLD HARMLESS: Each of the parties do hereby agree to indemnify and hold
the other harmless from any and all damages, costs, expenses, anorney fees, as well as
all claims which may arise out of either party's conduct of its portion of this agreement.
11. NOTICE: Any wrinen notice required pursuant to the terms of this agreement shall
at the following addresses:
12. DONOR LIST: It is expressly understood and agreed by the parties hereto, that any
and all names and addresses contributed, if any, by persons, firms, associations or
4
corporations which are obtained, developed, compiled or otherwise acquired for VVIA,
by or through the direct or indirect efforts of ACS, in connection with any services
rendered under this agreement shall remain the property of both parties. It is further
understood and agreed by VVIA that VVIA shall not use or sell the said Donor List for
any telemarketing and/or direct mail fundraising purposes what so ever during the tenn of
this agreement, unless agreed upon in writing by ACS . VVIA further agrees and
acknowledges that it shall not use or sell the said Donor List for any telemarketing and/or
direct mail fundraising purposes for a period of twenty-four (24) months, after the
tennination of this agreement.
c) Failure or refusal to fully and faithfully perfonn the duties of this agreement;
d) If ACS or VVIA is the recipient of adverse publicity due to the fault of ACS;
5
16. SEPARABILITY: Ifany provision or provisions of this agreement shall be held
to be invalid, illegal or unenforceable, the validity, legality and enforcement of the
remaining provisions shall not in any way be affected or impaired thereby .
17. LAW AND JURISDICTION: The parties agree that this agreement shall
be governed by and construed in accordance with the laws of the STATE of
MICHIGAN. [n the event of default, violation or any other question arising under the
tenns and conditions of the agreement which cannot be resolved by the parties hereto,
the matter, by consent of the parties, shall be submitted to binding arbitration. The
arbitration procedure shall take place in Chicago, illinois, and the resolution shaH be in
accordance with the rules of the American Arbitration Association. Said procedure
shall allow for the arbitrator to access the costs of the arbitration proceedings as he may
deem appropriate.
22. BANK ACCOUNTS: All funds will be deposited into a bank located in the
Metro Detroit area in an account in the complete control of VVIA. VVIA shall be
responsible and will pay for any and all charges which may be charged by the banle
6
23. BINDING EFFECT: This agreement shall be binding upon and inure to
the benefit of the respective party's successors or assigns.
IN WITNESS WHEREOF, the parties herein have executed this agreement on the day and year first
above written.
c/(tJ~-- BY~'\ci),~
:=-v~~~~ \\ Its
Date \~ . d1 -Olu
1)au~eJ;;- :~
Date /;1-- Z g---c>~
fL " fhcJA&
- ' i :iL.·t<- 7 · BY~~
7~ ~
Its· /~
Date I-V~7
7
7
EXHIBIT A
COMPENSATION
It is hereby agreed between VVIA and ACS that the commissions paid to ACS by VVIA
will be the following:
ACS will be paid eighty percent (80%) of the total gross collected funds and VVIA will
retain twenty percent (20%) of the gross collected funds.
~~- BY~~~~
I~~
Date i~ -d-~-o&
~~BY~
8
Attorney General Tom Miller
515-281-5926
E-mail: consumer@ag.state.ia.us
Please notice that the registration requirement is only for professional commercial fund
raisers as defined in Iowa Code Chapter l3C. Charitable or2anizations as defined in this
Chapter are not required to register.
Professional commercial fund-raisers must also complete the attached form, "Charitable
Organization Financial Information Disclosure Form," for EACH charity for which you
raise funds.
Q
I. Name of Professional Commercial Fund-raiser, including any d/b/a and trade names:
r=:
,C :--J
Associated Community Services
L.Q
I
--::.
~1
2. Address and telephone number of each office, chapter, branch or affiliate. Indicate the princillill
place of business: --:
:? -'
29777 Telegraph Road, Suite 3000 t'J
"CO
Southfield, MI 48034
248-352-2600
-\
v
"J . Form of business Corporation
(Individual, Partnership, Business Corporation, Nonprofit Corporation, etc.)
5. Full name, title, address and telephone number of each officer, director, partner or managing
agent of the professional commercial fund-raiser:
6. Name, address, telephone number and title of the following person(s) for the professional
commercial fund-raiser:
Same as above
c. The person(s) who directs and controls the activities of the professional commercial fund
raiser:
Robert W. Burland, Jr.
'. D
e. The person(s) responsible for custody of all funds raised by the professional comm~ rcial~{bnd -
raiser: r-.J
U)
-2
f. All persons managing or supervising fund-raising activities in or from Iowa:
Please refer to attached list of Phone Room Directors
7. Has the professional fund-raiser or any of the persons listed in response to Numbers 5 or 6 ever
been a party to any litigation, criminal or civil, involving claims of theft, fraud , unfair or
deceptive trade practices, conversion, mismanagement of funds, breach of fiduciary duty, or any
other claim involving alleged dishonesty?
DYes roNo If yes, attach detailed explanation as to agency involved, date, court, claim and
disposition. Attach copies of all complaints, petitions, settlement agreements, plea agreements,
assurances, consent judgments, final judgments, convictions, and/or other agreements or orders
resolving the matter.
8. Name, address and telephone number of the registered agent for service of process in Iowa:
Secretary of State
10. Has the professional fund-raiser's right to solicit funds ever been denied, suspended, revoked or
enjoined by any state or by any court, or are there any such proceedings pending?
II . Has the professional fund-raiser been the subject of a legal, administrative, or other proceeding
regarding any solicitation or registration as a solicitor or fund-raiser? Ifso, state the date,
location and nature of each such proceeding and the outcome of the proceeding.
~'.I..!'------------
12. Does the professional fund-raiser have custody of or access to contributions from a solicitation at
any time?
DYes MNo
13. Does registrant anticipate that any of the services it will provide to charitable organizations will
be provided by another entity under a subcontractor arrangement?
DYes ~No If yes, please identify the charity and the subcontractor below: (Attach a
list if more room is needed.)
-3
Charity Subcontractor Name & Address
Is registrant's contract with subcontractor filed with the office of the Iowa Attorney General?
14. Complete a Financial Information Disclosure form for each charitable organization for which you
will be soliciting money in or from Iowa.
Note: If additional contracts are entered into after the filing of this registration statement, submit a copy
of the new contract at that time.
Note: All information and documentation provided as part of this registration, including this form are
public records and all or some may be open to public inspection pursuant to the Iowa public
records law, Iowa Code chapter 22, and the Iowa Attorney General's Administrative Rules
relating to public records, 61 lAC chapter 2.
SIGNATURE
I hereby certify that I am authorized to sign this Registration and that the information provided is
true and complete to the best of my knowledge.
Name (Print)
:rres'lckfl~
T;tle~.
'" , ~ure
State of ;J?;,~
County of (;~7aL~J
7-(& ~/o (date) by
-4
-
(Seal)
~"j:2
My commission expires
s
5-1 ·7 -20/0
County of Oakland
-5
Associated Community Services
LISTp F CONTRACTS
..J.utism Spectrum Disorder Foundation, Inc., 228 W. Lincoln Highway #301, Schererville, IN
46375
Contract Term: to , Campaign Period: 11-17-2008 to
Cancer Fund of America, Inc., 2901 Breezewood Lane, Knoxville, TN 37921
Contract Term : to, Campaign Period: 02-21-2007 to
/ Cancer Recovery Foundation Of America, 6380 Flank Drive, Suite 400, Harrisburg, PA 17112
C ontract Term: to , Campaign Period: 06-08-2009 to
IChildren With Hair Loss, Inc., 12776 Dixie Hwy., South Rockwood, MI48179
Contract Term: to , Campaign Period: 06-01-2005 to 11-30-2019
,t'l ildren's Cancer Fund of America, Inc., 2317 W. Emory Road, Powell, TN 37849
f ontract Term : to , Campaign Period: 09-09-2005 to 05-31-2023
JDisabled Veterans Services, Inc., 364 Industrial Park Drive, Mount Juliet, TN 37122
Contract Term: to , Campaign Period: 06-09-2008 to
'Firefighters Assistance Fund, Inc., 10050 Burnt Store Road, Punta Gorda, FL 33955
ontract Term: to , Campaign Period: 06-01-2006 to
f Law Enforcement Alliance of America, Inc. , 5538 Port Royal Road, Springfield, VA 22151
/ I,J8W Enforcement Education Program, 667 E. Big Beaver, Suite 205, Troy, MI48083
JOperation Lookout National Center for Missing Youth, 6320 Evergreen Way, Suite 102,
Everett, WA 98203
Contract Term : to, Campaign Period: 11 -27-2006 to
f e Breast Cancer Society, Inc., 6859 E. Rembrandt Avenue, Suite 128, Mesa, AZ 85212
MI48034
MI48124
IOWA ATTACHMENT
QUESTION NUMBER 10
On June 16, 2009, the Charitable Licensing Division of the State of North
Carolina issued an order alleging that Associated Community Services failed to timely
file certain information with its office and, in connection therewith, suspended its license.
The agency subsequently withdrew its order and all issues are currently considered
resolved. A copy of the agreement is attached.
On May 18, 2010, the Oregon Department of Justice filed a lawsuit against
registrant and its client, Veterans of Oregon and Members of the Community, alleging
violations of Oregon laws governing telemarketing and charitable solicitations.
Registrant is filing an answer to the complaint in which it denies the allegations.
" ) .~)
)
In the Matter of: )
ASSOCIATED COMMUNITY SERVICES,
)
INC. )
)
) SETTLEMENTAGREErumNT
)
R. William Burland, President )
29777 Telegraph Rd, Ste 3000
Southfield, MI 48034
)
Respondent )
)
)
}
This Settlement Agreement is entered into by the Charitable Solicitation Licensing Division
[hereinafter "CSL"] of the North Carolina Department of the Secretary of State [hereinafter
"Department"] and Associated Community Services, Inc. [hereinafter "ACS"] to resolve the
provisions, including financial penalties, of an Order issued on June 16, 2009, by CSL. The
Order imposed penalties pursuant to the North Carolina Charitable Solicitation Act, § 131 f-l el
seq. andlor Rules implementing the Act. It also suspended the license of ACS and directed that
certain additional information be provided to CSL regarding activities that were the subject of
WHEREAS, the Charitable Solicitation Licensing Division (CSL) of the North Carolina
Department of the Secretary of State is the Division charged with charitable solicitation licensing
and enforcement in North Carolina under the Charitable Solicitation Act and Chapter 11 of Title
WHEREAS, on June 16,2009, CSL issued an Order signed by CSL D4'~ctor, Heather L.
Black, to Associated Community Services, Inc. assessing penalties pursuant to the Charitable
') )
Solicitation Act and relevant Rules and requiring ACS to proyide CSL with information about
WHEREAS, the Order was properly served and included a Notice of Appeal Rights to
the Office of Administrative Hearings (OAR) in compliance with Article 3 of the North Carolina
WHEREAS, Pauline F. Laubinger, CSL Attorney, and I-leather L. Black, CSL Director,
entered settlement discussions and negotiations with Nathan Thomas and EITol Copilevitz,
attorneys with the law firm ofCopilevitz & Canter in Kansas City, MO, that assists ACS with its
WHEREAS, negotiations have been successful with the terms of this Agreement having
THEREFORE, the parties have agreed to settle all outstanding issues related to the Order
issued to ACS and dated Jlllle 16,2009, through this Settlement Agreement, the specific tClms of
which are listed in the subsequent numbered paragraphs. The parties agree as follows:
and the Chal'itablc Solicitation Licensing Division (CSL) of the North Carolina Department of
the Secretary of State, through its Director, Heather L. Black, agree to the tenns as outlined
further in this Settlement Agreement to resolve aU issues, including the financial penalty and
2. In lieu of the financial penalty accrued under the Order of June 16, 2009, ACS
agrees to pay by check or money order the amount of $10,000.00 (Ten Thousand Dollars).
:) )
Payment will fully satisfY all financial obligations imposed by the terms of the Order if made
CSL on or before Monday, August 10, 2009, by the close of business (5 p.m.), together with one
signed original ofthis Sett1ement Agreement. All signatures must be under oath before a Notary.
each must arrive at the Charitable Solicitation Licensing Division of the North Carolina
Department of the Secretary of State by the close of business (5 p.m.) on or before the elates set
5. AI! payments listed in Paragraphs 3 and 4 shull be made payable to the North
Carolina Secretary of State and sent to the attention of Pauline F. Laubinger, CSL Attorney, at
6. Any breach of this Settlement Agreement, including failure to pay by the due
date, shall result in the entire payment assessed under the terms of this Agreement becoming
) )
immediately due, together with a financial penalty of $500.00 (Five Hundred Dollars) for failure
7. CSL will provide written notice ofthe breach and set a date certain for payment in
full that wiU be no later than fifteen (15) days from the date of the breach.
8. If payment in compliance with the aforesaid notice of breach from CSL is not
made on or before the payment deadline, without further notice, CSL will issue an Order to
assess financial penalties up to $1,000.00 (One Thousand Dollars) per day for each day for each
day the entire amOlmt due, including any amounts accrued under the Order for additional
with prejudice the contested case filed at the North Carolina Office of Administrative Hearings
and ~y not challenge any of the provisions of the aforesaid Order of June 16, 2009, at the
10. In addition, ACS agrees that it will not challenge any provisions of the aforesaid
Order of June 16,2009, in any other judicial forum, whether state or federal, in North Carolina
or elsewhere, whether or not the challenge is barred by lhe applicable statute of limitations.
11. CSL acknowledges that ACS retains, in all future actions taken by CSL with
regard to ACS, all rights of appeal and any other rights under applicable law.
12. Withdrawal of the contested case at the Office of Administrative Hearings must
occur not later than ten (10) days from the date this Settlement Agreement becomes effective,
which is the date that Mr. Burland signs it Wlder oath before a Notary.
' ") )
13. By entering into this Settlement Agreement, ACS acknowledges that it has the
sole responsibility to contact OAR and to provide the documentation required by OAR for
14. Within ten (10) days of the filing ofwithdrawaI documents with OAH, ACS will
provide CSL with copies of all documents filed at OAH in accordance with Paragraph 12 so that
CSL has a record that the Petition for a Contested Case Hearing has been withdrawn/dismissed
with prejudice.
15. The parties agree that CST. does not waive any authority on behalf of the
Secretary of Slate Lo take action in the futmc for any and all violations or aUeged violations of
the Charitable Solicitation Act, N, C. Gen. Stat. § l3lIq et seq. and the relevant Rules
provisions found in Chapter II of Title 18 of the North Carolina Administrative Code. CSL's
authority extends to matters of which CSL already has knowledge, excluding matters related to
the Order oUnne [6, 2009, and to malleI'S of which CSL subsequently becomes aware.
16. Entt'y into this Settlement Agreement by ACS is not an admission of liability for
the violations set forth in the Order of June 16,2009. ACS, however, does not challenge the right
of CSL to ask for and receive the information that ACS has now provided to CSL, as olltlined in
17. ACS acknowledges receipt of written notice in the aforesaid letter dated May 27,
2009, that if response to the matters outlined in the letter was not forthcoming by June 8,2009,
an Order imposing a penalty at the rate of $1,000.00 (One Thousand Dollars) per day would be
issued by CSL and that the penalty would continue to accrue until compliance occurred.
) )
~
otary Public
i~sion expires: (p. ~ 7- ,).0 1/
515-281-5926
E-mail: consumer@ag.state.ia.us
DISCLOSURE FORM
PLEASE NOTE IMPORTANT OPEN RECORDS INFORMATION TOWARDS THE END OF THIS FORM.
2. Identify the charitable organization for which you will be soliciting money within the
State oflowa during this registration period. (If more than one charitable organization,
file a separate Financial Information Disclosure form for each.)
C. Name, title, address and telephone number of the contact person(s) for the
charitable organization:
Page 1 of 5
3. Beginning and ending solicitation dates _UIl9i~o through ongoing (automatic annual renewal)
4_ Is the contract between the professional fund-raiser and the charitable organization on file
from which calls will be made. (If more than two locations, continue on a separate sheet):
N/A
Room 1
a. Address of telephone room (Include street, city and state):
b. All telephone number(s) from which solicitations are made: ___ ..___.__ __ ____ __ ._ .. _.
- -- -_ ._-_._----- .. --.-- ..
8. Will the solicitation campaign involve the sale of goods or services? Yes @
Page 2 of 5
If yes, check one or more of the following that apply:
o Tickets to an event 0 Advertising space in a program book, journal, or other
--~--~~--~--~----~~~~~~--~--~--~~----~
9. Will the professional fund-raiser collect donated funds directly from the donor( s) in person?
DYes 181 No
If "No," describe how the funds will be collected. Automotive Recovery Services will pick up the
donated vehicles, prepare them for and sell them at auction, and remit the proceeds to the charity.
10. If contributions will be made by mail, identify all addresses to which the mail will be sent.
If any of the addresses are different than the addresses listed in response to question 2 B,
please state: (1) whether the address is that of a post office box, commercial mail service,
bank of the professional fund-raiser or the address of a charitable organization; (2) the NfA
identity of the individual or entity responsible for collecting mail containing contributions.
N/A
11. State which of the following has the authority to withdraw the funds from any banking
account (check all that apply):
oo Neither
Professional fund-raiser I8iCharitabJe Organization DBoth or either
(please explain)
12. State whether contributions to the charitable organization are tax deductible:
@ No
13 . On an attached sheet, describe the charitable program for which the solicitation campaign is
being carried out.
Page 3 of 5
FINANCIAL INFORMATION
State the following information and indicate the applicable time period and dates (either the last
completed fiscal year or the previous twelve months):
b. Itemize the source(s), and dollar amounts per source, of all funds collected on
behalf of the charitable organization: (contributions or donations; payments for
tickets to events, government grants, private charities, foundations. etc.)
NI A NEWLY REGISTERED
(2) Total not given to charitable organization but expended on behalf of the
charitable organization: Itemize by dollar amount based on the following and any
NI A NEWLY REGISTERED
(3) State the total dollar amount billed to the charitable organization by the
professional commercial fund-raiser and itemize each such billing by purpose and
amount:
NI A NEWLY REGISTERED
Page 4 of 5
Note: All infonnation and documentation provided as part of this registration, including this
form are public records and all or some may be open to public inspection pursuant to the
Iowa public records law, Iowa Code chapter 22, and the Iowa Attorney General's
Administrative Rules relating to public records, 61 lAC chapter 2.
Note: Any changes or additions to the information provided in this notice must be reported
immediately.
SIGNATURE:
County of La; ¥~ )
) ss.
1. JOHN R. LE~~~_~_ , being first duly sworn on oath, depose and state that I am a
managing agent of the professional fund-raiser; that I have read the contents of this Charitable
Organization Financial Disclosure Form; that I know the contents thereof, and that each
statement made and each answer given is true to my ~wn knowlepg
D,MANAGER
Commislion II t9Ol287
NotIrJ PuIIIIc: • California
Page 5 of 5
AGENCY AGREEMENT
TIllS AGREEMENT, is made and entered by and between THE VEHICLE DONATION PROCESSING
CENTER, INC. a for-profit corporation, with offices at 626 So. Primrose Ave. Monrovia, CA 91016-3434
(hereinafter referred to as "Processor") and Iowa Council Of The United Blind, a tax-exempt organization, with
offices at 3912 Southeast Fifth Street, Des Moines IA (hereinafter referred to as "Charity'i).
The parties understand that Charity has the ability to successfully solicit for the donation of vehicles and other
valuables; and Processor has the expertise in securing and liquidating the donated vehicles, etc., and in
consideration of the mutual benefits contained herein, the parties agree to proceed as follows:
1. PURPOSE OF THE AGREEMENT. Charity does hereby retain the services of Processor to work under
Charity's direction and control in the conduct of Charity's vehicle donation program. Processor shall be entitled
to act on behalf of Charity only when specifically authorized by Charity to do so.
2. TERM. The term of this Agreement shall commence on the date it is signed by the parties, and shall be
for a period of one (I) year, which shall be automatically renewed unless either party gives written notice to the
other of its intention to allow this Agreement to expire. Said notice shall be given no less than sixty (60) days
prior to the date of expiration. If this Agreement is not otherwise terminated, it shall renew on an annual basis,
with either party having the right, at any time, to terminate the agreement on ninety (90) days written notice. In
the event that this agreement is tenninated, for any reason, all advertising expense will cease, at the end ofthe
cancellation period.; However, going forward, any further offers of acceptable donations to processor, on behalf
of charity, will continue to be processed in the manner proscribed by this agreement ,(i.e. where 50% of net
proceeds are paid to charity); unless charity specifically instructs processor, in writing, to divert processing of
such post cancellation offers to donate, to another charity of processor's choosing.
3. OBLIGATIONS OF CHARITY. In the conduct of its vehicle donation program, Charity shall determine
both the media and content of aU advertisements placed in a solicitation made to the general public. Charity will
provide the necessary paperwork and assist Processor, when appropriate, with providing receipts for qualified
vehicle donations.
4. OBLIGATIONS OF PROCESSOR. Processor agrees to act in accordance with Charity'S instructions in
making arrangements for delivery of vehicles and delivering the necessary documents evidencing receipt of any
contribution. Processor acknowledges that Charity reserves the right to take possession of any vehicle donated
and/or to give instructions for having said vehicle delivered to an independent and/or public auction for the
purpose of sale.
5. DIVISION OF PROCEEDS. The proceeds received from the sale ofan auctioned vehicle, boat, parcel of
real property, etc., shall be divided as follows, less the agreed upon expenses, to-wit:
(a) Actual towing fee.
(b) A fee of Seventy-Five ($75.00) Dollars to Processor for administrative overhead, data processing,
IN WITNESS WHEREOF, the parties have executed this Agreement on dates set forth herein below.
Dated:
. A (~,J006
tY" . .h.:I
..,. . .dt' a;h '"~
Address: i 'fI~ . s.f2.a 5>.3 IS'
~ '51 k l -M ,,,
*NOTE: Please a.lso include a copy of the IRS letter of determination authorizing the 501(c)(3) status.
December 1,2010
Automotive Recovery Services, Inc., an Indiana corporation (the "Buyer"), and Vehicle Donation
Processing Center, a Nevada corporation (the "Seller"), are parties to that certain Asset Purchase Agreement
(the "Purchase Agreement"), dated as ofNovernber 19,2010.
1. The Seller hereby agrees and acknowledges that, as of November 19,2010, in accordance with
and subject to the terms and conditions set forth in the Purchase Agreement, the Seller sold, assigned,
transferred, conveyed and delivered to the Buyer all of the Seller's right, title and interest in, to and under its
agreement with Iowa Council Of The United Blind (the "Assigned Contract").
2. The Buyer hereby agrees and acknowledges that, as of November 19,2010, in accordance with,
and subject to the terms set forth in, the Purchase Agreement, the Buyer accepted and assumed from the Seller
all of the Seller's right, title and interest in, to and under the Assigned Contract.
3. Each of the Buyer and the Seller acknowledges that the Assigned Contract is freely assignable
and that they know of no facts or circumstances that would in any way impede the assignment thereof.
IN WITNESS WHEREOF, the undersigned have executed and delivered this letter agreement as of
the date fIrst above written.
THE BUYER
Automotive Recovery Services, Inc.
crwtbd-
By:_ _ _ _ _ _ _ _ _ _ _ __
Name: Jo1m W. Kett
Title: Chief Financial OffIcer
THE SELLER
Vebic,e,,,A, ""'A'~..,Q.er
Title: President
Attorney General Tom Miller
515-281-5926
E-mail: consumer@ag.state.ia.us
Please notice that the registration requirement is only for professional commercial fund
raisers as defined in Iowa Code Chapter 13e. Charitable organizations as defined in this
Chapter are not required to register.
Professional commercial fund-raisers must also complete the attached form, "Charitable
Organization Financial Information Disclosure Form," for EACH charity for which you
raise funds.
I. Name of Professional Commercial Fund-raiser, including any d/b/a and trade names:
Automotive Recovery Services
2. Address and telephone number of each office, chapter, branch or affiliate. Indicate the principal
place of business:
69 Hinckley Rd.
Clinton , ME 04927
600-610-0071
-1
Corporation
3. Form of business
---------------------------------------------------
(Individual, Partnership, Business Corporation, Nonprofit Corporation, etc.)
Indiana
4. Identify the state in which registrant is organized or incorporated________
12/13/2000
Date organized or incorporated_______________________
5. Full name, title, address and telephone number of each officer, director, partner or managing
agent of the professional commercial fund-raiser:
See Attached
6. Name, address, telephone number and title of the following person(s) for the professional
commercial fund-raiser:
Carmel, IN 46032
317-249-4565
b. The person(s) responsible for the day-to-day operations of the professional commercial fund
raiser:
Susan Hughes - Operations Manager
69 Hinckley Rd .
Clinton, ME 04927
207-426-5142
c. The person(s) who directs and controls the activities of the professional commercial fund
raiser:
Michael Batchelor - Director of Diversified Services
Carmel, IN 46032
317-249-4565
d. The person(s) responsible for custody of the professional commercial fund-raiser's records:
John Kett - CFO
2 Westbrook Corporate Center
-----vlestchester, IL 60154
708 - 492-7304
e. The person(s) responsible for custody of all funds raised by the professional commercial fund
raiser:
Susan Hughes - Operations Manager
69 Hinckley Rd
Clinton, ME 04927
207-426 -5142
-2
f. All persons managing or supervising fund-raising activities in or from Iowa:
Susan Hughes - Operations Manager Pam Ellis - Supervisor
69 Hinckley Rd. 69 Hinckley Rd.
7. Has the professional fund-raiser or any of the persons listed in response to Numbers 5 or 6 ever
been a party to any litigation, criminal or civil, involving claims of theft, fraud, unfair or
deceptive trade practices, conversion, mismanagement of funds, breach of fiduciary duty, or any
other claim involving alleged dishonesty?
DYes E9No If yes, attach detailed explanation as to agency involved, date, court, claim and
disposition. Attach copies of all complaints, petitions, settlement agreements, plea agreements,
assurances, consent judgments, final judgments, convictions, and/or other agreements or orders
resolving the matter.
8. Name, address and telephone number of the registered agent for service of process in Iowa:
David Crowder
rAt. Des ""hles B<afteh Plaflage<
1914 East Euclid
Des Moines. TA 50313
10. Has the professional fund-raiser's right to solicit funds ever been denied, suspended, revoked or
enjoined by any state or by any court, or are there any such proceedings pending?
1I. Has the professional fund-raiser been the subject of a legal, administrative, or other proceeding
regarding any solicitation or registration as a solicitor or fund-raiser? If so, state the date,
location and nature of each such proceeding and the outcome of the proceeding.
No
12. Does the professional fund-raiser have custody of or access to contributions from a solicitation at
any time?
fl9Yes DNo
J 3. Does registrant anticipate that any of the services it will provide to charitable organizations will
be provided by another entity under a subcontractor arrangement?
DYes UNo If yes, please identify the charity and the subcontractor below: (Attach a
Jist ifmore room is needed.)
-3
Charity Subcontractor Name & Address
Is registrant's contract with subcontractor filed with the office of the Iowa Attorney General?
14. Complete a Financial Information Disclosure form for each charitable organization for which you
will be soliciting money in or from Iowa.
Note: If additional contracts are entered into after the filing of this registration statement, submit a copy
of the new contract at that time.
Note: All information and documentation provided as part of this registration, including this form are
public records and all or some may be open to public inspection pursuant to the Iowa public
records law, Iowa Code chapter 22, and the Iowa Attorney General's Administrative Rules
relating to public records, 61 lAC chapter 2.
SIGNATURE
I hereby certify that I am authorized to sign this Registration and that the information provided is
true and complete to the best of my knowledge.
Name (Print)
Title
M;ft;?: ~
~ignature
.!.M---..!:~( .!.b~W~
C",-
' , ~.<--~' O~~+-I==.In.dLW' «>6=-~=-_ _- - ( names of person(s) making statement).
-4
(Seal)
(Signature of Notary Public)
-5
13085 Hamilton Crossing Blvd.
Automotive Recovery Services Carmel, IN 46032
May 6,2010
State of Iowa
Attorney General Tom Miller
Consumer Protection Division
Hoover State Office Building
1305 E. Walnut, Des Moines, Iowa 50319
RE: Application for Registration as a Professional Fundraiser
Per the Professional Fundraiser application form please see the following responses.
Question 5 - Full name, title, address and telephone number of each officer, director, partner or
managing agent of the professional commercial fund-raiser
Question 9 - Attach a list of all other states where Professional Fundraiser is registered
California
Colorado
Connecticut
Kansas
Kentucky
Louisiana
Maine
Michigan
Missouri
New Hampshire
North Carolina
Oklahoma
Pennsylvania
Rhode Island
Utah
Wisconsin
Sincerely,
jlf7jAf2
Michael Batchelor
Director of Diversified Services
Attorney General Tom Miller
515-281-5926
E-mail: consumer@ag.state.ia.us
DISCLOSURE FORM
PLEASE NOTE IMPORTANT OPEN RECORDS INFORMATION TOWARDS THE END OF THIS FORM.
2. Identify the charitable organization for which you will be soliciting money within the
State of Iowa during this registration period: (If more than one charitable organization,
file a separate Financial Information Disclosure fonn for each.)
B..
Name IoW "'"- ~f~ SX;\d""o-i} \==-\~
Address and telephone number of the charitable organization:
'H'F"
c.. Name, title, address and telephone number of the contact person(s) for the
\) '-chalitakle organization: \ n
'T'\ \ c¥.-- ~ . :s C&, Q\l~/ J
~S- 2'\ b~~~ 3j"-7d.-.l- i:Aby
\'N}.j' \ 0""'" '"I.'A 5 d..30 2-
Page 1 of 5
3.
4.
Beginning and ending solicitation dates 01 01 through #01
Is the contract between the professional fund- iser and the charitable organization on file
with the office of the Iowa Attorney General?
6. ~ill be contacted by telephone and mail, how will the initial contact be made?
~Mail
7. If soliciting will be conducted by telephone, provide the following regarding the location
from which calls will be made. (If more than two locations, continue on a separate sheet):
~ml \
a. Address oftelephone room (lw:lude street, city and state)(Su.'::D CO ~o\Jo ~)
I ~ { £ " ~€(' ;c#\
V\ ftV'€.--
1,) PS--t ~ S~{)\V'-...9
\f\
=+~ s ,-
~O Y3
b. All telephone number(s)from which solicitations are made: _ _ _ _ _ _ _ _ _ __
(\-1(\,&"-/ Co V\ 5i-A+/ 1~
Room 2
8. Will the solicitation campaign involve the sale of goods or services? Yes 6)
Page 2 of 5
If yes, check one or more of the following that apply:
Other (describe)_=--=------:_,--_--:-::-_-,--_--:-::---:---:-:---,,--,--_:---::--_-:---:--_ _
9. Will the professional fund-raiser collect donated funds directly from the donor(s) in person?
Yes ~~
If"No,~Cribe how the funds will be collected. _ _ _ _ _ _ _ _ _ _ _ _ _ _ __
10. If contributions will be made by mail, identify all addresses to which the mail will be sent.
If any of the addresses are different than the addresses listed in response to question 2B,
please state: (1) whether the address is that of a post office box, commercial mail service,
bank of the professional fund-raiser or the address of a charitable organization; (2) the
identity of the individual or entity responsible for collecting mail containing contributions.
II. State which of the following has the authority to withdraw the funds from any banking
account (check all that apply):
12. State whether contributions to the charitable organization are tax deductible:
Yes c;J
13. On an attached sheet, describe the charitable program for which the solicitation campaign is
being carried out.
Page 3 of 5
FINANCIAL INFORMATION
State the following information and indicate the applicable time period and dates (either the last
completed fiscal year or the previous twelve months):
-$ \~3t 333,o±
b. Itemize the sOUTce(s), and dollar amounts per SOUTce, of all funds collected on
behalf of the chaTitable oTganization: (contributions or donations; payments for
tickets to events, government grants, private charities, foundations, etc.):
~O"'J'~ \ LO~<f6?~1'~
Cb r ~o (~ /1 (2-333. 3;>J
(.)) State the total dollar amount billed to the charitable organization by the
pTofessional commercial fund-raiser and itemize each such billing by purpose and ""\.
amount: . \ . _('" . _ n 9-()I1!lDrt-~.)
CS~ CO, ,T("'dvtt +11-<"5 0 ~"'C \ou; ':"1' .
S~ i'-±r{!, d7i~'Jf~IIc-- <;(hYYlNlLUl jJ;4lM r ~b J35J3
CJ2.J "S~ ¥ 7 ytl{C/! JM cL
~I
. ~~
$-~~lfB
j) 12-02.')
. /3 .
OS~;e---
~r\ ~ Page 4
-\of~ I /1;Md--.)O
t({J \ ~'!
~Cl( Q' O\f"l~ 1; 1171 b 7
Note: All infonnation and documentation provided as part of this registration, including this
fonn are public records and all or some may be open to public inspection pursuant to the
Iowa public records law, Iowa Code chapter 22, and the Iowa Attorney General's
Administrative Rules relating to public records, 61 lAC chapter 2.
Note: Any changes or additions to the information provided in this notice must be reported
immediately.
SIGNATURE:
State of1=--\ () ( \ g ~ )
County of ~a v6oScO
) ss.
)
I, --3 Q5-R ~h 5e~ \ , being fIrst duly sworn on oath, depose and state that I am a
managing agent of the professional fund-raiser; that I have read the contents of this Charitable
Organization Financial Disclosure Form; that I know the contents thereof; and that each
statement made and each answer given is true to my own know led
CHERYL KUPKOVICH
MY COMMISSION #00645456
Page 5 of 5
Attorney General Tom Miller
515-281-5926
E-mail: consumer@ag.state.ia.us
Please notice that the registration requirement is only for professional commercial fund
raisers as dermed in Iowa Code Chapter 13C. Charitable organizations as defined in this
Chapter are not required to register.
Professional commercial fund-raisers must also complete the attached form, "Charitable
Organization Financial Information Disclosure Form," for EACH charity for which you
raise funds.
I. Name of Professional Commercial Fund-raiser, including any d/b/a and trade names:
<. .'0
.
~; .,
,
-1
.' ...
3. Fonn of business C D ~()Ct?J: \0n
(Individual, Pa ershlp, BuslDess CorporatlOD, Nonprofit Corporation, etc.)
6. Name, address, telephone number and title of the following person(s) for the professional
commercial fund-raiser:
c. The person(s) who directs and controls the activities of the professional commercial fund
raiser:
d. The person(s) responsible for custody of the professional commercial fund-raiser's records:
e. The person(s) responsible for custody of all funds raised by the professional commercial fund
raiser:
-2
-rai~tiVities in or from Iowa:
7. Has the professional fund-raiser or any of the persons listed in response to Numbers 5 or 6 ever
been a party to any litigation, criminal or civil, involving claims of theft, fraud, unfair or
deceptive trade practices, conversion, mismanagement of funds, breach of fiduciary duty, or any
other claim involving alleged dishonesty?
DYes .¥ o If yes, attach detailed explanation as to agency involved, date, court, claim and
disposition. Attach copies of aU complaints, petitions, settlement agreements, plea agreements,
assurances, consent judgments, final judgments, convictions, and/or other agreements or orders
resolving the matter.
8. Name, address and telephone number of the registered agent for service of process in Iowa:
11. Has the professional fund-raiser been the subject of a legal, administrative, or other proceeding
regarding any solicitation or registration as a solicitor or ftmd-raiser? If so, state the date,
location and nature of each such proceeding and the outcome of the proceeding.
12. Does the professional ftmd-raiser have custody of or access to contributions from a solicitation at
any time?
~ DNo
13. Does registrant anticipate that any of the services it will provide to charitable organ.izations will
be provided by another entity under a subcontractor arrangement?
~Yes DNo If yes, please identify the charity and the subcontractor below: (Attach a
, ":..J\
I .'
-3
(' '.
\ "}
•
Charity Subcontractor Name & Address
Is registrant's contract with subcontractor flied with the office of the Iowa Attorney General?
14. Complete a Financiallnformation Disclosure form for each charitable organization for which you
will be soliciting money in or from Iowa.
Note: If additional contracts are entered into after the filing of this registration statement, submit a copy
of the new contract at that time.
Note: All information and documentation provided as part of this registration, including this form are
public records and all or some may be open to public inspection pursuant to the Iowa public
records law, Iowa Code chapter 22, and the Iowa Attorney General's Administrative Rules
relating to public records, 61 IAC chapter 2.
SIGNATURE
I hereby certity that I am authorized to sign this Registration and that the information provided is
true and complete to the best of my knowledge.
Date--.........L3~\),~5'-+-+ll-'<::>'-D--
-4
[ \', '. ~J~. ---
(Seal)
lMNbt"~
, r' (Publit)Z _Z d
(SigID;ture of '=.
2
__0 I
. ·on expues
My commissl
-5
Center Stage Attractions. Inc.
States Where Registered
Michigan 517-373-1152
Consumer Protection & Charitable Trust
690 Law Bldg 525 W Ottawa St
Lansing MI 48913
Minnesota 651-296-6172
Charities Division
445 Minnesota St Ste 1200
St Paul MN 55101
Attorney General Tom Miller
515-281-5926
E-mail: consumer@ag.state.ia.us
DISCLOSURE FORM
PLEASE NOTE IMPORTANT OPEN RECORDS INFORMATION TOWARDS THE END OF THIS FORM.
c. Name, title, address and telephone number of the contact person(s) for the
charitable organization:
3. Beginning and ending solicitation dates () ( 0' 101 tJrrOUgh~.
4. Is the contract between the professional ftmd-raiser and the charitable organization on file
with the office of the Iowa Attorney General?
6. I~l be contacted by telephone and mail, how will the initial contact be made?
(' 1 elepho~ Mail
""'---
7. If soliciting will be conducted by telephone, provide the following regarding the location
from which calls will be made. (If more than two locations, continue on a separate sheet):
Room 1
7 0 3 - f1C-7d[,7Y
a. Address of telephone room (Include street, city and state):
Other (describe)_----:-----:_.,--_ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ __
9. Will the professional fund-raiser collect donated funds directly from the donor(s) in person?
Yes 6?
1
If ''N 0," describe how the funds will be cOllected._.....tJ...L.....:.'1-----'.fY\--'---"c::A-""--.:::=-\-'----'\'----_ _ _ __
1O. If contributions will be made by mail, identify all addresses to which the mail will be sent.
If any of the addresses are different than the addresses listed in response to question 2B,
please state: (1) whether the address is that of a post office box, commercial mail service,
bank of the professional fund-raiser or the address of a charitable organization; (2) the
voS+- ~\CQ. . '60/-
identity of the individual or entity responsible for collecting mail containing contributions.
11. State which of the following has the authority to withdraw the funds from any banking
account (check all that apply):
12. State whether contributions to the charitable organization are tax deductible:
Yes @
13. On an attached sheet, describe the charitable program for which the solicitation campaign is
being carried out.
Page 3 of 5
FlNANCIAL INFORMAnON
State the following infonnation and indicate the applicable time period and dates (either the last
completed fiscal year or the previous twelve months):
b. Itemize the source(s), and dollar amounts per source, of all funds collected on
behalf of the charitable organization: (contributions or donations; payments for
tickets to events, government grants, private charities, foundations, etc.):
~ll
(3) State the total dollar amount billed to the charitable organization by the
professional commercial fund-raiser and itemize each such billing by purpose and
amount:
Slo 8'.c.{ ~
7 /0 , '27
Note: All information and documentation provided as part of this registration, including this
form are public records and all or some may be open to public inspection pursuant to the
Iowa public records law, Iowa Code chapter 22, and the Iowa Attorney General's
Administrative Rules relating to public records, 61 IAC chapter 2.
Note: Any cbanges or additions to the information provided in tbis notice must be reported
immediately.
SIGNATURE:
~ [a ~rJ)
) ss.
County of )
I, -:sQ~"'~, being fIrst duly sWOrn on oath, depose and state that I am a
managing agent of the professional fund-raiser; that I have read the contents of this Charitable
$
Organization Financial Disclosure Form; that I know the contents thereof; and that each
CHERYL KUPKOVlCH
MY COMMISSION #00645456
EXPIRES: FEB 28, 2011
Bonded through 1st State Insura~
L/1u.. . \ (L"
.-'L.
------ --- ....--
Page 5 of 5
CHARITY SERVICES INC.
~
encer Jaycees $1 8,825 Sue Staples
/, nkeny Jaycees $29,243 Mike Kossak
/ yteater Betttendorf Foundation $23,281 Cindy Wells
.1oWa Paralyzed Veterans $3788 John Schneider
." / t. Pleasant Music Boosters $20,312- Lois Roth
ashington Just Cause $15,022 Dean Greiner
" j ~irfield Band Aids $17,775 Arvin Bogaards
~
'N rth Libert Jaycees $ 20,120 Dawn Moore
. uscatine Lions Club $1 3,400 Glen Ries
~an Buren Jaycees $7145 Brian Heisel
~owa City Jaycees $$65, 168 Jeff Wagner
ltv1ason City Jay<,:ees $8750 Brad Sconfield
Attorney General Tom Miller
515-281-5926
E-mail:
DISCLOSURE FORM
PLEASE NOTE IMPORTANT OPEN RECORDS INFORMATION TOWARDS THE END OF THIS FORM.
~ Ie fff2- ()
C. Name, title, address and telephone number of the contact person(s) for the
charitable organization:
Anamosa Charities
Please mail this letter in (0 Dave Oldhall!JIt the address given. Please call Dave
with any questions!
Name
----------------------------------------------------------~---
~ 4- J I
3. Beginning and ending solicitation dates J u~ tm;QWg9 IV DJ ...
4. Is the contract between the professional fund-raiser and the charitable organization on file
with the office of the Iowa Attorney General?
6. If persons will be contacted by telephone and mail, how will the initial contact be made?
Telephone Mail
7. If soliciting will be conducted by telephone, provide the following regarding the location
from which calls will be made. (If more than two locations, continue on a separate sheet):
Room 1
~)3o '
b. All telephone number(s)from which solicitations are made:[ 3 (1)}
JOJ...· Y 3u) ,)
5.) I -: lfoSJ) {eJl- Vtz (J; 5-)/ LIft!
i ;?"
Room 2
a. Address of telephone room (Include street, city and state):_ _ _ _ _ _ _ _ _ __
Page 2 of 5
If yes, check one or more of the following that apply:
10. If contributions will be made by mail, identify all addresses to which the mail will be sent.
If any of the addresses are different than the addresses listed in response to question 2B,
please state: (1) whether the address is that of a post office box, commercial mail service,
bank of the professional fund-raiser or the address of a charitable organization; (2) the
identity of the individual or entity responsible for collecting mail containing contributions.
A(f /l7ti 1"1 1() e 5 d/~c if; fv ,9 ~dV/! ' V-£ :S i t S 04 {ofe
z;
11. State which of the following has the authority to withdraw the funds from any banking
account (check all that apply):
12. State whether contributions to the charitable organization are tax deductible: . (
Yes No j,ptds 0.,,,,'1,';' 15 "dOA.Jr.,;;' o"(rlt/f/ fk ~/'rJJ!5 :!:.kfo,,/5
13. On an attached sheet, describe the charitable program for which the solicitation campaign is
being carried out. , \I " f( ,
Page 3 of 5
FINANCIAL INFORMATION
State the following information and indicate the applicable time period and dates (either the last
completed fiscal year or the previous twelve months):
b. Itemize the source(s), and dollar amounts per source, of all funds collected on
behalf of the charitable organization: (contributions or donations; payments for
tickets to events, government grants, private charities, foundations, etc.):
a (( (1/1 Vr4lt' ) U/lCf/~t1~ /-/ v
~
(2) Total not given to charitable organization but expended on behalf of the
charitable organization: Itemize by dollar amount based on the following and any
other applicable categories: salaries/commissions/compensation; rent/mortgage;
transportation; professional services (attorneys, accountants, etc.);
advertising/promotion, etc.:
(3) State the total dollar amount billed to the charitable organization by the
professional commercial fund-raiser and itemize each such billing by purpose and
amount:
o
Page 4 of 5
Charity Services Inc.
PO Box 706
Marion, Iowa 52302
. (888) 400-7717 ..
(319) 560-0849
Payroll expense for telemarketers and staff $87.922 ( Four part time callers
.an·d:myself.) .
. 2005 KIA, insurances, payroll taxes, credit card, travel expense, miscoffice expense, accountant
. fees, areotherexpenses, jf you need exact figures, let me know.
Note: Any changes or additions to the information provided in this notice must be reported
immediately.
SIGNATURE:
State of I 6 tJ 0- )
County of
L .an
I
))ss.
-.- -- r"
I, :.J v ~ f:::. Y I '
c;.
, being ftrst duly sworn on oath, depose and state that I am a
managing agent of the professional fund-raiser; that I have read the contents of this Charitable
Organization Financial Disclosure Form; that I know the contents thereof; and that each
'
~.. l,,~! ~co:' ~ ~lV)cJ
i
JANET A. LANCIAL t1
Number 751_ ' VU LV ff·
Page 5 of 5
~
PO Box 706
Marion, Iowa 52302
(888) 400-7717
(319) 560-0849 ,
Charity Services is a small co~pany, we have two delivery people, four telemarketers, and myself.
We do nodkect mail a~d the group we are raising funds for cont~oll00% of the funds collected .The '
, group pays CSI our agreed percentage which is eithe'r 80% or 75% and the groupdeposits all raised
funds. CSI pays all cost ,o fthe campaigns for these groups, they have zero expenses.
. . . '
We do consecutive fundraising campaigns for our clients and every campaign is ran exactly the same
with theexceptio~ of the Iowa Paralyzed Veterans who do not allow us to offer light bulbs. We offer
. various
.
size of tra's. h bags and fo~r packs of florescent light bulbs as thank yougifts to the people
.
we call
and ask for a straight donation if they do not need the product. , '
, .
We deliver to every donor a thank y~u tetter arid 'invoice to all'donors. The letter is included with each
CSI ~~s been working ~ith these gro~ps for over ten' years and some nearly twentY, all contracts have at
one 'time been sent tothe state and these contracts are good until cancelled by either party.
, ,
We know our donorS and time our campaigns to keep them supplied with bags, therefore we call some
towns every si)( months some every five and so~e just once per year.
My callers average around SlOper hour and rriy drive~s earn lesst~an $25,000 per year and that
, includes their gas and car maintenance.
n
, , ' 0 "
:z
, Please look at the' enclosed financial disclosure sheet that follows. <n
c
r..,
:t:
:x
:;PO'
...-\.J,
~,
~,
::0 P1
5..-22:--(( .. '"U N
""
~
..,'
:::c W
, , ,
0 , fTl
Joe Eagle - Charity Services Inc. ...., :x
--l ~,
<::
(") rr,
--l
0
z '
'\D'
' .. 0
N
c
~
.
515-281-5926
E-mail:
DISCLOSURE FORM
PLEASE NOTE IMPORTANT OPEN RECORDS INFORMATION TOWARDS THE END OF THIS FORM.
C. Name, title, address and telephone number of the contact person(s) for the
charitable organization:
Page 1 of 5
4ntGf S {c.hL ~ 1)I€'sl ;a,ct
-r C u /l+~~f
Information: @ 364-8025
p.O. Box 11726 Cedar Rapids, lA 52410
Thank you for purchasing our trash liners or for making a donation.
We have been conducting a trash liner fund raiser in the community
for over twelve years and we would like to express our gratitude for
your help. It is people like you that enable us to continue to serve the
Cedar Rapids and now the Marion area as well.
We have listed below our current projects:
Due to the fact the Jaycee house was taken by the flood, we are still debating what we are
going to do as far as a new Jaycee house location. Thank you for your support.
If you would like to join the Cedar Rapids Jaycees, please call Amy Slater at the number
above or send this letter to the address given.
Nrune~====~~==== __~____~________=-~__________~______==__~_______
Address Phone_ _ _ _ _ _ _ _ _ __
3. Beginning and ending solicitation dates ~~~h
i !iJ(O.
4. Is the contract between the professional fund-raiser and the charitable organization on file
with the office of the Iowa Attorney General?
6. If persons will be contacted by telephone and mail, how will the initial contact be made?
Telephone Mail
7. If soliciting will be conducted by telephone, provide the following regarding the location
from which calls will be made. (If more than two locations, continue on a separate sheet):
Room 1
f1
a. Address of telephone room (Include street, city and state):
-.
Y 70 ..5 (,)
S)3o
b. All telephone number(s)from which solicitations are made:Q (1)r Jo~· y 30 ~ ,)
5J 1-;- CfOSJ) £JI- t/&;(J, S-JI i 4f1! ;;;;;=
8. Will the solicitation campaign involve the sale of goods or services? CY;> No
Page 2 of 5
If yes, check one or more of the following that apply:
Tickets to an event
9.
@)No
If "No," describe how the funds will be collected. ii/tvI'"&=- lefs..)(\. dr(/(/(f-S
/)co)vc-4-- ct-rc/ (G>IIr7,f~ lk//1C(f/o:'
f
10. If contributions will be made by mail, identify all addresses to which the mail will be sent.
If any of the addresses are different than the addresses listed in response to question 2B,
please state: (1) whether the address is that of a post office box, commercial mail service,
bank of the professional fund-raiser or the address of a charitable organization; (2) the
o.
Ier
. , v . '\,.1 - .
o
11. State which of the following has the authority to withdraw the funds from any banking
account (check all that apply):
12. State whether contributions to the charitable organization are tax deductible: . (
Yes No I,pe..).> ov"\..,'I,') /5 4cioA.,Jr.J4 o"lrltl'd fit ~1'c.A-l5 ~kfv5
13. On an attached sheet, describe the charitable program for which the solicitation campaign is
being carried out.. " . \t • t (
Page 3 of 5
FINANCIAL INFORMATION
State the following infonnation and indicate the applicable time period and dates (either the last
completed fiscal year or the previous twelve months):
Jf c1t~/~ . ~
b. Itemize the source(s), and dollar amounts per source, of all funds collected on
behalf of the charitable organization: (contributions or donations; payments for
tickets to events, government grants, private charities, foundations, etc.):
(3) State the total dollar amount billed to the charitable organization by the
professional commercial fund-raiser and itemize each such billing by purpose and
amount:
Page 4 of 5
. .
PO Box 706
Marion, Iowa 52302
(888) 400-7717 .
(319) 560-0849
.. Groups
.
received
- , .
· $59;65i30. (20 or 25% based on contract)
.
p~yroil expense for telemarketer~ and staff · $?7.922 ( Four part time callers
and myself.)
· ~ightBulbs . $2822'. 25
2005 KIA, insurances, payroll taxes, credit card; travel expense, misc office expense, accountant
··fees, areotherexpenses,
....
if you need exact
' .
figures, let me know. . .
.
.
Note: Any changes or additions to the information provided in this notice must be reported
immediately.
SIGNATURE:
State of -rtJlJc",- )
I, -~bE
7
~ ,being first duly sworn on oath, depose and state that I am a
managing agent of the professional fund-raiser; that I have read the contents of this Charitable
Organization Financial Disclosure Fonn; that I know the contents thereof; and that each
/J arvf /J. ~
<-//1 r>. 1 j}
N'ortry Public c71 l-<A I L. -i f
i
,
•
JANET A. LANCIAL
J CommisaIon Number 75t.
• MY COMMISSION EXPIRES
MIIrctl27. 2011
'
Page 5 of 5
,Charity Services Inc.
PO Box 706
Marion, Iowa 52302
(888) 400-7717
(319) 560-0849
Charity Services is a small company, we have two delivery people, four telemarketers, and myself.
We do no direct mail and the group we are raising funds for control 100% of the funds collected . The
group pays CSI our agreed percentage which is either 80% 005% and the group deposits all raised
funds. CSI pays all cost.of the campaigns for these groups, they have zero expenses.
We do consecutive fundraising campaigns for our clients and every campaign is ran exactly t~ same
"with the exception of the Iowa Paralyzed Veterans who do not allow us to offer light bulbs. We offer
various size of trash bags and four packs of florescent light bulbs as thank you gifts to the people we call
, '
and ask for a straight donation if they do not n'eed the product .
. .. " . ' ., " ' . ' , . '. .. ", .
We deliver to every donor a thank you letter and invoice to all donors. The letter is included with each
of these reports.
CSI
.
has
. ...
been' working
.
with
.. ! . .
these
",' .
ps for - over. ten .ye~rs~md
grou' ~ " .
some nearly. twentY, ail . contracts
~ .
have at '
one time been sent to the state and these contracts are good until cancelled by either party.
We kn6~ our donors 'and time our campaigns to keep them supplied with bags, therefore we call soine
towns every six months some every five and s6~e just once per year. , g-.
515-281-5926
E-mail:
DISCLOSURE FORM
Identify the charitable organization for which you will be soliciting money within the
State of Iowa during this registration period. (If more than one charitable organization,
file a separate Financial Information Disclosure form for each.)
Thank you for supporting the Fairfield Band Aids by purchasing our bags, bulbs, or for
your donation.. The Band Aids are dedicated to keeping the quality of the hand programs
in the Fairfield schools at the highest level possible and provide an extra-curricular
activity that can be a stepping stone to higher education and a productive way for our kids
to entertain others and express themselves.
Band and Choir Trips, the Drumming Clinic, The Middle School Concert, and Masters
Ifyou would like to continue to help make a difference in the instrumental music
education ofour children, become a member today. Send a $10 annual family
membership fee to the address above with this letter. THANK YOU!!!!
4. Is the contract between the professional fund-raiser and the charitable organization on file
with the office of the Iowa Attorney General?
6. If persons will be contacted by telephone and mail, how will the initial contact be made?
Telephone Mail
7. If soliciting will be conducted by telephone, provide the following regarding the location
from which calls will be made. (If more than two locations, continue on a separate sheet):
Room 1
Room 2
Page 2 of 5
If yes, check one or more of the following that apply:
Tickets to an event Advertising space in a program book, journal, or other
)0 ~qJ'# ~/:, rI- t '2:41 6ul
9.
(§)No
If "No," describe how the funds will be collected. 1.:>1/1/ frr- IPitS..;(\.. de(/lJ(es
.?Cc?hcf CtnJ (~/kcl~ a(,//lc<f(o~(
r
10. If contributions will be made by mail, identify all addresses to which the mail will be sent.
If any of the addresses are different than the addresses listed in response to question 2B,
please state: (1) whether the address is that of a post office box, commercial mail service,
bank of the professional fund-raiser or the address of a charitable organization; (2) the
identity of the individual or entity responsible for collecting mail containing contributions.
12. State whether contributions to the charitable organization are tax deductible: . I
Yes No j,~s 0.,,,-,-1,.) /5 4dC1t'l.I(.;~ OI1(rif'A/ fk ~/,,;)Jf5 ~kfJ5
13. On an attached sheet, describe the charitable program for which the solicitation campaign is
being carried out. \I I
Page 3 of 5
FINANCIAL INFORMATION
State the following infonnation and indicate the applicable time period and dates (either the last
completed fiscal year or the previous twelve months):
b. Itemize the source(s), and dollar amounts per source, of all funds collected on
behalf of the charitable organization: (contributions or donations; payments for
tickets to events, government grants, private charities, foundations, etc.):
q It I
Wli/&fe ~/l?·-(o~ r iv~ y.e/Vr'~ (
~'c
/
(3) State the total dollar amount billed to the charitable organization by the
professional commercial fund-raiser and itemize each such billing by purpose and
amount:
Page 4 of 5
.Charity Services Inc. .'
PO Box 706
Marion, Iowa 52302
. (888) 400-7717
(319) 560-0849
'. Payroll e~pensefor telemarketer~ and st~ff : . '. $~7.922 ( Four part time callers
and myself.) .
Invoicesand
,
. .
Delivery Materials .' .
$3550
'lightBulbs $2822.25
2005 ~IA,insurances, payroUtaxes, credit card; travel expense, miscoffice expense, accountant
fee~, are,other' exp~nses, if you needexactfigures, let me know. .' ,'. .
Note: Any changes or additions to the information provided in this notice must be reported
immediately.
SIGNATURE:
State of TOGJtV )
) ss.
County of L f "rJ I) )
I, ~~ 6 r r,
(
being first duly sworn on oath, depose and state that I am a
managing agent of the professional fund-raiser; that I have read the contents of this Charitable
Organization Financial Disclosure Form; that I know the contents thereof; and that each
£g;;
7
Subscribed and sworn to before me on 1r) /2!leA dJ. :2011
c;J,flMi: J} KtlIleJ
i~
JANET A. LANCIAt. :ary Public
~ Number 751.
MY COMMIsSION EXPIRES
M11a127. 2011
Page 5 of 5
Chmity Services Inc.
PO Box 706
. Marion, Iowa 52302
(888) 400-7717
. (319) 560-0849
. Charity Services is a small company, we have two delivery people, four telemarketers. and myself.
We do no direct mail and the group we are raising funds for control 100% otthe funds collected . The
· group pays CSI our agreed percentage which is either 80% or 75% and the group deposits all raised
· funds; CSI pay~ all cost .ofthe campaigns for these groups, they have zero expenses.
We doconseclltivefundraising campaigns for our clients and every campaign is ran exactly the same
., with theexception otthe Iowa Paralyzed Veterans who do not allow us to offer light bulbs. We offer
various size.of trash bags a~d fo~r packs offlorescent light bulbs as thank you giftsto the people we call
and ask for a straight donation if they donot need the product . . .
We deiiver to every donor athanky~uletter arid invoice to an"donors. The lett~r is included with each
of these reports.
CSI has been working with these grou'ps for over ten ye~rs"and some nearly twentY, all contr~cts have at •.
one 'ti.:neb~en sent t~ ~he state and these ~ontracts are good until cancelled by either party. .
We know our donors andtime ollr campaigns to keep themsupplh~dwith bags, therefore we call soine
,towns every six months some everyfrve and sci"~ejustonce per year . .
My callers average around $10 per hour andmydrivers earn less th~n $i5,OOO per year and that ·
includes their gas "and car maintenance. " ' ' < . . . ', .
. ~ . " , . . . .
.. ... ~.
(!)
. " . . .. ..
515-281-5926
E-mail:
DISCLOSURE FORM
PLEASE NOTE IMPORTANT OPEN RECORDS INFORMATION TOWARDS THE END OF THIS FORM.
Tk.
A.
&r~< ~ff
Name:f?34~ e. 16:
file a s;parate. Financial Information Disclosure form for each.)
~ / .
~d{)q"'-IO/l.
B. Address and telephone number of the charitable organization:
C. Name, title, address and telephone number of the contact person(s) for the
charitable organization:
Community Foundation
Halloween Parade/
NAME PHONE.______________
PLEASE MAIL THIS LETTER TO THE ADDRESS ABOVE AND WE WIll CAll YOU WITH THE NEXT
MEETING TIME' THANKS FOR YOUR SUPPORT!
The 2011 Easter Egg Hunt will be held at Crow Creek Park on
April 16th ••.•.• •.•••••• Thank you for your support III
C4t1
3. Beginning and ending solicitation dates , - 1C> t:kI:ough (Z - (0
~- 10 ",11<.:>
4. Is the contract between the professional fund-raiser and the charitable organization on file
with the office of the Iowa Attorney General?
6. If persons will be contacted by telephone and mail, how will the initial contact be made?
Telephone Mail
7. If soliciting will be conducted by telephone, provide the following regarding the location
from which calls will be made. (If more than two locations, continue on a separate sheet):
Room 1
f1
a. Address of telephone room (Include street, city and state):
-.--
<J 70 ..s (J..
S-) 3d
b. All telephone number(s)from which solicitations are made:Q (1) Jo~· y 3v ':>
r ,/
Page 2 of 5
If yes, check one or more of the following that apply:
Tickets to an event
9.
® No
If "No," describe how the funds will be collected. ,
tlt'v l '8=" /Jets..)(\. de/;'lJ(es
/}(c)rhof Ct"J (c>lle,/~ t/('//1C{f,o'.t
10. If contributions will be made by mail, identify all addresses to which the mail will be sent.
If any of the addresses are different than the addresses listed in response to question 2B,
please state: (I) whether the address is that of a post office box, commercial mail service,
bank of the professional fund-raiser or the address of a charitable organization; (2) the
II. State which of the following has the authority to withdraw the funds from any banking
account (check all that apply):
12. State whether contributions to the charitable organization are tax deductible: I
Yes No j,ptJs N\.. / 'I,~ ,'s . . d4t.J(,J~ o"(r t!{A/ fif f!rr~45 ~ kfv 5
13. On an attached sheet, describe the charitable program for which the solicitation campaign is
being carried out. \I t
Page 3 of 5
FINANCIAL INFORMATION
State the following infonnation and indicate the applicable time period and dates (either the last
completed fiscal year or the previous twelve months):
b. Itemize the source(s), and dollar amounts per source, of all funds collected on
(2) Total not given to charitable organization but expended on behalf of the
charitable organization: Itemize by dollar amount based on the following and any
other applicable categories: salaries/commissions/compensation; rent/mortgage;
transportation; professional services (attorneys, accountants, etc.);
advertising/promotion, etc. :
(3) State the total dollar amount billed to the charitable organization by the
professional commercial fund-raiser and itemize each such billing by purpose and
amount
o
Page 4 of 5
.. Charity Services Inc.
PO Box 706
Marion, Iowa 52302
(888) 400-7717
(319) 560-0849
.
: . ' .
. . GarbageBags $35,200.75"
'. . Light'Bulbs$2822;25 .
. 2005 KIA, insurances, payroll taxes, credit card, travel expense, misc office expense, accountant
fees, are other expenses, if you need exact fig~rE!s, let me know. '
Note: Any changes or additions to the information provided in this notice must be reported
immediately.
SIGNATURE:
State of To lJ () )
. ) ss.
County of 1- If) '7 )
I, Soe b r~ ,being fITst duly sworn on oath, depose and state that I am a
managing agent of the professional fund-raiser; that I have read the contents of this Charitable
Organization Financial Disclosure Fonn; that I know the contents thereof; and that each
(J.()/lfff A'iO/JC J2
ary Public
'i-.
•
JANET A. LANCIAL
J Commilalon Number 751.
MY COMMISSION EXPIRES
. MaICt127. 2011
Page 5 of 5
,Charity Services Inc.
PO Box 706
Marion, Iowa 52302
(888) 400-7717
, (319) 560-0849
Charity Services is a small company, we have two delivery people, four telemarketers, and myself.
We do no direct mail and the group we are raising funds for control 100% of the funds collected . The
, group pays CSI our agreed percentage which is either 80% or 75% and the group deposits all raised
funds; CSI pays all cost ofthe campaigns for these groups, they have zero expenses.
We do consecutive fundraising campaigns for our clients and every campaign ,is ran exactly the' same
, with the exception of ,t he Iowa Paralyzed Veterans who do not allow us to offer light bulbs . We offer
various size of trash bags and four packs of florescent light bulbs as thank you gifts to the people we call
', and ask for a straight donation if they do not need the product. ' ,
, ,
, We deliver to every donor athank y~u letter and invoice to all dono~s. The letter is included with each
of these reports.
, . " .
CSI hasbeen' working ~itti these grou'p sfor over ten years and some nearlytwentY, all contracts have at "
onetime been sent to the state and these contracts are good until cancelled by either party.
, ,
We know our donors and time our campaigns to keep them supplied with bags; therefore we call some
,towns every six months some every fNe and some just once per year. ~.,
o
" z
My caHers average around $10 per hour and my drivers earn less than $25,000 per year and ~at ~
,' ; , ', ' " ,- " ' :r ' ;bo , ;0,
, includes
- ,
their gas and car maintenance. "" , , ' ,
' , fTI
' :;;0
:;;0
M
~ N G
, please look at the enclosed financial disClosure sheet that f~lIows..
:;0
o
W
m
~ :n
:x .. -.
cr ' '
', /~
o /Ii
" -1
5~22--( ( o \.0 o
:z N
o .z:
- Joe Eagle - Charity Services lric. -:c:.
515-281-5926
E-mail:
DISCLOSURE FORM
PLEASE NOTE IMPORTANT OPEN RECORDS INFORMATION TOWARDS THE END OF THIS FORM.
C. Name, title, address and telephone number of the contact person(s) for the
charitable organization:
Current Prolects
The mission of the Iowa City/Coralville Jaycees is to provide young peoplethe opportunity to develop personal and leldership
skills through local community service and organiZiltional involvement while expanding the Junior Chamber movement.
Hershey's Track 8{ Field - we assist with the timing and recordkeeping For events at this local qualifier at City High's Bates
Field . In addition, For the last couple of yelr'S we have run a concession stand and have donated all of the proceeds From
the concession stand to a local charity or non-proFit organiZiltion.
Children's Holid<lY P<!rty <It the VIHC - in mder to lighten the spirits of the children who are not able to be home For the
holidays, we have been putting on our own special party For the kids at the University of Iowa Hospit'll <lnd Clinics. We
bring activities, presents and even a special guest to take the kids minds 0((of being away From Friends and filmily over the
holidays.
Fourth of July Fireworks - After nearly 60 ye<lrs the Jaycees won't be solely sponsoring the fireworks show . The group
continued monetary support in 09 <lnd 2010.
P<lthways Mult Hellth Center - $5000 Donation to the Center in 2010
New For this year is the Field of Scteqms: This October we are putting on a Haunted Corn M<lze at Century F<lrm Harvest Heat.
2968 Black Di<lmond R.oqd SW, Four miles south oFHighwqy 218. Come out <lnd en!oy a good scare at the Haunted Corn M<lze.
R.eI<lY For UFe, Dragon Bo;rt R.<!ces, <lnd Donations to Vptown Bills are <llso new projects For 2010 <IS well.
IF you are twenty one - Forty years of age and wqnt to make lifelong Friendships, improve your community, strengthen business
ties, and h<lve an excellent time doing it, if you enjoy seeing people benefit Fro m you and your Friends h<lrd work <lnd helping
those in need th<ln you need to fill out the inFo <It the bottom <lnd mail it to the <lddress at the top of this letter and you can join
NAME__ ~ _______________________________________
ADDRESS_______________________________________
3. Beginning and ending solicitation dates -,,-=-d.~
'J , ~.__
/0 ~~ t-D?!
9" L..l~
4. Is the contract between the professional fund-raiser and the charitable organization on file
with the office of the Iowa Attorney General?
6. If persons will be contacted by telephone and mail, how will the initial contact be made?
Telephone Mail
7. If soliciting will be conducted by telephone, provide the following regarding the location
from which calls will be made. (lfmore than two locations, continue on a separate sheet):
Room 1
\
8. Will the solicitation campaign involve the sale ofgoods or services Yes 'I No
)
Page 2 of 5
If yes, check one or more of the following that apply:
Tickets to an event
9.
® No
If "No," describe how the funds will be cOllected. . . . .lod~ . . ;!t. :. /. . ;.(j_f~'!=fI- Jl :-e~/. .:s~. >.;. (\. - Iod'-l.l-f:. :./;.;.'(E.;..;S:..-_
V,~
10. If contributions will be made by mail, identify all addresses to which the mail will be sent.
If any of the addresses are different than the addresses listed in response to question 2B,
please state: (1) whether the address is that of a post office box, commercial mail service,
bank of the professional fund-raiser or the address of a charitable organization; (2) the
identity of the individual or entity responsible for collecting mail containing contributions.
o (
11. State which of the following has the authority to withdraw the funds from any banking
account (check all that apply):
12. State whether contributions to the charitable organization are tax deductible: (
I j .II 1'5 J:. krvS
Yes No JI~.S' w'/~J ,.j. /5, 4.0Cj{.Jf.J~ o " Lr~A rJ-t' ;J /'r)J
13. On an attached sheet, describe the charitable program for which the solicitation campaign is
being carried out. ~ , \\ (( ,
Se~ c;/kciu>j ~I/V{'d ~C/lt7w /eiIPe..
Page 3 of 5
FINANCIAL INFORMATION
State the following infonnation and indicate the applicable time period and dates (either the last
completed fiscal year or the previous twelve months):
Jt S3 89" I
b. Itemize the source(s), and dollar amounts per source, of all funds collected on
behalf of the charitable organization: (contributions or donations; payments for
tickets to events, government grants, private charities, foundations, etc.):
(3) State the total dollar amount billed to the charitable organization by the
professional commercial fund-raiser and itemize each such billing by purpose and
amount:
Page 4 of 5
Charity Senices Inc.
PO Box 706
Marion,lowa 52302
(888) 400-7717
(319) 560-0849
Payroll expense for telemarketers and staff $87.922 ( Four part time callers
and myself.)
2005 KIA, insurances, payroll taxes, credit card, travel expense, misc office expense, accountant
fees, are other expenses, if you need exact figures, let me know.
Note: Any changes or additions to the information provided in this notice must be reported
immediately.
SIGNATURE:
I, ~e E~L r..e , being fIrst duly sworn on oath, depose and state that I am a
managing agent of the professional fund-raiser; that I have read the contents of this Charitable
Organization Financial Disclosure Form; that I know the contents thereof; and that each
Page 5 of 5
Charity Servi~s Inc.
PO Box 706
Marion. Iowa 52302
(888) 400-7717
(319)560-0849
Charity Services is a small company, we have two delivery people, four telemarketers, and myself.
We do no direct mail and the group we are raising funds for control 100% of the funds collected. The
group pays CSI our agreed percentage which is either 80% or 75% and the group deposits all raised
funds. CSI pays all cost of the campaigns for these groups, they have zero expenses.
We do consecutive fund raising campaigns for our clients and every campaign is ran exactly the same
with the exception of the Iowa Paralyzed Veterans who do not allow us to offer light bulbs . We offer
various size of trash bags and four packs of florescent light bulbs as thank you gifts to the people we call
and ask for a straight donation if they do not need the product.
We deliver to every donor a thank you letter and invoice to all donors. The letter is included with each
of these reports.
CSI has been working with these groups for over ten years and some nearly twenty, all contracts have at
one time been sent to the state and these contracts are good until cancelled by either party.
We know our donors and time our campaigns to keep them supplied with bags, therefore we call some
towns every six months some every five and some just once per year.
. on _.
My callers average around $10 per hour and my drivers earn less than $25,000 per year and 6 t
includes their gas and car maintenance. ~ ~
!;J :::0
~ N
Please look at the enclosed financial disclosure sheet that follows. ;g W
-I
~ ~
3..-22~ I (
515-281-5926
E-mail:
DISCLOSURE FORM
PLEASE NOTE IMPORTANT OPEN RECORDS INFORMATION TOWARDS THE END OF THIS FORM.
Page I of 5
Iowa Paralyzed
Veterans ofAmerica
6. If persons will be contacted by telephone and mail, how will the initial contact be made?
Telephone Mail
7. If soliciting will be conducted by telephone, provide the following regarding the location
from which calls will be made. (If more than two locations, continue on a separate sheet):
Room 1
b. All telephone n~ber(S)from which solicitations are made:Q (9) Jo~- y '3v:s ,/
}
Room 2
a. Address of telephone room (Include street, city and state): _ _ _ _ _ _ _ _ _ __
Page 2 of 5
If yes, check one or more of the following that apply:
Tickets to an event
9.
@No
If "No," describe bow the funds will be collected. ttl/vIr&=- ,/hIS..>(\. deir'(J(es
Jut!
,Qr()~c..'t" c<r.c/ (vliet(. f ~ bC//'ICt.llo1'
/"
i
10. If contributions will be made by mail, identify all addresses to which the mail will be sent.
If any of the addresses are different than the addresses listed in response to question 2B,
please state: (I) whether the address is that of a post office box, commercial mail service,
bank of the professional fund-raiser or the address of a charitable organization; (2) the
identity of the individual or entity responsible for collecting mail containing contributions.
12. State whether contributions to the charitable organization are tax deductible: . (
fk P5 ~ fT-(fvS
Yes No
'. • J
IlptAVs O'~"'" I
."
,~/5
I '
4.
I · '
tJ.Oy[.,lr.;<r 01'\ r.,/I /
( Q/\)J
-J'
13 . On an attached sheet, describe the charitable program for which the solicitation campaign is
being carried out. \{ t
Page 3 of 5
FINANCIAL INFORMATION
State the following infonnation and indicate the applicable time period and dates (either the last
completed fiscal year or the previous twelve months):
b. Itemize the source(s), and dollar amounts per source, of all funds collected on
behalf of the charitable organization: (contributions or donations; payments for
tickets to events, government grants, private charities, foundations, etc.):
(2) Total not given to charitable organization but expended on behalf of the
charitable organization: Itemize by dollar amount based on the following and any
other applicable categories: salaries/commissions/compensation; rent/mortgage;
transportation; professional services (attorneys, accountants, etc.);
advertising/promotion, etc.:
(3) State the total dollar amount billed to the charitable organization by the
professional commercial fund-raiser and itemize each such billing by purpose and
amount:
o
Page 4 of 5
..Charity Services Inc.
PO Box 706
Marion, Iowa 52302
(888) 400-7717 '.
(319) 560-0849
Groups received
.
$59.651.30- (20or 25% based
. . .
on contract)
, . .
'
.
. Payroll expense fortelemarketer~ and staff ' $87.922 ( Four part time callers
.and myself.) .
. ' 200SKIA, insurances, payroll taxes, credit card, travel ~xpense; miscoffice expense, accountant
'~" fees, are other expenses, ~f y()U need exact figures, let me know. ' .
Note: Any cbanges or additions to the information provided in this notice must be reported
immediately.
SIGNATURE:
State of To iJ 0..- )
) ss.
County of L nO
I )
1,.~ 6,~ , being fIrst duly sworn on oath, depose and state that I am a
managing agent of the professional fund-raiser; that I have read the contents of this Charitable
Organization Financial Disclosure Fonn; that I know the contents thereof; and that each
/l Xal)C~
NOa~
!
'i
o
r
,.
~
JANET A. LA~ , .
Commission Numb,
MY COMMISSION, .
. ~'Z7.20
Page 5 of 5
Ch~ty Services Inc.
PO Box 706
Marion, Iowa 52302
(888) 400-7717
(319) 560-0849
Charity Services is a small company, we have two delivery people, four telemarketers, and myself.
" '
We do no direct mail and the group we are raising funds for control 100% of the funds collected. The
group pays CSI our agreed percentage which is either 80% or 75% and the group deposits all raised
funds. CSI pays all cost ofthe campaigns for these groups, they have zero expenses.
We do consecutive fundraising campaigns for ourclientsand every campaign is ran exactly the same
"with the exception of the Iowa Paralyzed Veterans who do not allow us to offer light bulbs. We offer
various size of trash bags and four packs of florescent light bulbs as thank yougiftsto the people we call
and ask for a straight donation if they do notneedthe product.
We deliver to every donor a thank you letter and invoice to all donors. The letter is included with each
ohhese reports.
CSI has been working with these groups for over ten years and some nearly twentY, all contracts have at
" ' .
one time been sent to the state and these contracts are good until cancelled by either party.
We know our donors and time our campaigns to keep them supplied with bags, therefore we call some
, towns everY six months some every five and some just once per year. g
z , __
, '-,' e
(n'
~
My callers average around $10 per hour and my drivers earn less than $25,000 per year anditat~ _fg
,includes their gas and car maintenance. ,_~ N 'c-:.
,"
"
, ' " -
,
~,c...> JIl
financi~1 disclosure sheetthat follows.
-< >
please look at the enclosed ,.."
n ::x -<
--; IT!
/~
\.0 C;
0'
3---22:-- t( 9
Z N
.r
:<
Joe Eagle":" Charity Seniices Inc.
515-281-5926
E-mail:
DISCLOSURE FORM
PLEASE NOTE IMPORTANT OPEN RECORDS INFORMATION TOWARDS THE END OF THIS FORM.
A. Name:~Se)1{
~A.
G .---
It. ~cut C-Q e .5
B. Address and telephone number of the charitable organization:
C. Name, title, address and telephone number of the contact person(s) for the
charitable organization:
Thank you for purchasing our trash bags, hght bulbs, or for your
donation. It is people like you that enable us to continue our work here
in our community. The bags are made of factory direct recycled poly and th ey
are of excellent quahty and the bulbs are eco-friendly and long la s ting.
Conununi ty Programs
Sandbox Fill
Name__________________________________ ~
$._-
Address____________________________ ~ ______ ~~ ________
3. Beginning and ending solicitation dates ~jJf)__ ~ --f/1n.
4. Is the contract between the professional fund-raiser and the charitable organization on file
with the office of the Iowa Attorney General?
6. Ifpersons will be contacted by telephone and mail, how will the initial contact be made?
Telephone Mail
7. If soliciting will be conducted by telephone, provide the following regarding the location
from which calls will be made. (If more than two locations, continue on a separate sheet):
Room 1
Room 2
a. Address of telephone room (Include street, city and state):_ _ _ _ _ _ _ _ _ __
Page 2 of 5
If yes, check one or more of the following that apply:
Tickets to an event
@No
If"No," describe how the funds will be collected. j.Pl/v1t"&= fe(s.J!'- delr"(/(es
I
/[r}c.iuof Ct~J (c/II(1?f~ a(,//1Clf/()~'
10. If contributions will be made by mail, identify all addresses to which the mail will be sent.
If any of the addresses are different than the addresses listed in response to question 2B,
please state: (l) whether the address is that of a post office box, commercial mail service,
bank of the professional fund-raiser or the address of a charitable organization; (2) the
12. State whether contributions to the charitable organization are tax deductible: . (
Yes No
I,~.J
(.up&ws
-r
O~" I -; d
I·
15
J I'
4. t(C){., (oJtf 01'1 r
( 4(A
I fk Q/: , P5 !:.kfv 5
-J V-J,
13. On an attached sheet, describe the charitable program for which the solicitation campaign is
being carried out. \I t
Page 3 of 5
FINANCIAL INFORMATION
State the following information and indicate the applicable time period and dates (either the last
completed fiscal year or the previous twelve months):
_ . _
sfi &f? -~
f- - S
b. Itemize the source(s), and dollar amounts per source, of all funds collected on
behalf of the charitable organization: (contributions or donations; payments for
tickets to events, government grants, private charities, foundations, etc.):
C; ((
/
U'//u-b ~<;;£c,/lJ r (/rf\. [I-vic
L
I //dt~
1
(3) State the total dollar amount billed to the charitable organization by the
professional commercial fund-raiser and itemize each such billing by purpose and
amount:
Page 4 of 5
.Charity Services Inc.
PO Box 706
Marion, Iowa 52302
(888) 400-7717
(319) 560-0849
.
. . . " .
and 'myself.) .
2005 KIA, insurances, payroll taxes, credit card, travel expense, misc'office expense, accountant
fees, areother expenses, if you need exact figures, let me know . .'
Note: Any changes or additions to the information provided in this notice must be reported
immediately.
SIGNATURE:
...-r-'
State of -I- 0 LJc- )
County of L. /1} I]
)ss.
)
I, _ ~e 6 (
f ic, being fIrst duly sworn on oath, depose and state that I am a
managing agent of the professional fund-raiser; that I have read the contents of this Charitable
Organization Financial Disclosure Fonn; that I know the contents thereof; and that each
~J
/'
Subscribed and sworn to before me on ~tJ1eA d;l d)o/!
I~i~
. ~ JCommlaalon
JANET A.Number 75,,_
LANcIA!.
~/J %@CJ?
NotBIV
., • MY COMMISSION EXPIRES
~ March 27, 2011
Page 5 of 5
Charity .Services Inc.
. .
PO Box 706
Marion, Iowa 52302
(888) 400-7717
. (319) 560-0849
Charity Services is a small company, we have two delivery people, four telemarketers, and myself.
. . . .
W~ do no direct mail and the group we are raising funds for control 100% of the funds collected .The ·
group pays CSI our agreed percentage which is either 80% or 75% and the group deposits all raised
funds; CSI pays all cost of the campaigns for these groups, they have zero expenses.
We. do consecutive
. ... .
fundraising campaigns
.'.
for our. .clients and every campaign is ran exactly the same",
with the exception of the Iowa Paralyzed Veterans who do not allow us to offer light bulbs. We offer
various size of trash bags a~d four packs of florescent light bulbs as thank yougiftsto the people we call
.and ask fora straight donation if they do not need the product.
We deliver to every donor a thank y~u letter arid invoice to all donors. The letter is included with each
~ili~re~~ ' . ' . '
· CSI has been working~ith these grou'ps for over ten yearsand some nearIY,twenty,all contracts have at ·
one time been sent to the state and these contracts are good until cancelled byeitherparty.
. ' " . . . .
We know our donors and time our campaigns to keep them supplied with bags, the ref() re we call some
· .towns every six months some everyfrveand ~O~ejustonce per year . 0
. My cailers average around $10 per hour and my drivers earn less than $25,000 per year and that
. ' . . ' . ' . '
' . /~
. .
·, 5,-22--1{ ·
!:")
515-281-5926
E-mail:
DISCLOSURE FORM
PLEASE NOTE IMPORTANT OPEN RECORDS INFORMATION TOWARDS THE END OF THIS FORM.
C. Name, title, address and telephone number of the contact person(s) for the
charitable organization:
Right in time for summer clean-up, it is garbage bag sales time again, offered
through the Mt. Pleasant Community Schools Music Boosters. An additional offer:
4-packs of energy efficient fluorescent bulbs.
Within the next two weeks, a representative of the Charity Services organization
will be calling on behalf of the Music Boosters to explain the garbage bag and light bulb
sales, including price, sizes, quantity and how to place an order. The garbage bags and
light bulbs will be delivered directly to the customers' homes.
"The focus for this fundraising campaign is to help underwrite the cost of
microphones for the music department said Karen Bates Chabal, Mt. Pleasant Music
Boosters president. "We have a very active music program with a growing number of
students.
The sole purpose of the Mt. Pleasant Music Boosters is to support the K-l2
instrumental and vocal music programs of the Mt. Pleasant Community School District.
All fundraising dollars are used directly for these programs. The Music Boosters' efforts
enable the music programs to operate at the highest level possible, according to Bates
Chabal.
Ongoing Music Boosters projects include the Marching Band Invitational, High
School Variety Show, InMotion Show Choir Invitational, Dessert Theatre, OPUS (K-l2
honor choir), All-State Music Festival, and the Middle School Honor Band Festival.
Membership in the Mt. Pleasant Music Boosters organization is free and is
defined as anyone with children participating in music in Mt. Pleasant Community
Schools. "If you have a child participating in any music activity within the schools or if
you just love music, we invite everyone to join the fun of being involved in Music
Boosters," said Bates Chabal.
The Charity Services, Inc., organization is registered with the Iowa Attorney
General's Office and assists organizations throughout the Midwest with fundraising.
(
6. If persons will be contacted by telephone and mail, how will the initial contact be made?
Telephone Mail
7. If soliciting will be conducted by telephone, provide the following regarding the location
from which calls will be made. (If more than two locations, continue on a separate sheet):
Room 1
f1
Y 70S ()
---
a. Address of telephone room (Include street, city and state):
I)-3d
b. All telephone number(s)from which solicitations are made:L3 (1) r
dOJ.,.- Y '30 ~ ,/
5JI-:toSJ) S'JI-V&(J, 5-;;1,1./£1/ _?"
Page 2 of 5
If yes, check one or more of the following that apply:
Tickets to an event
9.
Other (describe)
Will the professional J .
< ( [
;, ..
< > = -~ .......
>.
(,' e
, .
:....<
® No
If"No," describe how the funds will be collected. tIt"Vi"'t:
II
Rr1 $. deir'tJ(es .J(\.
10. If contributions will be made by mail, identify all addresses to which the mail will be sent.
If any of the addresses are different than the addresses listed in response to question 2B,
please state: (1) whether the address is that of a post office box, commercial mail service,
bank of the professional fund-raiser or the address of a charitable organization; (2) the
identity of the individual or entity responsible for collecting mail containing contributions.
A(( (riCo'! J t> £? 5 j l f'fC iff f-v /1l(cvj) , tf£ :5 / S,O! Cafe
pr t!.o do4";s th2 f ref(,l;~51- Iv - 0A,' / ~ dot1Qf!o/l ,j1. r
11 . State which of the following has the authority to withdraw the funds from any banking
account (check all that apply):
Yes No I. ~.J
tNptAvS O v"\.. !
',J '
12. State whether contributions to the charitable organization are tax deductible:
,of /
J •
5 40.c>'{"£lt'o)<1
.
0/\[,.. 1(/1
/ fk /: 15 ~kfv's (
~ v...
13. On an attached sheet, describe the charitable program for which the solicitation campaign is
being carried out. \I (
Page 3 of 5
FlNANCIAL INFORMATION
State the following information and indicate the applicable time period and dates (either the last
completed fiscal year or the previous twelve months):
4 ) ~1 Fl£t{ ~ t4?
b. Itemize the source(s), and dollar amounts per source, of all funds collected on
behalf of the charitable organization: (contributions or donations; payments for
tickets to events, government grants, private charities, foundations, etc.):
dt .. 4 j
(1) Total given to charitable organization C{J, I '.
(2) Total not given to charitable organization but expended on behalf of the
charitable organization: Itemize by dollar amount based on the following and any
other applicable categories: salaries/commissions/compensation; rent/mortgage;
transportation; professional services (attorneys, accountants, etc.);
advertising/promotion, etc.:
(3) State the total dollar amount billed to the charitable organization by the
professional commercial fund-raiser and itemize each such billing by purpose and
amount;
Page 4 of 5
·Charity 'Services Inc. '
PO Box 706
Marion, Iowa 52302
(888) 400-7717 "
(319) 560-0849
Payroll expense for telemarketers and staff · ,, $?7.922 ( Four part time callers
' arid myself.) ,
. . . ....
, ,
2005 KIA, insurances, payroll taxes, credit card, travel expense, mise 'office expense, accountant
fees, are .other expenses, if you need exact figures, let me know. '
Note: Any changes or additions to the information provided in this notice must be reported
immediately.
SIGNATURE:
State of roUtL )
. ) ss.
County of L (71) )
I, ~& , being first duly sworn on oath, depose and state that I am a
managing agent of the professional fund-raiser; that I have read the contents of this Charitable
Organization Financial Disclosure Form; that I know the contents thereof; and that each
~'
,/
~A i4tJc,j)
Page 5 of 5
Charity Services Inc.
PO Box 706
Marion, Iowa 52302
(888) 400-7717
(319) 560-0849
Charity Services is a small company, we have two delivery people, four telemarketers, and myself.
. ' ' .
We do no direct mail and the group we are raising funds for control 100% of the funds collected. The '
funds. CSI pays all cost ofthe campaigns for these groups, they have zero expenses.
. . ' . ' . - .
We. doconsecutive
.. ..
fundraising campaigns for our clients and every campaign .is ran exactly
.
the same
"with the exception of the Iowa Paralyzed Veterans who do not allow us to offer light bulbs. We offer
various size of trash bags and four packs of fI~~escent light bulbs as thank you gifts to the people we call
and ask for a straight donation if theydo not n'eed the product.
We deliver to every donor a thank you letter and invoice to all donors. The letter is included with each
of these reports.
CSI has been working' with these groups for over ten year-sand some nearly twentY, all contracts h~ve at •
oneti~ebeen sent t~ ~he st~te and these ~ontracts are good untii cancelled by either party.
We kn()w our donors and time Ollr campaigns to keep them suppiiedwith bags, therefore we call some
towns ' every six months some every five and some'just once per year.
My callers average around $10 per hou'r and my drivers earn lesst~an $25,000 per year and that
o
x
, Piease'look at the enclosed financial disclosure sheet thai follows. (I)
c:
::x
'~
'- M
/\.I ,
3: ~ rr1
/~
~ , ,
515-281-5926
E-mail:
DISCLOSURE FORM
PLEASE NOTE IMPORTANT OPEN RECORDS INFORMATION TOWARDS THE END OF THIS FORM.
C. Name, title, address and telephone number of the contact person(s) for the
charitable organization:
Thank you for purchasing our trash liners, light bulbs, or for your donation. We feel the
bags and bulbs are great fundraising products as most of us have to buy them anyway.
We felt they would work great as a thank you for your support
Eye Glass, Hearing Aid, and Cell Phone Collection and Redistibution
Thank again for your support without people like you, we could not do our worfr hetfJ in our community.
If you would like some infonnation our would like to join our Lions Club, please call Glenn at the
Phone~ __~__~_______________________
I
,- / 6'
3. Beginning and ending solicitation dates ~~ __ u;ufiuw> iD (10 .
4. Is the contract between the professional fund-raiser and the charitable organization on file
with the office of the Iowa Attorney General?
6. If persons will be contacted by telephone and mail, how will the initial contact be made?
Telephone Mail
7. If soliciting will be conducted by telephone, provide the following regarding the location
from which calls will be made. Of more than two locations, continue on a separate sheet):
Room 1
~7 (t'
.
Room 2
a. Address of telephone room (Include street, city and state ):_ _ _ _ _ _ _ _ _ __
Page 2 of 5
If yes, check one or more of the following that apply:
Tickets to an event
®No
If"No," describe how the funds will be collected. tlt'vfri= leis..>(\. del/v(es
.,f)cu)ucA·- and (c;>Iit1ci~ ,1,Y/lCtfto4
10. If contributions will be made by mail, identify all addresses to which the mail will be sent.
If any of the addresses are different than the addresses listed in response to question 2B,
please state: (I) whether the address is that of a post office box, commercial mail service,
bank of the professional fund-raiser or the address of a charitable organization; (2) the
II, State which of the following has the authority to withdraw the funds from any banking
account (check all that apply):
Yes No
',J '
12. State whether contributions to the charitable organization are tax deductible:
I. ~ J I .•
CflfCAU·S' O~" I . ,of 1.5 4. t/ C>,1.·d ("IT 011
( . .I fit QI'.;vf5 s.kfo./5 (
"l/1 r-J
13. On an attached sheet, describe the charitable program for which the solicitation campaign is
being carried out. , . \(, t( ,
Page 3 of 5
FINANCIAL INFORMATION
State the following infonnation and indicate the applicable time period and dates (either the last
completed fiscal year or the previous twelve months):
b. Itemize the source(s), and dollar amounts per source, of all funds collected on
behalf of the charitable organization: (contributions or donations; payments for
tickets to events, government grants, private charities, foundations, etc.):
(3) State the total dollar amount billed to the charitable organization by the
professional commercial fund-raiser and itemize each such billing by purpose and
amount:
o
Page 4 of 5
,Charity Services·Inc.,
PO Box 706
Marion, Iowa 52302
(888) 400-7717 '
(319) 560-0849
.. ' .
, ,
'
Payroll expense for telemarketers and staff ' $87.922 ( Four part time callers
,'.and myself.) ,
. ,' ' 2005 KIA, insurances, payroll taxes, credit card, travel expense, misc office expense, accountant
fees, are other expenses, if you need exact figures, let me know.
Note: Any changes or additions to the information provided in this notice must be reported
immediately.
SIGNATURE:
I,
r-- ~
~oe... t:...41ie.
)
Organization Financial Disclosure Fonn; that I know the contents thereof; and that each
./
~
Subscribed and sworn to before me on "1f) ()I) cIJ ;; ~ d!l!/
QafIU !l dC(2()C/J!
No ry Public .
i
I
•
JANET A. LANCIAL
~ CommIesion Number 751.
• MY cow.etSSlON EXPIRES
I . MIn:h:n. 2011
Page 5 of 5
Charity Services Inc.
PO Box 706
Marion, Iowa 52302
(888) 400-7717
(319) 560-0849
Charity Services is a small company, we have two delivery people, four telemarketers. and myself.
. . . .
Wedo nodirect mail and the group we are raising funds for control 100% ofthe funds collected .The
group pays CSI our agreed percentage which is either 80% or 75% and the group deposits all raised
. funds: CSI pays all costof the campaigns for these groups, they have zero expenses ..
We do consecutivefundraising campaigns for our clients and every campaign is ran exactly the same
. with the exception of the Iowa Paralyzed Veterans whodo not allow us to offer light bulbs. We offer
various sizeoftra~h bags and four packs of florescent light bulbs as thank you giftsto the people we call
'.and ask for a straight donation if they do not need the product . ..
. . . . ". . ' . : " .. , -' . .
Wedeiiver to every donor a thank you letter and invoice to alldonors. Theletter is included with each
of these reports . .
CSt hasbeen' worldngwith these gro~ps for over ten yearsimd some nearly twentY, all contracts have at .'
one time been sentto the state and these contracts are good until cancefled by either party.
We know our donors and time our campaigns to keep them supplied with bags, therefore we call some
•towns every six months some everyfrveand some just once per year.
My callers
' .
average. . around
. ...
$10 per 'hour. andmy
. - . .
drivers earn less 'than
" .
$25,000
..
~
per year and. that
. '
;g c....,)
.">
::0
-rn
o
r,' "
rii
C")
::bo
M ::r..
:::! \.0 .
<
f'l1 .
o
:z:: .•-. Ci
.!;?
:<
....N
515-281-5926
E-mail:
DISCLOSURE FORM
PLEASE NOTE IMPORTANT OPEN RECORDS INFORMATION TOWARDS THE END OF THIS FORM.
1. NameofProfessionaIFund-RaiSer:h qr1t
C" 'i
7 ~('V1l..l.IS
(J ~
.LI7 ~.
2. Identify the charitable organization for which you will be soliciting money within the
State of Iowa during this registration period. (If more than one charitable organization,
file a separate Financial Information Disclosure form for each.)
Thank you for purchasing our trash bags, bulbs or for your donation. It is
people like you that enable us to continue our work here in our ever
growing community. We sell the bags and bulbs so that we may give you
a thank you gift that you can really use in return for your pledge.
The North Uberty Jaycees are a hard working group of people dedicated
to making life better for our fellow citizens. If you are between the ages of
18-40, want to make new friends, establish business relationships, better
your community, and have a great time doing it, then please call Todd at
the number above or send this letter to the address listed and become a
North Liberty Jaycee HI
Below are listed some of our past and present projects and programs!
Haunted Maze
6. If persons will be contacted by telephone and mail, how will the initial contact be made?
Telephone Mail
7. If soliciting will be conducted by telephone, provide the following regarding the location
from which calls will be made. (If more than two locations, continue on a separate sheet):
AJ:
Room 1
Room 2
a. Address of telephone room (Include street, city and state ):_ _ _ _ _ _ _ _ _ __
Page 2 of S
If yes, check one or more of the following that apply:
Tickets to an event
® No
If"No," describe how the funds will be collected. !tIr'VI'f= fJflS..)1\..
(I
deir'{)(es
f9(orbuf ,<"j (G>I!f,l~ (j('.//lC{ilo:r
10. If contributions will be made by mail, identify all addresses to which the mail will be sent.
If any of the addresses are different than the addresses listed in response to question 2B,
please state: (1) whether the address is that of a post office box, commercial mail service,
bank of the professional fund-raiser or the address of a charitable organization; (2) the
identity of the individual or entity responsible for collecting mail containing contributions.
(114 Ii
fee fio bk;S ·fltafr€,fu;,sl-" 1v-0i,-1 Y-Jve.. dOllo;fiO/1 J~.
12. State whether contributions to the charitable organization are tax deductible: (
Yes No
'". J -" J ' J •
O"lpvS O~" I f , -f /5 ... 0.'1{ .. f (.;'1 Oil
(
r -r;1
/ ~ f! /',)./,P5 J. f-.qfv 5
13. On an attached sheet, describe the charitable program for which the solicitation campaign is
being carried out. \I t
Page 3 of 5
FINANCIAL INFORMATION
State the following information and indicate the applicable time period and dates (either the last
completed fiscal year or the previous twelve months):
b. Itemize the source(s), and dollar amounts per source, of all funds collected on
behalf of the charitable organization: (contributions or donations; payments for
tickets to events, government grants, private charities, foundations, etc.):
(3) State the total dollar amount billed to the charitable organization by the
professional commercial fund-raiser and itemize each such billing by purpose and
amount:
o
Page 4 of 5
:Charity Services'Inc'• .
PO Box 706
Marion , Iowa 52302
(888) 400-7717
(319) 560-0849
. Payroll expense for telemarketers and staff . $~7.922 (Four parttime callers
. and myself.) ,
UghtBulbs >$2822.25
'. 2005 KIA, i~surances, payroll taxes, credit card, travel expense, mise'office expense, accountant
. . fees, are .ot,her' expenses, if you need ' exact figures, let me know . .
Note: Any changes or additions to the information provided in this notice must be reported
immediately.
SIGNATURE:
State of r 0 UIC )
) ss.
County of L/Q 4 )
I, Soc ~(~
, , being first duly sworn on oath, depose and state that I am a
managing agent of the professional fund-raiser; that I have read the contents of this Charitable
Organization Financial Disclosure Fonn; that I know the contents thereof; and that each
p 7~
Subscribed and sworn to before me on """"1rJ {f)e/, d d, do)/
JANET A. LANClAL.
ComrniMion Number 75t.
~af]~/ rd
MY COMMIsSION EXPIRES
Men:h 27. 2011
Page 5 of 5
Charity Services ~c.
PO Box 706 ·
Marion, Iowa 52302
(888) 400-7717
. (319) 560-0849
Charity Services is a small company, we have two delivery people, four telemarketers, and myself.
. . . . ' . .
We do no direct mail and the group we are raising funds for control 100% of the funds collected. The '
group pays CSI our agreed percentage which is either 80% or 75% and the group deposits all raised
funds; CSI pays all cost -ofthe
. .
campaigns for these groups, they have
.
zero expenses;
We do consecutive fundraising campaigns for our clients and every campaign is ran exactly the same
. with the exception of the Iowa 'Paralyzed Veterans who do not allow us to offer light bulbs. We offer
various sizeof trash bags and four packs of florescent light bulbs as thank you gifts to the people we call
andask fora straight donation if they do not need the product. · .
.' . '. .' . .
·We deliver to every donor athank you ietter and invoice to all donors. The lett~r is included with each
. ...of these reports.
. CSI has been workingwith these grou'ps for over ten yearsand some nearly twenty, all contracts have at •
. " . , . ' . ' . ' . .
onetime been sent to the state and these contracts are good until cancelled by either party.
We know our donors and time our campaigns to keep them supplied with bag~; therefore we call some.
·towns 'every six months some every five and some just once per year.
My.ealiers average around $10 per hour and rriy' drivers earn less than $25,000 per year and that
. I . ' . ... . .' . . . ' , • . ' . . ' . .
~ . ::X -,...
..,. :t:a ..-v
/~
- .:::0 rr-t
·'.),-22:-:t( .. tTl
;:u . N ~
I • ; .
PO Box 706
Marion, Iowa 52302
(888) 400-7717
(319) 560-0849
Charity Services is a small company, we have two delivery people, four telemarketers. and myself.
We do no direct mail and the group w~ are raising funds for control 100% of the funds collected. The
group pays CSI our agreed percentage which is either 80% or 75% and the group deposits all raised
'. funds: CSI pays all cost oUhe
: .
campaigns
,
for these groups,
.
they have zero expenses.
We do consecutive fundraising campaigns for our clients and every campaign is ran exactly the same
with the exception of t'he Iowa Paralyzed Veterans who do not allow us to offer light bulbs. We offer
various
.
size of trash bags a~d
.
four packs of florescent light bulbs as thank you gifts to the people we call
. and ask for a straight donation ,if they do not need the product . .
.We deliver to every donor a thank' y~uletter and invoice to all donors. The letter is included with each
of these reports.
CSI has been working with these gro~ps for over ten years and somene~rly twenty, all contracts have at •
. • I ' . : • • ~ .
one time been sent to the state and these contracts are good until cancelled by either party.
We know our donors 'and time our campaigns to keep them supplied with bag~, therefore we call some.
towns every six months some every five and so~e justonce per year .
!")
' . • ' . . . ' c'· . '· 0 _.
My callers average around $10 per hour and my drivers earn less thC!n $25,000 per year and~at-":'
.' ". ". ' . . ' .' 'c :J:
includes their gas and car maintenance. . .. . . . . . . . ~.' . ~ :::0
::0
N
rn
"l;l C")
Please look at the enclosed fi\1.ancial disclosure sheet that follows. ::0 W .
o . tTl ..
-l :x
~ " 5'-22~!(
.~ ., :x <:
--' P"!
C)
z
\.0 o
N
Joe Eagle Charity Services hic: 0 .s:
:<
515-281-5926
E-mail:
DISCLOSURE FORM
PLEASE NOTE IMPORTANT OPEN RECORDS INFORMATION TOWARDS THE END OF THIS FORM.
C. Name, title, address and telephone number of the contact person(s) for the
charitable organization:
Community Donations
Flagfest
Boy Scouts
Relay For Life
Presch ool Scholars h ip s
Haunted House
We are always looking for new members. If you are between the ages of
21-40, interested in making lifelong friends, building a better
community, working with the area's kids, and having a real good time
doing all these things.... Then please mail this letter to the address above
or call the number given and become a SPENCER J AyCEE ..... .
Name:
Phone s: H C__________________
4. Is the contract between the professional fund-raiser and the charitable organization on file
with the office of the Iowa Attorney General?
6. If persons will be contacted by telephone and mail, how will the initial contact be made?
Telephone Mail
7. If soliciting will be conducted by telephone, provide the following regarding the location
from which calls will be made. (If more than two locations, continue on a separate sheet):
Room 1
Room 2
Page 2 of 5
If yes, check one or more of the following that apply:
Tickets to an event
® No
If "No," describe how the funds will be collected. 1.>//vl''?=~,
jJe l sv (\.. dflt'iJ(eS
10. If contributions will be made by mail, identify all addresses to which the mail will be sent.
If any of the addresses are different than the addresses listed in response to question 2B,
please state: (1) whether the address is that of a post office box, commercial mail service,
bank of the professional fund-raiser or the address of a charitable organization; (2) the
identity of the individual or entity responsible for collecting mail containing contributions.
ZJ
11 . State which of the following has the authority to withdraw the funds from any banking
account (check all that apply):
12. State whether contributions to the charitable organization are tax deductible: . (
I. J I fif Q/'c)Jf5
Yes No
- I' I ' I "
rJtfO'V S o,~ I f ,of 15 4. C/OA"Ifr.J1/ 0/\
A (
4'A r .J
:!:. fGiv'5
13. On an attached sheet, describe the charitable program for which the solicitation campaign is
being carried out. \I I
Page 3 of 5
FINANCIAL INFORMATION
State the following information and indicate the applicable time period and dates (either the last
completed fiscal year or the previous twelve months) :
b. Itemize the source(s), and dollar amounts per source, of all funds collected on
behalf of the charitable organization: (contributions or donations; payments for
tickets to events, government grants, private charities, foundations, etc.):
(3) State the total dollar amount billed to the charitable organization by the
professional commercial fund-raiser and itemize each such billing by purpose and
amount:
o
Page 4 of 5
~
PO Box 706
Marion, Iowa 52302
(888) 400-7717
(319) 560-0849
.
, 2010expenses
, . .' . for
. all campaigns:
, ,
',' 200S KIA, insurances, payrolltaxes, credit card; travel expense; misc office expense, accountant
fees, are ,other' expenses,if you need exact figures, let me know. . '
' . . . . . .
Note: Any changes or additions to the information provided in this notice must be reported
immediately.
SIGNATURE:
State of fo UtA.. )
) ss.
County of L 1/) a )
I, ~o~ Eur~ , being fIrst duly sworn on oath, depose and state that I am a
managing agent of the professional fund-raiser; that I have read the contents of this Charitable
Organization Financial Disclosure Form; that I know the contents thereof; and that each
,/
£i£
Subscribed and sworn to before me on ~ a1 ch de; do/ / J
40f!!! II 'Mal
ryPubm;
Page 5 of 5
Attorney General Tom Miller
515-281-5926
E-mail:
DISCLOSURE FORM
PLEASE NOTE IMPORTANT OPEN RECORDS INFORMATION TOWARDS THE END OF THIS FORM.
2. Identify the charitable organization for which you will be soliciting money within the
State of Iowa during this registration period. (If more than one charitable organization,
file a sepamte Financ,llnfonnation Disclosure fonn for each.)
y~ ccAf~{d i-e--/;!h
Page 1 of 5
VAN BUREN COUNTY
JAYCEES
Thank you for purchasing some of our trash liners, light bulbs, or for your donation. It is
people like you that enable us to continue our work here in the community.
These trash liners are recycled plastic and one of the last seamed bags being
manufactured. We felt they would make a nice useful gratuity item. They are great bags.
The bulbs are efficient, fluorescent bulbs that last long and burn cheap.
We have listed some of our past and present projects and activities
below...
IF YOU ARE 18-40 YEARS OF AGE AND WANT TO MAKE LIFELONG FRIENDSHIPS, NEW BUSINESS CONTACTS, IMPROVE
YOUR OWN COMMUNITY, AND MAKE A DIFFERENCE, THEN BECOME A VAN BUREN COUNTY JA YCEE AND HELP US
BETIER OUR COMMUNITY. PLEASE RETURN THIS LETIER TO THE ADDRESS ON THE TOP AND MOST OF ALL ... THANK
you!!!! !!I!!!!!!!
NAME_______________________________
P~.-----------------
3. Beginning and ending solicitation dates Ji)O +--tftffittgh Gtit) Jtt
4. Is the contract between the professional fund-raiser and the charitable organization on file
with the office of the Iowa Attorney General?
-----
. ~ No If no, attach a copy of the contract to this fonn.
6. If persons will be contacted by telephone and mail, how will the initial contact be made?
Telephone Mail
7. If soliciting will be conducted by telephone, provide the following regarding the location
from which calls will be made. (If more than two locations, continue on a separate sheet):
Room 1
ft
a. Address of telephone room (Include street, city and state): (/ 70S (cJ
-.
S-) 3d .
b. All telephone number(s)from which solicitations are made:Q (1) Jo~· y ·30 ~ ,/
Page 2 of 5
If yes, check one or more of the following that apply:
Tickets to an event
9.
®No
If"No," describe how the funds will be collected. ttl/ v /("&= PtfS. .>1\.. d 'e(/{/(es
Jv
12[()~uf Cblc/
J
(c>llft<f~ tY{,.J/1~fro.1
. , '
10. If contributions will be made by mail, identify all addresses to which the mail will be sent.
If any of the addresses are different than the addresses listed in response to question 2B,
please state: (1) whether the address is that of a post office box, commercial mail service,
bank of the professional fund-raiser or the address of a charitable organization; (2) the
identity of the individual or entity responsible for collecting mail containing contributions.
11. State which of the following has the authority to withdraw the funds from any banking
account (check all that apply):
12. State whether contributions to the charitable organization are tax deductible: . . (
I. ~ J 'I v5
Yes No C1-1fX!"VS 0 *,,- i
J
,-f
.
15 4-
J
04t't
(.
foJl/ 0'"
(
r ifA
" fk Q'rJ.;P5
-J '
J:,fGf
13. On an attached sheet, describe the charitable program for which the solicitation campaign is
being carried out. \( t
Page 3 of 5
FINANCIAL INFORMATION
State the following information and indicate the applicable time period and dates (either the last
completed fiscal year or the previous twelve months):
Jt K S- L{.9 0/
b. Itemize the source(s), and dollar amounts per source, of all funds collected on
behalf of the charitable organization: (contributions or donations; payments for
tickets to events, g o v e 7 t s , private charities, foundations, etc.):
~j/( p (I/ j),* ()t7J/~ £r(/~ fjf'AvJ
tvt U;~.
(2) Total not given to charitable organization but expended on behalf of the
charitable organization: Itemize by dollar amount based on the following and any
other applicable categories: salaries/commissions/compensation; rent/mortgage;
transportation; professional services (attorneys, accountants, etc.);
advertising/promotion, etc.:
(3) State the total dollar amount billed to the charitable organization by the
professional commercial fund-raiser and itemize each such billing by purpose and
amount:
o
Page 4 of 5
:Charity Services Inc. . . ..
PO Box 706
Marion, Iowa 52302
(888) 400-7717 ·.
(319) 560-0849
,,' C~mpany
. .
Gross fOr 2010 was $273,974.30
..
,.,
. '
Payrollexpense fortelemarketers and staff . ',' $?7.922 ( Four part time callers
' arid myself.). , . . " ,
light'Bulbs . $2822.25
' : ..
.. 2005
. .
KIA, insurances,
'. . '.
payroll taxes, credit card; travel
. .
.. ' ,
expense, miscoffice
. '' " .
expense, accountant
'. . .
Note: Any changes or additions to the information provided in this notice must be reported
immediately.
SIGNATURE:
State of .row C' )
) ss.
County of L (174 )
1, ~ f? &r & ,being fIrst duly sworn on oath, depose and state that 1 am a
(
managing agent of the professional fund-raiser; that I have read the contents of this Charitable
Organization Financial Disclosure Form; that I know the contents thereof; and that each
~.
/
Subscribed and sworn to before me on 1)/)a;; cI; del do!1
JANET A. LAHCIAL
. '~ry Publtc
CommiIIIOf\ Number 151.
MY COMMISSION EXf'tAIS
Page 5 of 5
Charity Services Inc.
PO Box 706
Marion, Iowa 52302
(888) 400-7717
, (319) 560-0849
Charity Services is a small company, we have two delivery people, four telemarketers. and myself.
We:do nodirect mail and the group we are raising funds for control 100% of the funds collected. The'
group pays CSI our agreed percentage which is either 80% or 75% and the group deposits all raised
funds. CSI pays all cost ofthe campaigns for these groups, they have zero expense~.
, ,
We do consecutive fund raising campaigns for our clients and every campaign is ran exactly the same
. .. ' . . ' .
'. with the exception of the Iowa Paralyzed Veterans whodo not allow us to offer light bulbs. We offer
various size of trash bags and four packs of florescent light bulbs as thank you gifts to the people we call
and ask for a straight donation if they do not need the product.
We deliver to every donor a thank you ietter and invoice to a" donors. The letter is included with each
of these reports.
- . , , . .. .
CSI has been working with these groups for over ten years and some nearly twenty, all contracts have at
one time been sent to ~he state and these contracts are good until cancelled by either p~rty. .
We know our donors and time our campaigns to keep them supplied with bags, therefore we call some
towns every six months some every five and some just once per year.
' . ,
My callers average around , $10 per ~o~:rand my drivers earn lessth.an $25,000 per year and that
includes their gas and car maintenance.
0
please look at the' enclosed fioanciai di~losure sheetthat follows. z
(/)
c: :x
,..,
', /~
::I: .~ :::0
:u rrl
3,-2-2~ I ( :;u
":t)
:::c
N
w r·
r.'l
Joe Eagle':' Charity'Services hic. 0
--; ::c- <:
ITI
n :x rr1
- -(
0 .. t:J
\D
:z N
c U1
:<
515-281-5926
E-mail:
DISCLOSURE FORM
PLEASE NOTE IMPORTANT OPEN RECORDS INFORMATION TOWARDS THE END OF THIS FORM.
We need more members!! If you would like to help your community and become
involved with local projects, charities and community programs without paying high
dues and membership costs; then please call DEAN GREINER at the number above
and become a JUST CAUSE member. ... .
3. Beginning and ending solicitation dates (" (0 tJH:etlgh (,plIo £ . (I - IU
I
4. Is the contract between the professional fund-raiser and the charitable organization on file
with the office of the Iowa Attorney General?
~) No If no, attach a copy of the contract to this form.
.~
5. Soliciting will be conducted by (Check one or more that apply):
6. If persons will be contacted by telephone and mail, how will the initial contact be made?
Telephone Mail
7. If soliciting will be conducted by telephone, provide the following regarding the location
from which calls will be made. (If more than two locations, continue on a separate sheet):
Room 1
a. Addre s of telephone room (Include street, city and state): (,170 .5 () ft
-.-- ~
.))3d
b. All telephone number(s)from which solicitations are made:[3 (1) Jo~- y '3u ~
r ,/
Room 2
a. Address of telephone room (Include street, city and state): _ _ _ _ _ _ _ _ _ __
Page 2 of 5
If yes, check one or more of the following that apply:
9.
qtlhlehr (de";,ribe) I
W 1 t e prolesslOna
(fW!l l-Vf( 69EJ" _ lib!:. ~,jJ )
@)No
If "No," describe how the funds will be collected. &I/VFf=. (/
JJ f (S-.l(\.. deftv(es
iQ(oJuc.-f CIA) (ol!(1cJ~ (jc//1t(flo'.t
10. If contributions will be made by mail, identify all addresses to which the mail will be sent.
If any of the addresses are different than the addresses listed in response to question 2B,
please state: (1) whether the address is that of a post office box, commercial mail service,
bank of the professional fund-raiser or the address of a charitable organization; (2) the
v ,-J' . . . 0
f;c fio J{J4pr~ ih% f /efUq~5.f. Iv 05, I ~ d c/llq1!o/1 ,j1. r
(Co ~r- f/..a" ACi(/IA. e c, 4" r;/~r C; P> ~)Se c-/ Ja/~Sf
c./ I.
11 . State which of the following has the authority to withdraw the funds from any banking
account (check all that apply):
Yes No 1. ~ j
C7'fpvw-S 0 ,,,- I
',J '
12. State whether contributions to the charitable organization are tax deductible:
I . "
,of 15 ... o.OA.,( f u4 01"\
(
r~A
.I fit Q , .c).I
-.J
/J5
;
.
s. k fv 5
(
13. On an attached sheet, describe the charitable program for which the solicitation campaign is
being carried out. \I t
Page 3 of 5
FINANCIAL INFORMATION
State the following infonnation and indicate the applicable time period and dates (either the last
completed fiscal year or the previous twelve months):
q(
L£
0«fT
~ 1 -
~- ( Cell
2~
-
b. Itemize the source( s), and dollar amounts per source, of all funds collected on
behalf of the charitable organization: (contributions or donations; payments for
tickets to events, government grants, private charities, foundations, etc.):
(2) Total not given to charitable organization but expended on behalf of the
charitable organization: Itemize by dollar amount based on the following and any
other applicable categories: salaries/commissions/compensation; rent/mortgage;
transportation; professional services (attorneys, accountants, etc.);
advertising/promotion, etc.:
(3) State the total dollar amount billed to the charitable organization by the
professional commercial fund-raiser and itemize each such billing by purpose and
amount:
Page 4 of 5
, ,Charity-Services Inc.
PO Box 706
Marion, Iowa 52302
, (888) 400-7717
(319) 560-0849
Company
. Gross for 2010 was$273,974.30
.. .
Payroll expense for telemarketers and staff , $87.922 ( Four part time callers
' 2005 KIA, insurances, payroll taxes, credit cClrd, travel expense, 'misc office expense, accountant - '
fees, areOtherexpenses, if you need exact figures, let me know. '
Note: Any changes or additions to the information provided in this notice must be reported
immediately.
SIGNATURE:
State of roW (J...... )
. ) ss.
County of L 1171 )
I, ~e. ~<,. t.r , being fIrst duly sworn on oath, depose and state that I am a
managing agent of the professional fund-raiser; that I have read the contents of this Charitable
Organization Financial Disclosure Fonn; that I know the contents thereof; and that each
(/rClIV-t A
~o ~ry Public
'@C'~
I
I
Page 5 of 5
Charity Services Inc.
PO Box 706
Marion, Iowa 52302
(888) 400-7717
(319) 560-0849
Charity Services is a small company, we have two delivery people, four telemarketers, and myself.
We do no direct mail and the group w~ are raising funds for control 100% of the funds collected. The'
group pays CSI our agreed percentage which is either 80% or 75% and the groupdeposits all raised
funds; CSI pays all cost ofthe campaigns for these groups, they have zero expenses.
We doconsecutive fundraising campaigns for our clients and every campaign is ran exactly the same
. with the exception of the Iowa Paralyzed Veterans who do not allow us to offer light bulbs. We offer
various size of trash bags and four packs of florescent light bulbs as thank you gifts to the people we call
and ask fora straight donation if they do not need the product.
We deliver to every donor a thank you letter and invoice to atl donors. The letter is included with each
of these reports.
CSI has been working ~ith these grou'ps for over ten yearsand some nearly twentY, all contracts have at·
one time been sent to the state and these contracts are good until cancelled by either party.
We know our donors and time our campaigns to keep them supplied with bags, therefore we call some
towns every six months some every five and somejust once per year.
. . ..
My ~allers average around $10 per hour and my drivers ear~ less t~an $25,000 per year and ~t _.
c ~
.. /''1' 1,
".
-0
Ai
N
<...) c:,'
/~
o· . iT!
5,-22~1{ -i. :z:a
ex
" ..
.~ -<
-i f11
o ~
:<:
515-281-5926
E-mail: consumer@ag.state.ia.us
Please notice tbat tbe registration requirement is only for professional commercial fund-
raisers as defined in Iowa Code Cbapter 13C. Cbaritable organizations as defined in tbis
Cbapter are not required to register.
Professional commercial fund-raisers must also complete tbe attacbed form, "Cbaritable
Organization Financial Information Disclosure Form," for EACH cbarity for wbich you
raise funds.
I. Name of Professional Commercial Fund-raiser, including any d/b/a and trade names :
-1- Z'l d\ ~~ £2 ~3 ~. \ I,
CC:\ i\\j~.\3B
3. Form of business {:rp
~~~~~~~~~~-----
(Individual, Partnership, Business Corporation, Nonprofit Corporation, etc.)
4. _ _A____
Identify the state in which registrant is organized or incorporated,_-::L
5. FuJI name, title, address and telephone number of each officer, director, partner or managing
agent of the professional commercial fund-raiser:
6. Name, address, telephone number and title of the following person(s) for the professional
commercial fund-raiser:
::£~ E;;}£
b. The person(s) responsible for the day-to-day operations of the professional commercial fund-
raiser:
50~ C::L~
"'"
c. The person(s) who directs and controls the activities of the professional commercial fund
raiser:
~ c:r (v
d. The person(s) responsible for custody of the professional commercial fund-raiser's records:
Xz 6~~
-0
e. The person(s) responsible for custody of all funds raised by the professional commercial fund-
raiser:
,..-,- ~ I
~ ()L C:C:;i~
v
-2
f. All persons managing or supervising fund-raising activities in or from Iowa:
~e Cdri'.
7. Has the professional fund-raiser or any of the persons listed in response to Numbers 5 or 6 ever
been a party to any litigation, criminal or civil, involving claims oftbeft, fraud, unfair or
deceptive trade practices, conversion, mismanagement of funds, breach of fiduciary duty, or any
other claim involving alleged dishonesty?
DYes ~o If yes, attach detailed explanation as to agency involved, date, court, claim and
disposition. Attach copies of all complaints, petitions, settlement agreements, plea agreements,
assurances, consent judgments, final judgments, convictions, and/or other agreements or orders
resolving the matter.
8. Name, address and teleph?ne number of the registered agent for service of process in Iowa:
<
10. Has the professional fund-raiser's right to solicit funds ever been denied, suspended, revoked or
enjoined by any state or by any court, or are there any such proceedings pending?
11. Has the professional fund-raiser been the subject of a legal, administrative, or other proceeding
regarding any solicitation or registration as a solicitor or fund-raiser? If so, state the date,
location and nature of each such proceeding and the outcome of the proceeding.
12. Does the professional fund-raiser have custody of or access to contributions from a solicitation at
any time?
.AYes DNo
13. Does registrant anticipate that any of the services it will provide to charitable organizations will
be provided by another entity under a subcontractor arrangement?
DYes ~ If yes, please identify the charity and the subcontractor below: (Attach a
list if more room is needed.)
-3
I n xal7c -cJ}
(Seal) (Signatuife of Notary Public)
I
~~ CommIMIon
JANEt A.Number
lANClM.
1fltM
• MY COMMISSION EJlPIAE8
. Marc:tl27. 20"
-5
Charity Services Inc.
I wanted to get my registration in for 2011. I am in the process of getting the group report
done. Charity Services has the exact same client list as last year (and the last 10 years
before that) I will submit all group totals upon completion of the report.
sincery/x'
Joe Eagle - CSI
2----2(-((
Address Reply To:
11Bepartment of jJustire
Marc h 15,2011
Joseph A. Eagle
470S12th
Marion, IA 52302
This letter is notification to you that our office has received your completed renewal
registration form and ten dollar fee for professional commercial fundraisers, pursuant to the
requirements ofIowa Code Chapter 13C.
This letter is also the registration permit for Charity Services, Inc. to solicit contributions
for a charitable purpose in the State ofIowa. This permit expires February 2012.
Thank you .
Sincerely,
Helen Alessio
Consumer Protection Division
hka
DATE s.-j-I ~-U No. 329816
0.\
-I
RECE'VEO FROMc;£i "-"-,~
;:
~.
S0 es) ®.D -rlo!c. I$ 10 fJ'" I
UJ DOLLARS
Ug;~~VtR
J. i' ~CCOUNT
l\.:W 1 PAYMENT
0
O~~~
CASH
'!~FROM .
~O~-
(9'CHECK
BAL DUE 0 CREDIT
CARD hMB ~:O~ l
- - - - 1182 a.~
16350
CHARITY SERVICES INC.
PH. 319-373 -1288
470 S 12TH ST.
MARION , IA 52302-4215 72-1167/739
"'7 DATE J...-I J-.J- ( ! (
:f~ J at/V? 5 D. __
1,- 0
DOLLARS l!..J =-'.. --.
Ie;;;:;: f~ M'
b j 5 0 III I: 0 7 j 9 l. l. b 7 b I : 7~ 507
Attorney General Tom Miller
515-281-5926
E-mail: consumer@at:.state.ia.us
DISCLOSURE FORM
PLEASE NOTE IMPORTANT OPEN RECORDS INFORMATION TOWARDS THE END OF THIS FORM.
2. Identify the charitable organization for which you will be soliciting money within the
State of Iowa during this registration period. (If more than one charitable organization,
file a separate Financial Information Disclosure form for each.)
C. Name, title, address and telephone number of the contact person(s) for the
charitable organization:
Page 1 of 5
4. Is the contract between the professional fund-raiser and the charitable organization on file
with the office of the Iowa Attorney General?
Yes No If no, attach a copy of the contract to this form. See Attached
6. If persons will be contacted by telephone and mail, how will the initial contact be made?
X Telephone Mail
7. If soliciting will be conducted by telephone, provide the following regarding the location
from which calls will be made. (If more than two locations, continue on a separate sheet):
Room!
a. Address of telephone room (Include street, city and state): 1006 Magnolia Parkway,
Waterloo, IA 50703
Room2 N/A
8. Will the solicitation campaign involve the sale of goods or services? Yes X No
Page 2 of 5
If yes, check one or more of the following that apply:
Other (describe)__:;-;:--;----:------:-:----;-----:--::--~__:_:____,~:___.__:;____;_7_:'"---
9. Will the professional fund-raiser collect donated funds directly from the donor(s) in person?
Yes XNo
If"No," describe how the funds will be collected. Funds will be collected from the
P.O. Box by the Program Chairperson.
1O. If contributions will be made by mail, identify all addresses to which the mail will be sent.
If any of the addresses are different than the addresses listed in response to question 2B,
please state: (1) whether the address is that of a post office box, commercial mail service,
bank of the professional fund-raiser or the address of a charitable organization; (2) the
P.O. Box 806, Cedar Falls, IA 50613
P.O. Box of the Charitable Organization.
identity of the individual or entity responsible for collecting mail containing contributions.
Charitable Organization Chairperson
11. State which of the following has the authority to withdraw the funds from any banking
account (check all that apply):
12. State whether contributions to the charitable organization are tax deductible:
Yes X No
13. ~ an a~hed sheet, describe the charitable program for which the solicitation campaign is
bemg earned out.
Page 3 of 5
AGREEMENT
This Agreement made and entered into this ;.:;- day of /7'l4rtc./~ , -i9-t2/1 ,by and
between CJW, Inc., herein called "Company" and the Cedar Falls Police Association herein called "Sponsor'
WITNESSETH
For and in consideration of the mutual covenants, agreements and promises herein made, the parties agree that:
1. Sponsor engages the services of Company and its affiliates for the promotion of the Fund Raising Project and, or
production of a (an) Booster Sticker Drive and Shop with a CoP® Program , herein called "Project", promoted" in
the name of Sponsor and in connection therewith Sponsor allows, grants and extends to Company and its affiliates, the
use of its good name, good will and cooperation.
2. Sponsor will pay to Company for its services hereunder, the amount equal to twenty-five percent (25%) of all gross
monies collected from the project. Such monies shall be paid each week out of monies the project collected.
3. Sponsor will open a separate checking account, herein called "Project Account" designated as the parties may agree, in
. bank located in Cedar Falls, IA . All receipts from the Project shall be deposited in the Project Account.
Withdrawals from the Project Account shall be made on checks signed by an authorized representative or Sponsor.
Sponsor agrees to authorize the bank to send copy of each monthly statement on the account to Company. In the event
the bank will not send monthly statement to the Company then Sponsor agrees to furnish one to Company within five (5)
days after having received the same. Sponsor further agrees to continue such statements to Company for a period of
thirty (30) days after the project.
4. All expenses incurred in the Project shall be paid from the Project Account, except as herein noted to reduce project
costs. The sponsor will assist in any way required by the Company in arranging for the auditorium, if a show is produced,
and also will arrange office space suitable for the use of an Advance Promotions Representative of the Company: further,
the Sponsor shall arrange for the installation of telephones in said space for the use and promotion of the project.
Expenses shall include all telephone costs, carding telephone book, computer and data processing and any and all other
expenses incurred in the promotion of the Fund Raising Project with the understanQing that the carding shall become the
permanent property of the Company. If the project account is not sufficient to pay an expenses, the Company will
promptly pay any deficiency. Company agrees to indemnify and hold Sponsor harmless from any financial liability of loss
whatever kind in connection with the Fund RaiSing Project.
5. If the project account is not sufficient to pay all expenses, the Company will promptly pay any deficiency. Company
agrees to indemnify and hold Sponsor harmless from any financial liability of loss whatever kind in connection with the
6. local or State licenses or permits, if any, the auditorium, in the case of a show, and/or other expenses may be
contracted for in other party's name, if this will serve as a reduction of costs, and upon prior agreement of both parties.
7. The Company will furnish the services of an affiliate coordinator for the soliciting of public support as may be deemed
advisable. The promotional coordinator is to be paid for his services, expenses and the cost of administration of himself
and for sales personnel from the Project Account. The payments for these expenses shall be made weekly based upon
the oolleCti()rf or-donatioriswliichhave been deposited in the Project Account. lit is further understood by and between
Company and Sponsor that the promotional coordinator is an independent contractor who shall be working on a
commission basis and shall receive for his compensation for the work he does a sum equal to forty percent (40%) of the
weekly collections made by said coordinator and that out of this should be paid the aforementioned expenses incurred by
the coordinator. Company shall indicate to the Sponsor the portion of the forty percent (40%) to be paid to the personnel
assistant and public relations person who are assisting in the project. For a period of two (2) years from the last day of
telephone solicitation, the Sponsor agrees not to employ the affiliated Promotional Coordinator referred by the Company,
or any other CJW, Inc. employees or affiliates, directly or indirectly, for any purpose comparable to those services
provided by the same under the terms of this agreement, without first obtaining prior written consent of the Company.
Said consent may be withheld in the sole discretion of the Company.
8. All work shall be handled in a dignified and businesslike manner in the name of the Sponsor, with due regard for the
reputation and standing of the Sponsor.
9. Company, at their option will or (will not), sell advertising for and publish a program book for the project This program
book may contain a listing of all businesses and/or residents who pay monies for the purpose of advertising their name
and/or businesses in the program book. Proceeds from the program book will be considered as part of the project
account, as well as, the expenses attributed to the program book.
b) 75% of all net profits from project which net profits shall be derived by deducting from all monies received after
all expenses, which expenses shall include but not be limited to costs of project, costs of solicitation, Company's
costs and taxes.
11 . A settlement of all sales and outstanding bills shall be completed within forty-five (45) days after the last day of the
telephone solicitation. After settlement of all sales and outstanding bills, the amount of money remaining in the account
guaranteed to Sponsor under this Agreement shall be recognized to Sponsor's account.
12. In the event of any adverse publicity hindering or damaging the project or if project is stopped against the will of the
Company, the Company shall not be liable for any guarantee set forth in this agreement.
13. Company will estimate the length of the solicitation, however, Company reserves the right to work up to the day of the
even in thos-e tnstances where there is a scheduled spectal event.
14. Until after the completion of the Project, and at least 90 days before the starting solicitation in this Project, Sponsor
will not conduct nor permit to be conducted, any other promotional or fund raiSing activities in its name such as may
interfere with the fund raiSing project as contemplated herein.
15. Both parties represent that they have full authority to enter into this Agreement and that execution of its terms will not
violate any other agreement by-laws, regulation or any other obligations of either party hereto, to any third parties, any
governmental or regulatory agency.
16. The Agreement shall continue for a term of one (1) year.
17. It is understood by and between the Company and Sponsor that this contract is not binding upon Company until
Signed by Edward J. Wiza, 111 President of CJW INC.
IN WITNESS WHEREOF, the parties have set their hands this It;; day of (!lftrs~i r 2 Olf
COMPANY: SPONSOR
~ : ~-:r)(r¢5
State of Iowa
Department of Justice
Consumer Protection Division
Hoover Building
Des Moines, IA 50319
Enclosed you will find a completed Charitable Financial Infonnation Disclosure Fonn
and a copy of signed contract between CJW, Inc. (the Professional Fund-Raising
Company), and the Cedar Falls Police Association, Cedar Falls, Iowa (the Charitable
Organizati on).
If you have any questions in reference to this matter, please do not hesitate to contact me.
Sincerely,
.~~~
Licensing Director
LASlknc
Enclosure:
515-281-5926
E-mail: cOllsumer@>ag.state.ia.us
DISCLOSURE FORM
PLEASE NOTE IMPORTANT OPEN RECORDS INFORMATION TOWARDS THE END OF THIS FORM.
2. Identify the charitable organization for which you will be soliciting money within the
State of Iowa during this registration period. (If more than one charitable organization,
file a separate Financial Information Disclosure form for each.)
IOWA ASSOCIATION OF CHIEFS OF POLICE AND PEACE OFFICERS
A. Name:_____________________________________________________
C. Name, title, address and telephone number of the contact person(s) for the
charitable organization:
TERRY DEHMLOW, SECRETARY-TREASURER; SAME ADDRESS AND TELEPHONE # AS ABOVE
Page 1 of 5
3. Beginning and ending solicitation dates 7/1/07 tlrrough 6/30/10 .
FINANCIAL INFORMATION HEREIN INCLUDED FOR CALENDAR 2009
4. Is the contract between the professional fund-raiser and the charitable organization on file
with the office of the Iowa Attorney General?
6. ~II be contacted by telephone and mail, how will the initial contact be made?
'~Mail
7. If soliciting will be conducted by telephone, provide the following regarding the location
from which calls will be made. (If more than two locations, continue on a separate sheet):
Room 1
. SAFETY SERVICES LLC
a. Address of telephone room (Include street, city and state): ..
750 TRANSFER ROAD, #20, SAINT PAUL, MN 55114
JARROD BIFULK-CARLSON
Room 2
8. Will the solicitation campaign involve the sale of goods or services? Yes
Page 2 of 5
If yes, check one or more of the following that apply:
Yes@
If "No," describe how the funds will be collected. _ _ _ _ _ _ _ _ _ _ _ _ _ _ __
H~/'-
10. If contributions will be made by mail, identify all addresses to which the mail will be sent
If any of the addresses are different than the addresses listed in response to question 2B,
please state: (1) whether the address is that of a post office box, commercial mail service,
bank of the professional fund-raiser or the address of a charitable organization; (2) the
identity of the individual or entity responsible for collecting mail containing contributions .
2463 BEAVER AVE. PMB 324, DES MOINES, IA 50310
1L State which of the following has the authority to withdraw the funds from any banking
account (check all that apply) :
-
Charitable Organization Both or either
12. State whether contributions to the charitable organization are tax deductible:
Yes~
13 . On an attached sheet, describe the charitable program for which the solicitation campaign is
being carried out. SPONSORSHIPS SUPPORT THE ASSOCIATION, ITS MEMBER
SERVICES, ACTIVITIES, AND COMMUNITY CONCERNS.
Page 3 of 5
FINANCIAL INFORMATION
State the following information and indicate the applicable time period and dates (either the last
completed fiscal year or the previous twelve months) :
§. 169,796.50
b. Itemize the source(s), and dollar amounts per source, of all funds collected on
behalf of the charitable organization: (contributions or donations; payments for
tickets to events, government grants, private charities, foundations , etc .):
Sponsorships $ 169,796.50
Commissions $ 108,080.40
Miscellaneous §. 277.67
(3) State the total dollar amount billed to the charitable organization by the
professional commercial fund-raiser and itemize each such billing by purpose and
amount:
Total ~ 29,790.90
Page 4 of 5
Note: All information and documentation provided as part of this registration, including this
form are public records and all or some may be open to public inspection pursuant to the
Iowa public records law, Iowa Code chapter 22, and the Iowa Attorney General's
Administrati ve Rules relating to public records, 61 lAC chapter 2.
Note: Any changes or additions to the information provided in this notice must be reported
immediately.
SIGNATURE:
State of Minnesota
------)
County of Hennepin
---=------- )) ss .
J. Michael Callan .
I, , belllg first duly sworn on oath, depose and state that I am a
managing agent of the professional fund-raiser; that I have read the contents of this Charitable
Organization Financial Disclosure Form; that I know the contents thereof; and that each
~-----
. 1 3~1 6
Subscnbed and sworn to before me on J
----------------------
Page 5 of 5
Attorney General Tom Miller
515-281-5926
E-mail: consumcr@.ag.state.ia.us
Please notice that the registration requirement is only for professional commercial fund
raisers as defined in Iowa Code Chapter 13e. Charitable oreanizations as defined in this
Chapter are not required to register.
Professional commercial fund-raisers must also complete the attached form, "Charitable
Organization Financial Information Disclosure Form," for EACH charity for which you
raise funds.
1. Name of Professional Commercial Fund-raiser, including any d/ b/a and trade names:
2. Address and telephone number of each office, chapter, branch or affiliate. Indicate the principal
place of business:
763-559-4000
,.
,..t'I
. r<e.:~'~"-'
""v
C(~~),. .... ~\
-J-
.(" , 'J ) . '"~~
" ,. , " ,
". ~~~
't\\ ',"\)
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.... \
~
." «~
,\"
,\
0
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\ ) .,
J. Form of business LIMITED LIABILITY COMPANY
(Individual, Partnership, Business Corporation, Nonprofit Corporation, etc.)
5. Full name, title, address and telephone number of each officer, director, partner or managing
agent of the professional commercial fund-raiser:
ATTACHED
6. Name, address, telephone number and title of the following person(s) for the professiona l
commercial fund-raiser:
Same as #2
b. The person(s) responsible for the day-to-day operations of the professional commercial fund
raiser:
same as 6a
c. The person(s) who directs and controls the activities of the professional commercial fund
raiser:
attached
d. The person(s) responsible for custody of the professional commercial fund-raiser's records:
same as 6a
e. The person(s) responsible for custody of all funds raised by the professional commercial fund
raiser:
same as 6a
-2
f. All persons managing or supervising fund-raising activities in or from Iowa:
N/ A
7. Has the professional fund-raiser or any of the persons listed in response to Numbers 5 or 6 ever
been a party to any litigation, criminal or civil, involving claims of theft, fraud, unfair or
deceptive trade practices, conversion, mismanagement of funds, breach of fiduciary duty, or any
other claim involving alleged dishonesty?
DYes ~o If yes, attach detailed explanation as to agency involved, date, court, claim and
disposition. Attach copies of all complaints, petitions, settlement agreements, plea agreements,
assurances, consent judgments, final judgments, convictions, and/or other agreements or orders
resolving the matter.
8. Name, address and telephone number of the registered agent for service of process in Iowa:
N/ A
10. Has the professional fund-raiser's right to solicit funds ever been denied , suspended, revoked or
enjoined by any state or by any court, or are there any such proceedings pending?
I I. Has the professional fund-raiser been the subject of a legal, administrative, or other proceeding
regarding any sol icitation or registration as a sol icitor or fund-raiser? If so, state the date,
location and nature of each such proceeding and the outcome of the proceeding.
ATTACHED
12. Does the professional fund-raiser have custody of or access to contributions from a solicitation at
any time?
~Yes DNo
13. Does registrant anticipate that any of the services it will provide to charitable organizations will
be provided by another entity under a subcontractor arrangement?
lXYes DNo If yes, please identify the charity and the subcontractor below: (Attach a
list ifmore room is needed .)
-3
Charity Subcontractor Name & Address
Iowa Assoc~at~on of Ch~efs Safety Services, LLc, 750 Transfer Road,
of Police and Peace Officers Saint Paul, MN 55114
Is registrant's contract with subcontractor filed with the office of the Iowa Attorney General?
14. Complete a Financial Information Disclosure form for each charitable organization for which you
will be soliciting money in or from Iowa.
Note: If additional contracts are entered into after the filing of this registration statement, submit a copy
of the new contract at that time.
Note: All information and documentation provided as part of this registration, including this form are
public records and all or some may be open to public inspection pursuant to the Iowa public
records law, Iowa Code chapter 22, and the Iowa Attorney General's Administrative Rules
relating to publ ic records, 61 lAC chapter 2.
SIGNATURE
I hereby certify that I am authorized to sign this Registration and that the information provided is
true and complete to the best of my knowledge.
T;tj~~
~,
~ature
State of Minnesota
County of Hennepin
-4
(Seal)
, Minnesota
5
~ cgm,TiuioQ, EWirfs 1n~ry.,,31cl:?22
-5
Attachment to registration renewal for Community Safety, LLC
5.
Member Companies of Community Safety, LLC
MNT, Inc., 13120 County Road 6, Minneapolis, MN 55441
North American Guardian, Inc., 12100 West Marion Lane #6202 Minnetonka, MN 55305
Officers
J. Michael Callan, PresidenUSecretaryrrreasurer, 13120 County Road 6, Minneapolis, MN 55441 :
763/559-4000
763/559-4000
6 (c)
J. Michael Callan, PresidenUSecretary/Treasurer, 13120 County Road 6, Minneapolis, MN 55441:
763/559-4000
763/559-4000
11.
Community Safety, LLC, consented to entry of an administrative order, dated April 12,2005, issued by the
secretary of state of Georgia regarding certain registration procedures and other matters. The order was a
compromise settlement of a disputed claim and did not constitute an admission of wrongdoing by
Community Safety, LLC.
Community Safety, LLC, consented to entry of an assurance, dated August 26,2008, in a proceeding by
the state of Minnesota regarding certain solicitation procedures and other matters. The assurance was a
compromise resolution of a disputed claim and did not constitute an admission of wrongdoing.
Attorney General Tom 1\1iJ1er
515-281-5926
E-mail: consumer@ag.state.ia.us
2, Please type or carefully prillt your responses. Answer all questions fully and cOITectly.
3, Return this formes) with copies of contract(s), if applicable and the Professional Commercial
PLEASE NOTE IMPORTANT OPEN RECORDS INFORMATION TOWARDS THE END OF THIS FORM.
1. Name of Professional Fund-Raiser: CoM. tj E...T rn A1l K.E-T/IJG (SA OU-f\ XI\) C .
2, ldentify the charitable organization for which you will be soliciting money within the
State oflowa during this registration period. (If more than one charitable organization,
file a separate Financial Information Disclosure form for each.)
charitable orgullization:
Page 1 of 5
3. Beginning ami ending solicitation dates 3-15-D& through .3-14-15.
4. Is the contract between the professional funcl-raiser anel the charitable organization on file
with the office oftbe Iowa Atromey Generaj"
6.
7. If soliciting will be conducted by telephone, provide the following regarding the location
fr0111 which calls will be made. (lfmore than two locations, continue on a separate sheet):
Room 1
a. Address of telephone ro0111 (Include street, city and state): ;.:11'1 STOWe.. Ai) eNLLE..
ro t-D foB.\> Q~ 915"01
b. All telephone number(s)from which solicitations are made: 5 L! \ -134- - 01 S Co S-
c. Name(s) of manager(s) and/or supervisor(s) of the room: saC K eN t:>&.\ '" A-T ,
VP of QPE.&A-TLcNS
Room 2
~{A
b. All telephone number(s)from which solicitations are made: _ _ _ _ __ _ __ _ _
8. Will the solicitation campaign involve the sale of goods or services? yeG
Page 2 of 5
If yes, check one or more of the following thaI apply :
Yes ~
If"No," describe how the fund s will be collected. A LL t=-l.LN~S 7/CoNTR. \BLLTlONS
ME- 5 E.NT d)IRr.<C;JLY ]D CL\.E.,t-.,JT·
10. If contributions will be made by mail, identify all addresses to which the mail will be sent.
If any of the addresses are different than the addresses listed in response to question 2B,
please state: (I) whether the address is that of a post office box, commercial mail service,
bank of the professional fund-raiser or the address ofa charitable organization ; (2) the
identity of the individual or entity responsible for collecting mail containing contributions.
J 1. State which of the following has the authority to withdraw the funds from any banking
account (check all that apply):
12. Stale whether contributions to the charitable organization are tax deductible:
Yes No
13. On an attached sheet, describe the charitable program for which the solicitation campaign is
being carried out.
Page 3 of 5
FINANCIAL INFORMA nON
State the following information and indicate the applicable time period and dates (either the last
completed fiscal year or the previous twelve months):
b. Itemize the source(s), and dollar amounts per source, of all funds collected on
behalf of the chari table organization: (contributions or donations; payments for
tickets to events, government grants, private charities, foundations, etc.):
c. Itemize how the professional commercial fund-raiser expended the funds: tL~
(1) Total given to charitable organization #~8 J 1'i:J . .3 I
(2) Total not given to charitable organization but expended on behalf of the
charitable organization: Itemize by dollar amount based on the following and any
other applicable categories: salaries/commissions/compensation; rent/mortgage;
transportation; professional services (attorneys, accountants, etc.);
advertising/promotion, etc.:
NlA.
(3) State the total dollar amount billed to the charitable organization by the
professional commercial fund-raiser and itemize each such billing by purpose and
amount:
Page 4 of 5
PROGRAM COSTS
CLIENT IPR
Note: Any changes or additions to the information provided in this notice must be reported
immediately.
SIGNATURE:
State of oRf.Cro,.J )
) ss.
County of 3AcK50,J )
I, BRu.CF to. Hol.l.6H ,being first duly sworn on oath, depose and state that I am a
managing agent of the professional fund-raiser; that I have read the contents of this Charitable
Organization Financial Disclosure Form; that I know the contents thereof; and that each
136~
Subscribed and sworn to before me on SfP'(f.tn.8e.R ~8
J
f),r;oq.
•
OFFICIAL SEAL
ARLENE DICKINSON
NOTARY PUBLlC·OREGON
Page 5 of 5
Attorney General Tom Miller
515-281-5926
E-mail: consumer@a2.state.ia.us
Please notice that the registration requirement is only for professional commercial fund
raisers as defined in Iowa Code Chapter l3e. Charitable oreanizations as defined in this
Chapter are not required to register.
Professional commercial fund-raisers must also complete the attached form, "Charitable
Organization Financial Information Disclosure Form," for EACH charity for which you
raise funds.
I. Name of Professional Commercial Fund-raiser, including any d/b/a and trade names:
2. Address and telephone number of each office, chapter, branch or affiliate. Indicate the principal
place of business:
a~ i\\3\ :1?j
1
Ej
3. Form of business {!oi<-POR....A-'LO ~
(Individual, Partnership, Business Corporation, Nonprofit Corporation, etc.)
6. Name, address, telephone number and title of the following person(s) for the professional
commercial fund-raiser:
d. The person(s) responsible for custody of the professional commercial fund-raiser's records:
raiser:
8R.H Ct... G. f.\-oLLE:,\-\ ~OTE-". Cnl'h. i\J Er /Y14-R KE.TI Ai? GRowJ "DOES /001
ftA1.e CH.!SWOq of" ANY C LIE-NT Fu. !\JOS . Al.-L Eu.-tJDS /florJTR.II3LA'TlONS
J J~
PrR..£ 5f10T D/I2&TL-Y WittE C.L.IE.rJt· \'IS
~··?i';. \
-2- ""\ \ \j't\t\ ('" \\
'J:> - ~~\
C'\C\ \ · S..
.\'-, . \\6 .,~
("~.\ ,. ( \ ..... tJ
v /
.. '\ \\
\ \"
......
.'
COMNET
'-1:' Ml: ~ I I~IG ~
"C 'jC. Ji'
A-n-A-Ch-rYl ~T ft S
ComNet Marketing Group, Inc.
Company Officers
Executive
Vice President Bob Bailey 260 S. Oregon
Jacksonville OR 97530
Vice President of
Operations Jack Endrikat 4130 Cherry Lane
Medford OR 97504
f. All persons managing or supervising fund-raising activities in or from Iowa:
~
7. Has the professional fund-raiser or any of the persons listed in response to Numbers 5 or 6 ever
been a party to any litigation, criminal or civil, involving claims of theft, fraud, unfair or
deceptive trade practices, conversion, mismanagement of funds, breach of fiduciary duty, or any
other claim involving alleged dishonesty?
DYes ~ If yes, attach detailed explanation as to agency involved, date, court, claim and
disposition. Attach copies of all complaints, petitions, settlement agreements, plea agreements,
assurances, consent judgments, final judgments, convictions, and/or other agreements or orders
resolving the matter.
8. Name, address and telephone number of the registered agent for service of process in Iowa:
II. Has the professional fund-raiser been the subject of a legal, administrative, or other proceeding
regarding any solicitation or registration as a solicitor or fund-raiser? If so, state the date,
location and nature of each such proceeding and the outcome of the proceeding.
1>.)/&
12. Does the professional fund-raiser have custody of or access to contributions from a solicitation at
any time?
DYes L
13. Does registrant anticipate that any of the services it will provide to charitable organizations will
be provided by another entity under a subcontractor arrangement?
DYes ~IfyeS, please identify the charity and the subcontractor below: (Attach a
list if more room is needed.)
-3
A~c t\- yy\ E/\Ji tt: q P'() I 0 f2..-
Alabama Illinois
Office of Attorney General Office of the Attorney General
Consumer Affairs Section Charitable Compliance Section
11 S Union Street 100 W Randolph, 3rd Floor
Montgomery AL 36130 Chicago IL 60601
Alaska Indiana
Office of Attorney General 302 W Washington St
Department of Law 5th Floor
1031 West 4th Ave., Suite 200 Indianapolis IN 46204
Anchorage AK
Arizona Iowa
Corporations Division Office of Attorney General
Arizona Corporation Commission Consumer Protection Division
1300 W Washington 1305 E Walnut
Phoeniz AZ.. 85007-2929 Des Moines IA 50319
Arkansas Massachusetts
Office of the Attorney General Office of the Attorney General
323 Center Street Suite 200 Div. of Public Charities
Little Rock AR 72201-2610 One Ashburton Place
Boston MA 02108-1698
California Michigan
Office of the Attorney General Dept. of Attorney General
Registry of Charitable Trusts Charitable Trust Section
POBOX 903447 POBOX 30214
Sacramento CA 94203-4470 Lansing MI 48909
Connecticut Minnesota
Dept. of Consumer Protection Office of the Attorney General
Public Charities Unit Charities Unit
55 Elm Street Suite 1200, NCL Tower
Hartford CT 06106 445 Minnestoa Street
St Paul MN 55101-2130
Florida
Dept. of Ag. & Consumer Services Pennsylvania
2nd Floor, Mayo Building Department of State
Tallahassee FL 32399-0800 Bureau of Charitable Organizations
POBOX 8723
Georgia Harrisburg PA 17105
2 MartinLuther King Jr Dr
Suite 802 West Tower South Carolina
Atlanta GA 30334 Secretary of State
Public Charities Division
paje 2. o-f 2....
POBOX 11350
New Hampshire Columbia SC 29211
Department of State
Corp. Division South Dakota
State House Rm 204 500 East Capitol Avenue
107 N Main St Pierre SD 57501
Concord NH 03301-4989
North Carolina
Solicitation Licensing Branch Vermont
POBOX 29530 Office of the Attorney General
Raleigh NC 27626 109 State Street
Montpelier VT 05609-1001
North Dakota
Secretary of State Virginia
600 E Boulevard Ave., Dept 108 Dept. of Ag & Consumer Services
Bismarck ND 58505 POBOX 1163
Richmond VA 23218
Ohio
Attorney General Washington
Charitable Solicitation Division 801 Capitol Way S
101 E Town Street Olympia WA 98504
Columbus OH 43215-5148
West Virginia
Oregon Secretary of State
Dpeat of Justice Building 1 Suite 157-K
Charitable Activities Section Charleston WV 25305-0770
1515 SW Fifth Ave Suite 410
Portland OR 97201-5451
Charity Subcontractor Name & Address
Is registrant's contract with subcontractor filed with the office of the Iowa Attorney General?
14. Complete a Financial Information Disclosure form for each charitable organization for which you
will be soliciting money in or from Iowa.
Note: If additional contracts are entered into after the filing of this registration statement, submit a copy
of the new contract at that time.
Note: All information and documentation provided as part of this registration, including this form are
public records and all or some may be open to public inspection pursuant to the Iowa public
records law, Iowa Code chapter 22, and the Iowa Attorney General's Administrative Rules
relating to public records, 61 lAC chapter 2.
SIGNATURE
I hereby certify that I am authorized to sign this Registration and that the information provided is
true and complete to the best of my knowledge.
eR~1 DE-Wr
Titl73-~~
Signature
State of OB E.60~
County of ;::s&ct<..50~
Signed and sworn to (or affirmed) before me on 'J"A r-J v...A R Y J./. , S- 0 II (date) by
-4
(Seal)
?tJaJ aJzit~o ~4~
(Signature of Notary Public)
•• OFFICIAL SEAL
LILA ARLENE DICKINSON
NOTARY PUBLIC-OREGON
COMMISSION NO. 453311
MY COMMISSION EXPIRES NOVEMBER 04, 2014
My commission expires A,)O\l. -1.
•
~Q 14
-5
Attorney General Tom Miller
515-281-5926
E-mail: consumer@a2.state.ia.us
DISCLOSURE FORM
PLEASE NOTE IMPORTANT OPEN RECORDS INFORMATION TOWARDS THE END OF THIS FORM.
2. Identify the charitable organization for which you will be soliciting money within the
State of Iowa during this registration period. (Ifmore than one charitable organization,
file a separate Financial Information Disclosure form for each.)
Grimes, IA 50111
C. Name, title, address and telephone number of the contact person(s) for the
charitable organization:
Page 1 of 5
3. Beginning and ending solicitation dates 7/112007 through 6130/2011
4. Is the contract between the professional fund-raiser and the charitable organization on file
with the office of the Iowa Attorney General?
IX\YeGo !fno, attach a copy of the contract to this form.
s. Soliciting will be conducted by (Check one or more that apply):
6. Ifpersons
Telephon X
tIl ~ c~l!~cted
ailU
by telephone and mail, how will the initial contact be made?
7. If soliciting will be conducted by telephone, provide the following regarding the location
from which caUs will be made. (If more than two locations, continue on a separate sheet):
Room 1
a. Address of telephone room (Include street, city and state): _ _ _ _ _ _ _ _ _ __
Please refer to attached list of Phone Rooms.
Room 2
a. Address of telephone room (Include street, city and state): _ _ _ _ _ _ _ _ _ __
8. Will the solicitation campaign invo]ve the sale of goods or services? YefX~o[]
Page 2 of 5
If yes, check one or more of the following that apply:
Ye~oD
If "No," describe how the funds will be collected._ _ _ _ _ _ _ _ _ _ _ _ _ __
10. If contributions will be made by mail, identifY all addresses to which the mail will be sent.
If any of the addresses are different than the addresses listed in response to question 2B,
please state: (1) whether the address is that of a post office box, commercial mail service,
bank of the professional fund~raiser or the address of a charitable organization; (2) the
identity of the individual or entity responsible for collecting mail containing contributions.
See attachment.
11. State which of the following has the authority to withdraw the funds from any banking
account (check all that apply):
D
Professional fund-raiSejXbharitable OrganizatioDoth or eitherD
12. State whether contributions to the charitable organization are tax deductible:
YesD No~
13. On an attached sheet, describe the charitable program for which the solicitation campaign is
being carried out.
Page 3 of 5
FINANCIAL INFORMATION
State the following infonnation and indicate the applicable time period and dates (either the last
completed fiscal year or the previous twelve months): 7/1/08 _6/30/09
b. Itemize the source(s), and dollar amounts per source, of all funds collected on
behalf of the charitable organization: (contributions or donations; payments for
tickets to events, government grants, private charities, foundations, etc.):
sale of magazine subscription
(2) Total not given to charitable organization but expended on behalf of the
charitable organization: Itemize by dollar amount based on the following and any
other applicable categories: salaries/commissions/compensation; rent/mortgage;
transportation; professional services (attorneys, accountants, etc.);
advertising/promotion, etc.:
(3) State the total do]]ar amount billed to the charitable organization by the
professional commercial fund-raiser and itemize each such billing by purpose and
amount:
Page 4 of 5
Note: AlJ information and documentation provided as part of this registration, including this
form are public records and all or some may be open to public inspection pursuant to the
Iowa public records law, Iowa Code chapter 22, and the Iowa Attorney General's
Administrative Rules relating to public records, 61 lAC chapter 2.
Note: Any changes or additions to the information provided in this notice must be reported
immediately.
SIGNATURE:
State of New Jersey
------)
County of Bergen ) ss.
-----)
I, Noreen Kaminski , being first duly sworn on oath, depose and state that I am a
managing agent of the professional fund~raiser; that I have read the contents of this Charitable
Organization Financial Disclosure Fonn; that I know the contents thereof; and that each
fLM~t
~ o~
JANINE E. DIAZ
Page 5 of 5
PHONE ROOM LOCATIONS & DIRECTORS
Form Attachments
METHOD OF COLLECTION
Bank of America
Cranford, NJ 07016
1305 E. Walnut
If you have any questions, please contact our attorney Shaun Petersen at Mac Murray,
Petersen & Shuster LLP at (614) 939-9955 or myself regarding this matter.
Sincerely,
~
Noreen Kaminski
Vice President, Government Affairs
Enc!.
., ,'" , " .'. ~-,,,,,, ". " ,.~ - "~,,
~ S:\ Hd SZ 33:\ U\
\... \, _._) I .,\ •-:~'
.......; \...
) ~i--' ~...:J
FINANCIAL INFORMATION
State the following infonnation and indicate the applicable time period and dates (either the last
completed fiscal year or the previous twelve months): 11/1/08-10/31/09
b. Itemize the source(s), and dollar amounts per source, of all funds collected on
behalf of the charitable organization: (contributions or donations; payments for
tickets to events, government grants, private charities, foundations, etc.):
charitable fundraising through magazine sales and direct donations.
(2) Total not given to charitable organization but expended on behalf of the
charitable organization: Itemize by dollar amount based on the following and any
other applicable categories: salaries/commissions/compensation; rent/mortgage;
transportation; professional services (attorneys, accountants, etc.);
advertising/promotion, etc.:
(3) State the total dollar amount billed to the charitable organization by the
professional commercial fund-raiser and itemize each such billing by purpose and
amount:
$.00
Page 4 of 5
Attorney General Tom Miller
515-281-5926
E-mail: consumer@ag.state.ia.us
PLEASE NOTE IMPORTANT OPEN RECORDS INFORMATION TOWARDS THE END OF THIS FORM.
2. Identify the charitable organization for which you will be soliciting money within the
State of Iowa during this registration period. (If more than one charitable organization,
file a separate Financial Information Disclosure form for each.)
A. Name: Special Olympics Iowa (Charitable fundraising through magazine sales and direct donations)
C. Name, title, address and telephone number of the contact person(s) for the
charitable organization:
Page 1 of 5
3. Beginning and ending solicitation dates 11/1/2009 through 10/31/2011
4. Is the contract between the professional fund-raiser and the charitable organization on file
with the office of the Iowa Attorney General?
6. "If persons will be contacted by telephone and mail, how will the initial contact be made?
r· r
Telephone J1ail
7. If soliciting will be conducted by telephone, provide the following regarding the location
from which calls will be made. (If more than two locations, continue on a separate sheet):
Room 1
Room 2
8. Will the solicitation campaign involve the sale of goods or services? [R]Y es No
Page 2 of 5
If yes, check one or more of the following that apply:
Yes No X
If "No," describe how the funds will be collected. Each bill we send to customers will specify payment to
Special Olympics Iowa, PO Box 42065, Des Moines, IA 50323-0981. The US Postal Service forwards payments
received from the PO Box 42065 to us for processing at our head quarters 960 Macarthur Blvd ., Mahwah, NJ 07495.
All payments received by us from the US Postal Service shall be deposited into a bank account in the name of Special
Olympics Iowa.
IO. If contributions will be made by mail, identify all addresses to which the mail will be sent.
If any of the addresses are di fferent than the addresses listed in response to question 2B,
please state: (1) whether the address is that of a post office box, commercial mail service,
bank of the professional fund-raiser or the address of a charitable organization; (2) the
identity of the individual or entity responsible for collecting mail containing contributions.
(1) Each bill we send to customers will specify payment to Special Olympics Iowa. PO Box 42065. Des Moines. IA
50323-0981. (2) The US Postal Service forwards payments received from PO Box 42065 to us for processing at
our head quarters 960 Macarthur Blvd., Mahwah, NJ 07495
11. State which of the following has the authority to withdraw the funds from any banking
account (check all that apply):
12. State whether contributions to the charitable organization are tax deductible:
[IYes No
13. On an attached sheet, describe the charitable program for which the solicitation campaign is
being canied out.
Page 3 of 5
FINANCIAL INFORMATION
State the following information and indicate the applicable time period and dates (either the last
completed fiscal year or the previous twelve months): 11/1/2009-10/31/2010
$528,308.10
b. Itemize the source(s), and dollar amounts per source, of all funds collected on
behalf of the charitable organization: (contributions or donations; payments for
tickets to events, government grants, private charities, foundations, etc.):
Charitable fundraising through magazine sales and direct donations
(2) Total not given to charitable organization but expended on behalf of the
charitable organization: Itemize by dollar amount based on the following and any
other applicable categories: salaries/commissions/compensation; rent/mortgage;
transportation; professional services (attorneys, accountants, etc.);
advertising/promotion, etc.:
(3) State the total dollar amount billed to the charitable organization by the
professional commercial fund-raiser and itemize each such billing by purpose and
amount:
$ .00
Page 4 of 5
Note: All infonnation and documentation provided as part of this registration, including this
fonn are public records and all or some may be open to public inspection pursuant to the
Iowa public records law, Iowa Code chapter 22, and the Iowa Attorney General's
Administrative Rules relating to public records, 61 lAC chapter 2.
Note: Any changes or additions to the information provided in this notice must be reported
immediately.
SIGNATURE:
I, Noreen Kaminski , being first duly sworn on oath, depose and state that I am a
managing agent of the professional fund-raiser; that I have read the contents of this Charitable
Organization Financial Disclosure Fonn; that I know the contents thereof; and that each
~&2I ;d~
12/23/2010
Subscribed and sworn to before me on ---------------------
JnvflU'_2j7~
.
ty~tary Public
JAN\NE E. DlAl
~Olt«( pU8UC Ck NEW JERSEY15
tJr'I comm\s5lOO ExpireS 9112/20
Page 5 of 5
~HONE ROOM LOCATIONS & DIRECTORS
515-281-5926
E-mail: consumer@D2.state.ia.us
Please notice that the registration requirement is only for professional commercial fund
raisers as defined in Iowa Code Chapter 13C. Charitable or2anizations as defined in this
Chapter are not required to register.
Professional commercial fund-raisers must also complete the attached form, "Charitable
Organization Financial Information Disclosure Form," for EACH charity for which you
raise funds.
1. Name of Professional Commercial Fund-raiser, including any d/b/a and trade names:
2. Address and telephone number of each office, chapter, branch or affiliate. Indicate the principal
place of business:
Mahwah, NJ 07495
201-327-0200
~
'tlJ \{C\St-I.O·:',
-1- \. 'J)1.IJl'i~
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.t-.\\j ,,0\ -' \
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3. Fonn of business~C~o~lp~o:.:..r~at:::lo~n::-.._ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ __
(Individual, Partnership. Business Corporation, Nonprofit Corporation, etc.)
5. Full name, title, address and telephone number of each officer, director, partner or managing
agent of the professional commercial fund-raiser:
6. Name, address, telephone number and title of the following person(s) for the professional
commercial fund-raiser:
Noreen Kaminski
c. The person(s) who directs and controls the activities of the professional commercial fund
raiser:
d. The person(s) responsible for custody of the professional commercial fund-raiser's records:
Same as ft.
e. The person(s) responsible for custody of all funds raised by the professional commercial fund
raiser:
Same liS a.
-2
f. All persons managing or supervising fund-raising activities in or from Iowa:
Please refer to attached list of Phone Room Directors.
7. Has the professional fund-raiser or any of the persons listed in response to Numbers 5 or 6 ever
been a party to any litigation, criminal or civil, involving claims of theft, fraud, unfair or
deceptive trade practices, conversion, mismanagement of funds, breach offtduciary duty, or any
other claim involving alleged dishonesty? .
DYes tIi:INo If yes, attach detailed explanation as to agency involved, date, court, claim and
disposition. Attach copies of all complaints, petitions, settlement agreements, plea agreements,
assurances, consent judgments, final judgments, convictions, and/or other agreements or orders
resolving the matter.
8. Name, address and telephone number of the registered agent for service of process in Iowa:
¥A
9. Is the professional fund-raiser registered to solicit funds in other states?
10. Has the professional fund-raiser's right to solicit funds ever been denied, suspended, revoked or
enjoined by any state or by any court, or are there any such proceedings pending?
II. Has the professional fund-raiser been the subject of a legal, administrative, or other proceeding
regarding any solicitation or registration as a solicitor or fund-raiser? If so, state the date,
location and nature of each such proceeding and the outcome of the proceeding.
N/A
12. Does the professional fund-raiser have custody of or access to contributions from a solicitation at
any time?
DYes ~No
13. Does registrant anticipate that any of the services it will provide to charitable organizations will
be provided by another entity under a subcontractor arrangement?
DYes KINo If yes, please identify the charity and the subcontractor below: (Attach a
list if more room is needed.)
-3
Charity Subcontractor Name & Address
Is registrant's contract with subcontractor filed with the office of the Iowa Attorney General?
14. Complete a Financial Information Disclosure form for each charitable organization for which you
will be soliciting money in or from Iowa.
Note: If additional contracts are entered into after the filing of this registration statement, submit a copy
of the new contract at that time.
Note: All information and documentation provided as part of this registration, including this form are
public records and all or some may be open to public inspection pursuant to the Iowa public
records law, Iowa Code chapter 22, and the Iowa Attorney General's Administrative Rules
relating to public records, 61 lAC chapter 2.
SIGNATURE
I hereby certify that I am authorized to sign this Registration and that the information provided is
true and complete to the best of my knowledge.
Vice President
~;z;;;«; Signature
County of Bergen
-------
Signed and sworn to (or affirmed) before me on 12/23/2010 (date) by
-4
~ i~eal) .
-5
D1ALAMERICA MARKETING, INC. FEIN:
Children's Wish Foundation International, Inc., 8615 Roswell Road, Atlanta, GA 30350
CampaignPeriod: 02-01-2007 to 12-31-2008, 01-01-2009 to 12-31-2010 (Co-venture Magazine Subscription Sales)
Mothers
.
Against Drunk Driving, 5] 1 East John Carpenter Freeway,
. Suite 700, Irving, TX 75062
Campaign Period: 07-01-2010 to 06-30-20 12;(Business-to-Business fundraising)
Mothers Against Drunk Driving, 511 East John Carpenter Freeway, Suite 700, Irving, TX 75062
The National Cbildren'sCancer Society, Inc., One South Memorial Drive, Ste. 800, St. Louis; M0631 02
Kcniucky: Consumer Protection Division, 1024 Capital Center Drive, Frankfort. KY 40601
Louisiana: Consumer Protection Section, 1885 N. 3rd Street, Baton Rouge. LA 70802
Maine: Office of Licensing and Regulation, 122 Northern Ave, Gardiner, ME 04345
. Maine: Office of Licensing and Regulation, 122 Northern Ave, Gardiner. ME 04345
Michigan: Chariiable Trust Section, 690 Law Bldg, 525 W. Ottawa Street, Lansing, MI 489\ 3
or
Minnesota: Office the Attorn~y General/Charities, 445 Minnesota Street, Suito 1200, St Paul, MN 5510 I
Missouri: Mis.souri Attorney General, 207 W. High Street, Jefferson City, MO 65102
. Mississippi:Offtce Of The Secretary Of State, 700 Nol1h Street, Jackson, MS 39202-3024
Liii~Oln. Nebraska: • 555 South 10th Street, Lincoln, N I 68508
North Carolina: Secretary Of~tat(l, 2 Soulh Salisbury Street, Raleigh. NC 2760 \
Nol1hDlikota: Secretary Of Siaie. 600 East Boulevard, Bismarck, ND 58505
New Hampshire: Cnaritable TrUsts Unit, 33 Capitol Street, Concord, NH 03301
New.Jers.ey: Office Of Consumer Protection, 124 Halsey Street. 7th Floor, Newark, NJ 07101
New York: CharitieS Bureau, 120 Broadway. New York. NY 10271
co.iuinbus, Ohio: Charitable Solicitations License Section, 750 Piedmont Road. Columbus, 01 43224
Ohio: Charituble Foundation Section, 150 E. Gay Steet, 23rd Floor, Columbus, OH 43215
Okiiih(mia: Oklahoma Secretary Of State, 2300 N. Lincoln Blvd., Room 101. Oklahoma City, OK 73105
Oregon: Dopilltmeill OfJustice, 1515 SW 5th Avenue, Suite 410, Portland, OR 97201
Pennsylvarila:Burcau Of Charitable Organizations. 207 North Office Building, Harrisburg, PA 17120
Rhodelshind:Charitable Organization Section, 1511 Pontiac Ave, Bldg 69- \, Cranston, RI 02920
South Caiolirui; Office OfThe Attorney General. 1205 Pendleton Street, Ste 525, ColumbIa, SC 2920 I
Souih Dakota: Office afThe AttorneY General, 500 East Capitol, Pierre, SD 57501
TonncisScc:Division Of Charitable SolicitatIons, 312 Rooft L. Parks Avenue, 8th Floor, Nashville, TN 37243
Uiah:nlvlsion QfConsumer Protection, 160 East 300 South, Salt Lake City, UT 45804
Vir8irtia:' Office of Consumer Affairs, 102 Governor Street, Lower Level. Richmond, VA 23219
Washington: Charitable Solicitation Division, 80 I Capitol Way South, Olympia, WA 98504
WisOOilsin:Dcpt Of Regulation & Licensing, 1400 E. Washington Avenue, Madison, WI 53702
West Virginia: Office Of The Secretary Of State, 1900 Kanawha Blvd., East, Charleston, WV 25305
DIALAMERICA MARKETING, INC.
Officers And Directors List
David J. Aboussleman, Vice President Carole Gowrie, Asst. Secretary Justin Piccione, Vice President
960 Macarthur Blvd 960 Macarthur Blvd 960 Macarthur Blvd
Mahwah, NJ 07495 USA Mahwah, NJ 07495 USA Mahwah, NJ 07495 USA
Michael Bardwell, Vice President Dina loppolo, Vice President Darlene Picha, Vice President
960 Macarthur Blvd 960 Macarthur Blvd 960 Macarthur Blvd
Mahwah, NJ 07495 USA Mahwah, NJ 07495 USA Mahwah, NJ 07495 USA
Larry Blumenstyk, Vice President Thomas Januski, Vice President John Redinger, Vice President
960 Macarthur Blvd 960 Macarthur Blvd 960 Macarthur Blvd
Mahwah, NJ 07495 USA Mahwah, NJ 07495 USA Mahwah, NJ 07495 USA
Deirdre Booth, Vice President Noreen Kaminski, Vice President Judith Reifler, Vice President
960 Macarthur Blvd 960 Macarthur Blvd 960 Macarthur Blvd
Mahwah, NJ 07495 USA Mahwah, NJ 07495 USA Mahwah, NJ 07495 USA
Arthur W. Conway, President/CEO/Director Randl Kaplan, Vice President Eileen Renowden, Vice President
960 Macarthur Blvd 960 Macarthur Blvd 960 Macarthur Blvd
Mahwah, NJ 07495 USA Mahwah, NJ 07495 USA Mahwah, NJ 07495 USA
Chris Conway, Sr. Vice President WIlliam A. Kirchner, Vice Robert Schultz, Vice President
960 Macarthur Blvd Presldent/Controller/Asst. Sec 960 Macarthur Blvd
960 Macarthur Blvd
Mahwah, NJ 07495 USA Mahwah, NJ 07495 USA
Mahwah, NJ 07495 USA
9/16/20102:04:00 PM Page 1 of 1
·.
PHONE ROOM LOCATIONS & DIRECTORS
Suite 303
Jacksonville, FL 32225
Phone: 904-724-0411
Westlake, OH 44145
Phone: 440-835-5967
Fairlawn, OH 44333
Phone: 330-836-5293
Suite 170
Ocala, FL 34474
Phone: 352-854-8860
Suite 150
Columbus, OH 43235
Phone: 614-985-3005
Special Olympics Iowa
Now, Mr (s)___, you are familiar with Special Olympics, right? (Listen
& Respond naturally)...
They provide year round sports training and competition for children
and adults with intellectual disabilities. I don't know if you've had the
opportunity to see the events yourself...these athletes are so inspiring!
We really believe their participation builds confidence and self-esteem,
which is great isn't it? (Get buy-in!) I agree! That's why we are
working to help get more athletes involved...
And those are just to name a few ... Which ONE can I tell you more
about to help Special Olympics Iowa this year?
08-03 10:30 » 2094912091 P 4/5
An accurate report or
the work product wtll be provided to Iowa AA staff throughout the project.
Subsequent revisions or amendments to this agreement mus~ be submitted In writing and signed by
authortzed representatives of University of Iowa Alumni Association md DtrectLtne Technologies, Inc.
Schedule
$25,000.00 Lapsed Qata: Delivery 11101/10
$ 0.00 Tentative Lapsed Call Start Date 12/01110
$ 0.00 Lapsed Call Completion 12131110
$ 0.00 Renewed Datil DeHvel,. 01103/11
$ 0.00 Tentative Renewal Call Start Date 02/01111
$ 0.00 RentWIIl Cllll CompletIon 02128111
Contract Conditiotls
I. PricIng Is for this contract only, and remiJlns valtd for 60 days from date of issue. 121 interest will be
charged on accounts 30 days PiI$t due.
II. Data must be supplied In the requtred format.
1II. Prospect datI! includes accurate addresses and telephone numbers, as described in the proposal
assocIated with this contrnct, to enSure anticipated performance. Should drla qu!lity, or the
distribution of records among prospect segments, v~ry Significantly from protections assOciated with
this contract, revised prolections wlll be produced by DirectLtne lor low! AA written approval. Any
lind Ill! guilrimtees wlll be confirmed, or set liside, on the basts of such mutually agreed revisions.
IV. All lists utiliud throughout this program remain the properly of Untversity of Iowa Alumni
Association and wtllnot be used for uny purpose other than those outlined. The Mme and address of
each person pledging to loin, together wtth the date and amount of the commitment, Shall be the
sole exclustve property or the charitable trust with no rights to transfer, sell, rent, or otherwise CaUse
to be used by the originating chzrrihble trust.
V. low.! AA will provide data, caller trainmg materials, letter text (tf any), $ignature samples, and
necess6Iry approvals to DTl staff 30 days prIor to call d1lte or proiect delays will occur.
V!. Customlz.!tion requests must be mutually a:greed and specjfjed at the time of diltll delivery.
VII. Iowa AA agTees that DTl will be its sole provider of telemarketing solicitation services for the
contrClct dUflltion.
VII!. Should Iowll AA eontract for reminder servtce Iowa AA st:tff is required to report payments via: DTI's
secure client web site a minimum of every .seven calenda:r days; ffdlure to do so will constitute a
breach of contrClct and void !dl guarantees. Payment reports must include anpayments received
includIng checks, electronic fund transfers, and credit card payments processed as a result of credit
cards accepted and reported to Iowa AA at the time of the telephone pledge.
IX. DlrectLtne Technologies, Inc. agrees to maintain PCL DSS certtfication as requIred of University of
Iowa Alumni Association by UnIversity of low! Alumni ~sodatton's merchant card network{s.)
X. 100" of gross contributions wtll be deposited by University of Iowa Alumni AsSOciation to account(s)
within its control. At no time will funds or assets he collected, c:rged, processea, handled, managed,
received, deposited, Or controlled by DirectLine Technologies, Inc.
XL University of Iowa Alumni Association w1ll to receive a minimum 100% of gross income generated as
II result of this solicitation.
Xli_ The montes raised as Il result of thi9 telephone solicitation will be used for providing services lind
benefits to alumni and students of the University of lowlI.
XIIl. DlrectLine Technologies, Inc. will provide Untverslty of Iowa Alumni Association with all
COl'\stltuent requests to be placed on University of Iown Alumni Association's do-not· cOlli Hst at
rroject conclusIon. University of lowa: Alumni Associatton bears full responsibility for transferring
'these do-not-call requests to internal databases, and matntatntng tnternal do-not-clrl1lists, ilS may be
rt'qulred by state or federlrllaw.
XTV_ Any cell phone number prOVided to DlrectLjneT~chnologtes fol' the purposes stilted In this contract
are provided wtth the express consent of tne tndtvId~lal who provided the cell phone number as their
COt tact number.
XV. DirectUne Technologies Inc. guarantees that In no case wtll fees exceed the total amount of pledged
tl:1come.
If this contract meets with the approval of University of lower Alumnt Associlltion's lIuthoriied
representatives, please sign below and return one copy to DirectLine TechnolOgies, Inc.
/
~ =- ~ -.J.2
~J1nor, P~stdent~ CEO
date C@).:1 Mr. Vince Nelson, PreSIdent
-,i'o.lill,t,
515-281-5926
E-mail: consumer@ag.state.ia.us
PI~ase notice that !he registration requirement is only for professional commercial fund
raisers as defined III Iowa Code Chapter 13C. Charitable or2 anizations as defined in this
Chapter are not required to register.
Professional commercial fund-raisers must also complete the attached form, "Charitable
Organization Financial Information Disclosure Form," for EACH charity for which you
raise funds.
I. Name of Professional Commercial Fund-raiser, including any d/b/a and trade names:
2. Address and telephone number of each office, chapter, branch or affiliate. Indicate the principal
place of business:
1600 N. CARPENTER ROAD, BUX;. D, IDDES'ro, CA 95351-1145
(209) 491-2020
-1
,
:-,:'
f. A.ll persons managing or supervising fund-raising activities in or from Iowa:
N/A
7. Has the professional fund-raiser or any of the persons listed in response to Numbers 5 or 6 ever
been a party to any litigation, criminal or civil, involving claims of theft, fraud, unfair or
deceptive trade practices, conversion, mismanagement of funds, breach of fiduciary duty, or any
other claim involving alleged dishonesty?
DYes lXNo If yes, attach detailed explanation as to agency involved, date, court, claim and
disposition. Attach copies of all complaints, petitions, settlement agreements, plea agreements,
assurances, consent judgments, final judgments, convictions, and/or other agreements or orders
resolving the matter.
8. Name, address and telephone number of the registered agent for service of process in Iowa:
[XYes DNo If yes, attach a list of all other states. SEE ATTACHED
10. Has the professional fund-raiser's right to solicit funds ever been denied, suspended, revoked or
enjoined by any state or by any court, or are there any such proceedings pending?
11. Has the professional fund-raiser been the subject of a legal, administrative, or other proceeding
regarding any solicitation or registration as a solicitor or fund-raiser? Ifso, state the date,
location and nature of each such proceeding and the outcome of the proceeding.
NO
12. Does the professional fund-raiser have custody of or access to contributions from a solicitation at
any time?
DYes IE.No
13. Does registrant anticipate that any of the services it will provide to charitable organizations will
be provided by another entity under a subcontractor arrangement?
DYes ~No If yes, please identify the charity and the subcontractor below: (Attach a
list ifmore room is needed.)
-3
(Seal)
-5
Directline Technologies, Inc.
Item 5. Full name, title, address and telephone number of each officer, director, partner or managing agent of the
professional commercial fund-raiser:
i) Martha E. Connor, President/CEO (209) 491-2020
1600 N. Carpenter Road, Bldg. D, Modesto, CA 95351-1145
ii) Gary S. Connor, Secretary/CiO (209) 491-2020
1600 N. Carpenter Road, Bldg. D, Modesto, CA 95351-1145
iii) Michael P. Zagaris, Chairman of the Board (209) 491-2020
1120 Scenic Drive, Modesto, CA 95350
Item 9. list of States Registered as a Professional Fund-Raiser:
i) Alabama
ii) Alaska
iii) Arizona
iv) California
v) Colorado
vi) Connecticut
vii) Florida
viii) Georgia
ix) Illinois
X) Indiana
xi) Kansas
xii) Kentucky
xiii) Louisiana
xiv) Maine
xv) Maryland
xvi) Massachusetts
xvii) Michigan
xviii) Minnesota
xix) Mississippi
xx) Missouri
xxi) New Hampshire
xxii) New lersey
xxiii) New Yo rk
xxiv) North Carolina
xxv) Ohio
xxvi) Oklahoma
xxvii) Oregon
xxviii) Pennsylvania
xxix) Rhode Island
XXX) South Carolina
xxxi) Tennessee
xxxii) Utah
xxxiii) Virginia
xxxiv) Washington
XXXV) Wisconsin
Is registrant's contract with subcontractor filed with the office of the Iowa Attorney General?
14. Complete a Financial Information Disclosure form for each charitable organization for which you
will be soliciting money in or from Iowa. SEE ATI'ACHED
Note: If additional contracts are entered into after the filing of this registration statement, submit a copy
of the new contract at that time.
Note: All information and documentation provided as part of this registration, including this form are
public records and all or some may be open to public inspection pursuant to the Iowa public
records law, Iowa Code chapter 22, and the Iowa Attorney General's Administrative Rules
relating to public records, 61 lAC chapter 2.
SIGNATURE
I hereby certify that I am authorized to sign this Registration and that the information provided is
true and complete to the best of my knowledge.
12/13/10
Date_ _ _ _ _ _ _ _ _ _ _ _ _ __ MARTHA E. OONIDR
Name (Print)
PRESIDENT /CED
Title
/
SignatUre
State of CALIFORNIA
County of STANISLAUS
-4
mRPORA'l'ION
3. Fonn of business
---------------------------------------------------
(Individual, Partnership, Business Corporation, Nonprofit Corporation, etc.)
4. CALIFORNIA
Identify the state in which registrant is organized or incorporated______________
5. Full name, title, address and telephone number of each officer, director, partner or managing
agent of the professional commercial fund-raiser:
SEE ATl'ACHED
6. Name, address, telephone number and title of the following person(s) for the professional
commercial fund-raiser:
MARTHA E. mNOOR .
c. The person(s) who directs and controls the activities of the professional commercial fund
raiser:
MARTHA E. mNNOR
d. The person(s) responsible for custody of the professional commercial fund-raiser's records:
MARTHA E. mNOOR
e. The person(s) responsible for custody of all funds raised by the professional commercial fund
raiser:
rur APPLICABLE - AT ro TIME 00 WE mLL'ECl', CAGE, PROCESS, HANDLE,
MANAGE, RECEIVE OR mNIROL ANY FUNDS OR ASSETS SOLICITED FOR
CHARITABLE PURPOSES.
-2
Attorney General Tom Miller
515-281-5926
E-mail: consumer@ag.state.ia.us
PLEASE NOTE IMPORTANT OPEN RECORDS INFORMATION TOWARDS THE END OF THIS FORM.
2. Identify the charitable organization for which you will be soliciting money within the
State ofIowa during this registration period. (If more than one charitable organization,
file a separate Financial Information Disclosure form for each.)
Page I of 5
ZOU CDJMJMIUU~h'IHs Ells·} Au4eS, Ii'{, S71J/I, 'J7S'- 2~If-BJJ/)3
3. Beginning and ending solicitation d a t e s . through IJw.p I.
4. Is the contract between the professional fund-raiser and the charitable organization on file
with the office of the Iowa Attorney General?
6. Ifpersons will be contacted by telephone and mail, how will the initial contact be made?
orelephone DMaiJ
7. If soliciting will be conducted by telephone, provide the following regarding the location
from which calls will be made. (If more than two locations, continue on a separate sheet):
Room 1
RushaAwad
Room 2 NIA
a. Address of telephone room (Include street, city and state):_ _ _ _ _ _ _ _ _ __
8. Will the solicitation campaign involve the sale of goods or services? DYes DNo NIA
Page 2 of 5
If yes, check one or more of the following that apply: NIA
9. Will the professional fund-raiser collect donated funds directly from the donor(s) in person?
DYes ~No
10. If contributions will be made by mail, identify all addresses to which the mail will be sent.
If any of the addresses are different than the addresses listed in response to question 2B,
please state : (1) whether the address is that of a post office box, commercial mail service,
bank of the professional fund-raiser or the address of a charitable organization; (2) the
identity of the individual or entity responsible for collecting mail containing contributions.
11. State which of the following has the authority to withdraw the funds from any banking
account (check all that apply):
12. State whether contributions to the charitable organization are tax deductible:
DYes DNo
13. On an attached sheet, describe the charitable program for which the solicitation campaign is
being carried out.
Page 3 of 5
FINANCIAL INFORMATION
State the following infonnation and indicate the applicable time period and dates (either the last
completed fiscal year or the previous twelve months):
organization.
b. Itemize the source(s), and dollar amounts per source, ofal! funds collected on
behalf of the charitable organization: (contributions or donations; payments for
tickets to events, government grants, private charities, foundations, etc.):
PBS does not collect money. All monies go directly to the charitable
organization.
(2) Total not given to charitable organization but expended on behalf of the
charitable organization: Itemize by dollar amount based on the following and any
other applicable categories: salaries/commissions/compensation; rent/mortgage;
transportation; professional services (attorneys, accountants, etc.);
advertising/promotion, etc.:
NIA- PBS does not have custody or control ofthe fund raised.
(3) State the total dollar amount billed to the charitable organization by the
professional commercial fund-raiser and itemize each such billing by purpose and
amount:
Page 4 of 5
Note: All infonnation and documentation provided as part of this registration, including this
fonn are public records and all or some may be open to public inspection pursuant to the
Iowa public records law, Iowa Code chapter 22, and the Iowa Attorney General's
Administrative Rules relating to public records, 61 lAC chapter 2.
Note: Any changes or additions to the information provided in this notice must be reported
immediately.
SIGNATURE:
State of JI/du~ )
:I::1It.~
) ss.
County of )
I, .~ ~", ~eing first duly sworn on oath, depose and state that I am a
managing agent of the professional fund-raiser; that I have read the contents of this Charitable
Organization Financial Disclosure Fonn; that I know the contents thereof; and that each
~~
Subscribed and sworn to before me on 1,- -/{ ~ JO
----------------------
Nom!rkric 11f/J
- ~'CHAA: J..DI<J.I, RAFALSKJ
NOTARV PJ8~ 2 · S'A;£ 0< MICHIGAN
COut-:rv C< INGHAt;'
._~m~s.:siQ(l Exptr.. May !3.:.~
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Page 5 of 5
C l - \?. Co L 7 - 09
PROFESSIONAL SERVICES CONTRACTUAL AGREEME~~T
THIS PROFESSIONAL SERVICES CONTRACTUAL AGREEMENT (hereafter Agreement) is made by and between
IOWA STATE UNIVERSITY (also referred to as "University" or "ISU"), and Phone Bank Svst ms Inc. (also referred to as
·'Contractor). Should the total compensation under this Agreement including reimbursables bp projected to exceed
S2,000 this Agreement is not valid until signed by the ISU Purchasing Department.
FOR CONSIDERATION of the mutual promises and covenants contained in this Agreement,
agree as follo ws:
t* University and Contractor
1. SCOPE OF WORK
A. PROFESSIONAL SERVICES: Contractor agrees to provide the following services (hereafter also referred to
as Professional Services):
The outbound calling program includes, but is not limited to , the following functions:
• Conduct monthly calling programs to solicit fundraising donations, up to 500 names per month
• Script development
• Campaign and real-time reporting
e Testing
• Training
B. PERFORMANCE MONITORING: The Contractor shall produce the following written reports or take the
specified actions necessary to fu lfill this Agreement (collectively referred to as "deliverables") by the dates
indicated:
All written reports required under this Agreement are to be delivered to ----,W:.-,·...:e..:.:n...:d.Ly...:R'7-'id:.:o:..:u:.:t_.,--_ _ __ __ _
the University 'S Project Manager or Principal Investigator, in accordance with the schedule above.
2. PERIOD OF PERFORMANCE This Agreement, unless earlier tem1inated according to the provisions contained
herein, shaJl cover the period of January 1, 2011 through June 30, 2011. The Agreement may be extended annuaJly
for up to 4 additional one year periods, by written murual consent of both parries.
A. The University agrees to pay Contractor for the Professional Services referenced above in accordance with the
rates and provisions set forth below:
NCOA research at $.0 I per record found that is 18-47 months old, with a $250 ,Or' minimum. Records which
are 48 months or older are billed at S.02 per record wIth a $400.00 mmll11Um.
Maiiing of reminder ietters at S3.70 pius actuai postage coSt (currentiy 50.44 per r tamp) per decision to do
so. This would only be done at the request ofIPR.
C. University agrees to reimburse Contractor in accordance with the rates currently established and approved for
Iowa State University (11 tm:': \ \\V \ \ .:1[, .i :h l~lte. c dil j V i! h i"iac (:\lllntin l.; : n C W [l'~l vei DOi ic ies, i1 ll1l==nCWn1r3ir"lre" .) (Lower
maximum rates may be established by the University Project Manager or Principal Ji1vestigator.)
1. Meals while in travel status and on site in Iowa shall be reimbursed up to $;31 per day (B "" $6; L = $9;
D = $16). Alcoholic beverages are not a reimbursable expense. Tips for meaJs are allowable for no
more than 15% of the food bill and the total cost of the tip and meal may not exceed the maximum
allowed for meal reimbursement. Must submit receipts for reimbursement.
2. Lodging expenses shall be reimbursed at reasonable rates up to $75.00 plus taxes consistent with the
University's travel policy. Must submit receipts for reimbursement.
3. Mileage reimbursement, if company or personal vehicle is authorized, shalt not exceed $0.39/mile.
4. Necessary car rental, if authorized by Project Manager, shall not exceed the subcompact rate. Must
submit receipt for reimbursement.
University will only reimburse Contractor for related travel and temporary living expenses upon receipt of
a list of itemized allowable expenses. Expense reimbursement requests shall be sJbmitted within 60 days of the
date incurred. Universiry will not reimburse Conu-actor for dry cleaning, laundry, valet expenses, and charges for
enrel1ainment expenses.
Contractor agrees to be responsible for all travel and temporary living expenses inc~rred by Contractor personnel ,
which exceed rates consistent with the University travel policy or any lower maximums established by the Project
Manager or Principal Investigator.
D. Payment will be made in one of two ways . Contractor may either submit a fin~l bill upon completion of the
task(s) defined above or submit a bill at stated intervals for work completed at timeiof billing, no more frequentl y
than monthly. At its discretion, the University may hold monthly payments l.1ntil sufficient value has been
received, from its perspective, before releasing one or more monthly payment~. All bills must include the
compensation rate and the number of hour or days of service if other than fixed fe~. The University reser ves the
right to withhold ten percent (10%) from each payment until the University agrees :t he project has been completed
to its satisfaction.
Please send invoices referencing the assigned purchase order number to the following address:
Iowa State University I
Purchasing Payables
3617 Administrative Services Building
Ames, IA 50011-3617
B. The added cost or cost reduction to the University resulting from a change in the Ag;reement shall be detennined
in one or more of the following ways: '
i. by muruai acceptance of a lump sum properiy itemized and supported by sufficiept data to permit evaiuatiol1,
2. by unit prices stated in the Agreement or subsequently agreed upon ,
3. by cost to be determined in a manner agreed upon by the parties , or
4. by a murually acceptable fixed or percentage fee.
e. It shall be the responsibility of the Contractor before proceeding with any chang¢ in scope to verify that the
change has been properly authorized on behalf of the university . No additional cHarges or any other change in
the Agreement will be allowed unless previously authorized in writing by the U1 iversity, with the applicable
compensation method and maximum authorized additional sum stated.
A. Contractor agrees to hold in truSt and confidence any confidential and proprietary ipfom1ation or data relating to
university business and shall not disseminate or disclose such confidential infom1ation to any individual or entity,
except Contractor's employees or subcontractors perfom1ing services hereunder (who shall be under a duty of
confidentiality), and any other individuals specifically permitted in each instance by the University.
B. With respect to any confidential information, the ContractOr's obligations of nondisclosure set forth above shall
continue to apply to such information for as long after this Agreement expires or tem1inates, as such inforn1ation
remains confidential.
C. An item will not be considered confidential information or a trade secret of the Uniyersity if it is:
I. In the public domain prior to disclosure to Contractor or subsequent to such di~closure but through no fault of
Contractor; or
2. Obtained from a third party not subject to a duty of confidentiality.
I
D. Contractor agrees that any computer programs, software, documentation, cOlPyrightable work, discoveries,
inventions, improvements, or other deliverables (hereinafter "Work") develope~ by Contractor solely, or with
others, reSUlting from the performance of Contractor's responsibilities and obligatipns pursuant to this Agreement
are the property of the University. If for any reason the Work would not be cqnsidered a work made for hire
under applicable law, for the consideration included herein, Contractor does herfbY sell, assign, and transfer to
the University, its successors and assigns, the entire right, ritle and interest in aneJi to the Work, including but not
limited to exclusive rights to reproduce, distribute, prepare derivative works, qisplay and perform the Work.
Contractor agrees to provide whatever assistance is necessary for the Univer~ity to preserve its commercial
interest including, but not limited to, the filing of patent and copyright protectioil. This provision shall survive
expiration and termination of this Agreement.
6. TERMIl\ATlON
A. The University may tenninate this Agreement, upon ten (10) days written not~fication, without penalty to the
University, should the Contractor fail to carry out its provisions or fail to prqvide services acceptable to the
University.
B.
With the murual agreement of the parties, upon receipt and acceptance of not less than fifteen (15) days written
notice, this Agreement may be terminated without penalty to either party.
c. Upon tennination or Agreement expiration, the University shall pay Contractor: all services fees and authorized
reimbursable expenses due ~ontractor for services already provided or expens9s incurred through the effective
date of Agreement tenmnatJon, prOVIded such expenses are reasonable, doc4 me nred, and represent servIces
requested by the University. Upon termination, Contractor shall turn over to the university all Work performed
to date.
purported change in the terms of this agreement, shall be binding upon either of the parties!unless in writing and signed
by authorized representatives of both.
HAVING READ AND UNDERSTOOD THIS AGREEMENT, the parties have signed this Agreement and caused it to be
executed in duplicate, with each of the copies to be considered an original agreement. Contractor certifies that none of the
following represent paid employees of ISU or any other Regent instirution: Contractor, Contractor's spouse and ContractOr's
minor child. In addition, Contractor cenifies that no individual, their spouse or minor child, who is a paid employee of ISU or
any other Regent institution, is also a partner in Contractor's firm or owns five percent (5%) or more of Contractor ' s corporate
stock. See Section 24 herein for additional infomlation if a conflict of interest exists.
DATE:
r ,
1•/ /011
I
/ S;
"
BY:Y-#~Y\..d
// . I
D ~ I -1---.
TITLE: i
iV/C; fl# ~
(l:./
1A'
J. f.// VV'
P'dncipatilwestigator
'-
DATE: I/Ztj;!/ BY ~
Purchasing Depanment
515-281-5926
E-mail: consumer@ag.state.ia.us
Please notice that the registration requirement is only for professional commercial fund
raisers as defined in Iowa Code Chapter 13e. Charitable or2anizations as defined in this
Chapter are not required to register.
Professional commercial fund-raisers must also complete the attached form, "Charitable
Organization Financial Information Disclosure Form," for EACH charity for which you
raise funds.
I. Name of Professional Commercial Fund-raiser, including any d/b/a and trade names:
Phone Bank Systems, Inc.
2. Address and telephone number of each office, chapter, branch or affiliate. Indicate the principal
place of business:
517/332-1500
-1
3. Form of business For profit corporation
(Individual, Partnership, Business Corporation, Nonprofit Corporation, etc.)
4. Identl·fy testate
h . w h·IC h
In ·
registrant . . d· d Michigan
IS organize or Incorporate _ _ _ _ _ _ __
5. Full name, title, address and telephone number of each officer, director, partner or managing
agent of the professional commercial fund-raiser:
Sarah Shaw - President - 4990 North wind Dr.,Ste. 235 East Lansing, MI 48823 517/332-1500
Rusha A wad - Vice President - 4990 North wind Dr.,Ste. 235 East Lansing, MI 48823 517/332-1500
6. Name, address, telephone number and title of the following person(s) for the professional
commercial fund-raiser:
Rusha Awad - 4990 North wind Dr.,Ste. 235 East Lansing, M1 48823 517/332-1500
Sarah Shaw - 4990 Northwind Dr.,Ste. 235 East Lansing, MI 48823 517/332-1500
c. The person(s) who directs and controls the activities of the professional commercial fund
raiser:
Sarah Shaw - 4990 North wind Dr.,Ste. 235 East Lansing, MI 48823 517/332-1500
Rusha Awad - 4990 North wind Dr.,Ste. 235 East Lansing, MI 48823 517/332-1500
d. The person(s) responsible for custody of the professional commercial fund-raiser's records:
Sarah Shaw - 4990 North wind Dr.,Ste. 235 East Lansing, MI 48823 517/332-1500
Rusha Awad - 4990 North wind Dr.,Ste. 235 East Lansing, MI 48823 517/332-1500
e. The person(s) responsible for custody of all funds raised by the professional commercial fund
raiser:
N/A - PBS does not have custody or controL ofthe funds raised by its
11On-proflt clients.
-2
f. All persons managing or supervising fund-raising activities in or from Iowa:
NIA
7. Has the professional fund-raiser or any of the persons listed in response to Numbers 5 or 6 ever
been a party to any litigation, criminal or civil, involving claims of theft, fraud, unfair or
deceptive trade practices, conversion, mismanagement of funds, breach of fiduciary duty, or any
other claim involving alleged dishonesty?
DYes tzINo If yes, attach detailed explanation as to agency involved, date, court, claim and
disposition. Attach copies of all complaints, petitions, settlement agreements, plea agreements,
assurances, consent judgments, final judgments, convictions, and/or other agreements or orders
resolving the matter.
8. Name, address and telephone number of the registered agent for service of process in Iowa:
NIA
10. Has the professional fund-raiser's right to solicit funds ever been denied, suspended, revoked or
enjoined by any state or by any court, or are there any such proceedings pending?
II. Has the professional fund-raiser been the subject of a legal, administrative, or other proceeding
regarding any solicitation or registration as a solicitor or fund-raiser? If so, state the date,
location and nature of each such proceeding and the outcome of the proceeding.
NIA
12. Does the professional fund-raiser have custody of or access to contributions from a solicitation at
any time?
DYes I2INo
13. Does registrant anticipate that any of the services it will provide to charitable organizations will
be provided by another entity under a subcontractor arrangement?
DYes I2INo If yes, please identify the charity and the subcontractor below: (Attach a
list ifmore room is needed.)
-3
Charity Subcontractor Name & Address
Is registrant's contract with subcontractor filed with the office of the Iowa Attorney General?
14. Complete a Financial Information Disclosure form for each charitable organization for which you
will be soliciting money in or from Iowa. Attached
Note: If additional contracts are entered into after the filing of this registration statement, submit a copy
of the new contract at that time.
Note: All information and documentation provided as part of this registration, including this form are
public records and all or some may be open to public inspection pursuant to the Iowa public
records law, Iowa Code chapter 22, and the Iowa Attorney General's Administrative Rules
relating to public records, 61 lAC chapter 2.
SIGNATURE
I hereby certify that I am authorized to sign this Registration and that the information provided is
true and complete to the best of my knowledge.
Py--.e,ste/tnt
nle ~2iltAA2
Signature
-4
(Seal)
(Signature of Notary Public)
~
.I / ....::-......_ ....... .
<-//2 -/~
My commission expires ____________
COIJt-;TY OF INGt-W
-5
.,.
515-281-5926
E-mail: consumer@a~.state.ia.us
DISCLOSURE FORM
PLEASE NOTE IMPORTANT OPEN RECORDS INFORMATION TOWARDS THE END OF THIS FORM.
2. Identify the charitable organization for which you will be soliciting money within the
State of Iowa during this registration period. (If more than one charitable organization,
file a separate Financial Information Disclosure form for each.)
IOWA STATE POLICE ASSOCIATION
A. Name:____________________________________________________ _
515-299-5320
C. Name, title, address and telephone number of the contact person(s) for the
charitable organization:
RICK HOST, TREASURER, SAME AS 'B', ABOVE
Page 1 of 5
3. Beginning and ending solicitation dates through _____'
ONGOING, information contained herein for calendar 2009
4. Is the contract between the professional fund-raiser and the charitable organization on file
with the office of the Iowa Attorney General?
7. If soliciting will be conducted by telephone, provide the following regarding the location
from which calls will be made. (If more than two locations, continue on a separate sheet):
Room I
Room 2
8. Will the so lieitation campai gn involve the sale of goods or services? Yes S
Page 2 of 5
If yes, check one or more of the following that apply:
Yes@
If"No," describe how the funds will be collected._m_a_1_'l_ _ _ _ _ _ _ _ _ _ _ __
10. If contributions will be made by mail, identify all addresses to which the mail will be sent.
If any of the addresses are different than the addresses listed in response to question 2B,
please state: (1) whether the address is that of a post office box, commercial mail service,
bank of the professional fund-raiser or the address of a charitable organization; (2) the
identity of the individual or entity responsible for collecting mail containing contributions.
8657 Douglas Ave, PMB 381
Urbandale, IA 50322
11. State which of the following has the authority to withdraw the funds from any banking
account (check all that apply):
12. State whether contributions to the charitable organization are tax deductible:
Yes
® 501(c)6
13. On an attached sheet, describe the charitable program for which the solicitation campaign is
being carried out.
Iowa State Police Association member services,
activities, programs and general fund. Public safety
Page 3 of 5
".
FINANCIAL INFORMATION
State the following infonnation and indicate the applicable time period and dates (either the last
completed fiscal year or the previous twelve months):
$ 263,813.30
b. Itemize the source(s), and dollar amounts per source, of all funds collected on
behalf of the charitable organization: (contributions or donations; payments for
tickets to events, government grants, private charities, foundations, etc.):
Sponsorships $ 263,813 . 30
(2) Total not given to charitable organization but expended on behalf of the
charitable organization: Itemize by dollar amount based on the following and any
other applicable categories: salaries/commissions/compensation; rent/mortgage;
transportation; professional services (attorneys, accountants, etc.);
advertising/promotion, etc.:
N / A
Page 4 of 5
Note: All information and documentation provided as part of this registration, including this
form are public records and all or some may be open to public inspection pursuant to the
Iowa public records law, Iowa Code chapter 22, and the Iowa Attorney General's
Administrative Rules relating to public records, 61 lAC chapter 2.
Note: Any changes or additions to the information provided in this notice must be reported
immediately.
SIGNATURE:
State of (Y\ ~ 1\'\e 'S<dt: )
) ss.
County of Rel\feC :f\ )
I, l.6obul- ( /J.. LLlb ? being first duly sworn on oath, depose and state that I am a
managing agent of the professional fund-raiser; that I have read the contents of this Charitable
Organization Financial Disclosure Form; that I know the contents thereof; and that each
~~
Subscribed and sworn to before me on a d obe, 1'1. d ol O
N~~ ft~
Page 5 of 5
.f" .r..
PROGRAM AGREEMENT
THIS AGREEMENT, made and entered into as of October 1, 2008, by and between PUBLIC
SAFETY COUNCIL, a limited liability partnership (hereinafter referred to as "PSC") and the lOW A STATE
POLICE ASSOCIA nON (hereinafter referred to as "Association"):
WHEREAS, Association desires to contract with PSC for purposes of communicating a program
service message and securing financial support from the general public (hereinafter referred to as the
"Program");
NOW, THEREFORE, in consideration of the mutual covenants and agreements herein contained, and
for other good and valuable consideration, the receipt and sufficiency of which is hereby acknowledged, the
parties hereby agree as follows:
1. Grant of Authority to Use Association Name. Association hereby grants PSC, subject to
terms, conditions and provisions hereof, the right during the term hereof to use its name in connection with
the procurement of sponsorships and related program service campaign as described in paragraph 3(a) below.
2. Acceptance and Acknowledgment. PSC hereby accepts the foregoing grant from Association
and agrees to perform the duties and undertakings imposed by this Agreement.
3. The Program.
(a) PSC shall create, develop and arrange for implementation of the Program. Progtatn
shall consist of telephone contacts to the general public requesting participation as a sponsor of Association.
Each paid sponsor shall be provided with a brochure, decal or similar item bearing Association's name to
evidence participation in Program. Program materials, including presentations, decals, letters, brochures or
other Program supplies will not be used without the prior notification and approval of Association. PSC
acknowledges that at no time shall Association have any responsibility for any costs or expenses incurred by
PSC for Program.
(b) PSC shall perform, contract for or otherwise arrange for implementation of Program as
provided under this Agreement PSC or any per-sons or entities performing services in connection with
Program shall not for any purpose be deemed the employees of Association.
1
"
.,,,' ,..
4. Term. This Agreement and the rights granted hereunder shall be for a term commencing
October 1, 2008 and ending November 30, 2011. Thereafter, the term of this Agreement shall be
automatically extended for additional terms of three (3) years each unless either party shall give the other 120
days written notice prior to the expiration of the then current tenn of its intention not to extend the
Agreement. Any renewal and extension hereof shall be subject to the undertakings and agreements herein
provided
5. Program Revenues.
(a) All Program revenues received shall be paid to the name of Association and shall be
received by PSC. Association hereby authorizes PSC to endorse in the name and on behalf of Association
any check, money order or other remittance paid with respect to Program sponsors. All such checks, money
orders or other remittances evidencing collected Program revenues shall be deposited by PSC on a weekly
basis into a separate bank account established for this purpose and maintained by PSC (the "Project
Account") .
(b) Throughout the term of this Agreement and any renewal tenus, PSC shall pay
Association sixteen percent (16%) of gross collected Program revenues. Such payments shall be made by
PSC on a weekly basis and shall be accompanied by a report showing total collected Program revenues for
the applicable weekly period.
(c) Upon payment to Association by PSC of the amounts specified in subparagraph (b) of
this paragraph 5, PSC shall be entitled to retain and withdraw from the Project Account the balance of
collected Program revenue as compensation for all its services provided herein.
6. Representations. Duties and Obligations of Association. Association hereby makes the following
representations and agree to perform the following duties and obligations as indicated:
(a) During the term hereof, Association and its Board of Directors shall recognize, endorse
and support Program and will do nothing during the term hereof which shall have an adverse effect upon
Program.
(b) Association understands and agrees that contractors secured by PSC shall be permitted
to contact prospective sponsors in all areas throughout Iowa.
(c) During the term of this Agreement and for a period of one full year following the
effective date of any termination or expiration thereof, Association agrees that it shall not, without the prior
written consent of PSC, either directly or indirectly employ, hire or otherwise retain, for the purpose of any
2
.:
other revenue-producing process, any person, corporation or finn which shall have previously been retained
by or through PSC to contact prospective sponsors.
(d) Association understands and agrees that all records and information relating to sponsors
shall be and shall remain the sole and exclusive property ofPSC and Association shall have no claim thereto.
The ownership and exclusive right to the information in these records is a material inducement to PSC in
entering this Agreement.
7. Cancellation. This Agreement shall be canceled and terminated upon the happening of any
of the following events:
(a) Expiration of the term hereof or any renewal term.
(b) In the event PSC determines that available revenue is not sufficient to make
continuation of this activity profitable for it, PSC shall have the right to cancel and terminate this Agreement
effective ninety (90) days following delivery to Association, personally, by certified mail or by documented
overnight delivery, of written notice of such cancellation.
(c) In the event that PSC shall be in breach of any of the terms and provisions of this
Agreement and shall not take affinnative action to correct the same within thirty (30) days following receipt
from Association of written notice of such breach, Association shall thereupon have the right to cancel and
tetminate this Agreement, by majority vote of its Board of Directors, upon delivery to PSC, personally, by
certified mail or by documented overnight delivery of sixty (60) days written notice of such cancellation.
Provided, however, that no such cancellation notice shall be given unless and until PSC shall have been
given the reasonable opportunity to meet with the Board of Directors of Association to discuss arty alleged
breach.
(d) Following notice of cancellation or termination, PSC shall continue to account for and
pay Association in the manner set forth in Paragraph 5 to the extent that such sponsor revenues are ultimately
collected by PSC.
8. Miscellaneous.
(a) It is understood and agreed and that this Agreement may be assigned at any time to any
other corporation, partnership or other entity in which management remains in the hands of the present
management of PSC, provided, however, that any other assignment shall not be made without the prior
written consent of Association, which consent shall not be unreasonably withheld.
3
,'.
(b) It is agreed and understood that PSC is an independent contractor and is not in any
manner the employee of Association nor has Association any interest in the business of PSC, except to the
extent set forth in this Agreement.
(c) Reference is made to a certain Royalty and License Agreement, entered into as of
January 15, 1996, between PSC and Association, as renewed and amended by a certain Renewal and
Extension Agreement, dated as of March 17, 1999 (such agreements being hereafter collectively referred to
as the "Prior Program Agreement"). The parties agree that the Prior Program Agreement shall be deemed
tenninated effective as of the close of business September 30, 2008 and that neither party shall have any
further obligations with respect thereto. The parties further agree that all sponsorship revenue collected from
and after October 1, 2008 shall be deemed Program revenue under this Agreement and shall not constitute
sponsor revenue under the Prior Program Agreement.
(d) This Agreement shall be binding upon and inure to the benefit of the parties hereto and
their respective successors, legal representatives and assigns.
(e) This Agreement constitutes the entire agreement and understanding between the
parties with respect to the subject matter hereof, and there are no representations or warranties of any kind
except to the extent specifically set for herein.
(f) The undersigned were authorized to execute this Agreement on behalf of and as the free
act and deed of Association and of PSC and by their signatures hereon certify the grant of such authority by
Association and PSC, respectively.
IN WITNESS WHEREOF, the parties hereunto caused this Agreement to be executed as of the day
and year first above written
Accepted at 01 v'\fre'"'t1.~~;~
t vt)ri
4
?
515-281-5926
E-mail: consumer@ag.state.ia.us
DISCLOSURE FORM
PLEASE NOTE IMPORTANT OPEN RECORDS INFORMATION TOWARDS THE END OF THIS FORM.
2. Identify the charitable organization for which you will be soliciting money within the
State oflowa during this registration period. (If more than one charitable organization,
file a separate Financial Infonnation Disclosure fonn for each.)
IOWA STATE RESERVE LAW OFFICERS ASSOCIATION
A. Name:________________________________________________________
B. Address and telephone number of the charitable organization:
PO BOX 106, MARSHALLTOWN, IA 50158
641-753-3400
C. Name, title, address and telephone number of the contact person(s) for the
charitable organization:
DAN BRANDT, SECRETARY-TREASURER, SAME AS 'B', ABOVE
Page I of 5
3. · · an d en d'mg so1'"
Begmrung lCltatlOn d ates ONGOING th roug h _____.
financial information contained herein for calendar 2009
4. Is the contract between the professional fund-raiser and the charitable organization on file
with the office of the Iowa Attorney General?
6. If persons will be contacted by telephone and mail, how will the initial contact be made?
~eph~ Mail
7. If soliciting will be conducted by telephone, provide the following regarding the location
from which calls will be made. (If more than two locations, continue on a separate sheet):
Room I
Room 2
8. Will the solicitation campaign involve the sale of goods or services? Yes No
Page 2 of 5
If yes, check one or more of the following that apply:
yesCS)
If "No," describe how the funds will be collected. _ _ _ _ _ _ _ _ _ _ _ _ _ _ __
10. If contributions will be made by mail, identify all addresses to which the mail will be sent.
If any of the addresses are different than the addresses listed in response to question 2B,
please state: (1) whether the address is that of a post office box, commercial mail service,
bank of the professional fund-raiser or the address of a charitable organization; (2) the
identity of the individual or entity responsible for collecting mail containing contributions.
6750 Westown Parkway #200-224
11. State which of the following has the authority to withdraw the funds from any banking
account (check all that apply):
12. State whether contributions to the charitable organization are tax deductible:
Yes ~ SO/{G) 4
13. On an attached sheet, describe the charitable program for which the solicitation campaign is
being carried out.
Page 3 of 5
FINANCIAL INFORMATION
State the following information and indicate the applicable time period and dates (either the last
completed fiscal year or the previous twelve months) : 1/1/09 - 12/31/09
$ 97,265.39
b. Itemize the source(s), and dollar amounts per source, of all funds collected on
behalf of the charitable organization: (contributions or donations; payments for
tickets to events, government grants, private charities, foundations, etc.):
Sponsorships $ 97,265.39
(2) Total not given to charitable organization but expended on behalf of the
charitable organization: Itemize by dollar amount based on the following and any
other applicable categories: salaries/commissions/compensation; rent/mortgage;
transportation; professional services (attorneys, accountants, etc.);
advertising/promotion, etc.:
N L A
Page 4 of 5
Note: All information and documentation provided as part of this registration, including this
form are public records and all or some may be open to public inspection pursuant to the
Iowa public records law, Iowa Code chapter 22, and the Iowa Attorney General's
Administrative Rules relating to public records, 61 lAC chapter 2.
Note: Any changes or additions to the information provided in this notice must be reported
immediately.
SIGNATURE:
~
State of [\\ f\.(\es otz::' )
) ss.
County of {;-\e'fY'(?f )
I, eob l i t u.LlO (being first duly sworn on oath, depose and state that I am a
managing agent of the professional fund-raiser; that I have read the contents of this Charitable
Organization Financial Disclosure Form; that I know the contents thereof; and that each
C::522~2
Subscribed and sworn to before me on dc+b r jy. C)JIG,
.G.·"
,
, ,'
.lJ
MELODY A NAf'ltJE
Notary Public
Minnesota NO~f'; ~
~ S?m.Ti~iO!E~i,!s 1n&z.3~28J5
Page 5 of 5
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PROGRAM AGREEMENT
THIS AGREEMENT, made and entered into as of July 31,2002, by and between PUBLIC
SAFETY COUNCIL, LLP (hereinafter referred to as "PSC"), and the row A STATE RESERVE
LAW OFFICER'S ASSOCIA TJON, INC. (hereinafter referred to as "Association"):
WHEREAS, Association desires to contract with PSC for purposes pf communicating a
program service message and procuring Association sponsors (hereinafter referred to as the
"Program");
NOW, THEREFORE, in consideration of the mutual covenants and agreements herein
contained, and for other good and valuable consideration, the receipt and sufficiency of which is
hereby acknowledged, the parties hereby agree as follows:
1. Grant ofAuthority to Use Association Name. Association hereby grants PSC, subject
to the terms, conditions and provisions hereof, the exclusive right during the term hereof to use its
name in connection with Program including the procurement of sponsorships and related program
. .
service campatgn.
2. Acceptance and Acknowledgment. PSC hereby accepts the foregoing grant from
Association and agrees to perform the duties and undertakings imposed by this Agreement.
3. The Program.
(a) PSC shall create, develop format and arrange for implementation of the
Program. Program shall consist of telemarketing ·contacts to the general public requesting
participation as a sponsor of Association. Each paid sponsor shall be provided with a brochure,
sticker or similar item bearing Association's name to evidence participation in Program.
(b) PSC shall perform, contract for or otherwise arrange for implementation of
Program as provided under this Agreement. PSC or any persons or entities performing services in
connection with Program shall not for any purpose be deemed the agent.. or employees of
Association.
4. Term. This agreement and the rights granted hereunder shall be for a term of two (2)
years, commencing September I, 2002 and ending July 3 I, 2004. Thereafter, this Agreement shall
be automatically renewed and extended for additional terms of two (2) years each, unless either party
.-
shall give the other 120 days written notice prior to expiration of the then current term of its intention
not to renew and extend the Agreement Any renewal and extension hereof shall be subject to the
undertakings and agreements herein provided.
5. Program Revenues.
(a) All revenues from the procurement of Program sponsors shall be paid by
sponsors to the name of Association. As part of its agreement hereunder,. Association hereby
authorizes PSC to endorse in the name and on behal f of Association any check, money order or other
remittance paid with respect to Program sponsorships. PSC agrees that all such checks, money
orders or other remittances evidencing Program revenue shall be deposited by PSC directly into a
separate bank: account established for this purpose.
(b) Association shall be entitled to receive a payment from PSC in the amount
of fifteen percent (15%) of collected Program revenues. PSC agrees that such payments shall be
remitted to Association on a weekly basis. PSC shall be entitled to retain eighty-five percent (85%)
ofcollected Program revenues as compensation for its services hereunder and implementation ofthe
Program campaign.
6. Representations, Agreements and Obligations of Association. Association hereby
makes the following representations and agreements as indicated:
(a) During the term hereof, Association and its Board ofDirectors shall recognize
and endorse Program, and Association hereby grants PSC the sole and exclusive right to arrange for
contact of residences in Iowa on behalf of, or in the name of, Association. Association shall not
enter into any agreement with any individual, firm, corporation or organization during said term for
any fundraising activity that includes contact of Iowa residences on behalf of, or using the name, of
Association.
(b) Association will not nothing during the term hereof which shall have an
adverse effect upon Program and understands and agrees that contractors secured by PSC shall be
permitted to market Program in all areas throughout Iowa.
(c) Association understands and agrees that all records and infonnation relating
to sponsors shall be and shall remain the sole and exclusive property ofPSC and Association agrees
that it shall have no right or claim thereto.
(d) During the term of this Agreement and for a period of one full year following
the effective date of any termination or expiration thereof, Association agrees that it shall not,
without the prior written consent of PSC, either directly or indirectly employ, hire or otherwise
retain, for the purpose ofany other revenue producing process, any perSOll, corporation or firm which
shall have previously been retained by PSC to conduct Program hereunder.
7. Cancellation. This Agreement shall be canceled and terminated upon the happening
of any of the following events:
(a) Expiration of the term hereof or any renewal term.
(b) In the event PSC determines that available revenue is not sufficient to make
continuation of this activity profitable for it, PSC shall have the right to cancel and terminate this
Agreement effective ninety (90) days following delivery to Association, personally or by certified
mail, of written notice of such cancellation.
(c) In the event that PSC shall be in breach of any of the terms and provisions of
this Agreement and shall not take affirmative action to correct the same within thirty (30) days
following receipt from Association of written notice of such breach, Association shall thereupon
have the right to cancel and terminate this Agreement, by majority vote of its Board of Directors,
upon delivery, personally or by certified mail , of sixty (60) days written notice of such cancellation.
Provided, however, that no such cancellation notice shall be given unless and until PSC shall have
been given the rea'>onable opportunity to meet with the Board of Directors of Association to discuss
any alleged breach.
(d) Following notice ofcancellation or termination, PSC shall continue to account
for any pay Association any and all amounts in the manner set forth in paragraph 5 to the extent that
sponsorship revenues are ultimately collected by PSc.
8. Miscellaneous.
(a) It is agreed and understood that PSC is an independent contractor and is not
in any manner the employee or agent of Association nor has Association any interest in the business
of PSC, except to the extent set forth in this Agreement.
(b) It is further understood and agreed that th is Agreement may be assigned at any
time to any other corporation, partnership or other entity, in which management remains in the hands
3
.,
of the present management of PSC provided, however, that any other assignment shall not be made
\-vithout the prior written consent of Association, which consent shall not be unreasonably withheld .
(c) This Agreement constitutes the entire agreement and understanding between
the pa11ies with respect to the subject matter hereof, and there are no representations or warranties
of any kind, except to the extent specifically set forth herein.
(d) This Agreement shall be binding upon and inure to the benefit of the parties
hereto and their respective successors, legal representatives and assigns.
(e) The undersigned was duly authorized to execute this Agreement on behalf of
and as the free act and deed of Association and by his signature hereon certifies the grant of such
authority of Association.
TN WITNESS WHEREOF, the parties hereunto caused this Agreement to be executed as of
the day and year first above written .
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Ba;> G~£,,-,. ~ By /?d!:J::-Y Z:;;k
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515-281-5926
E-mail: consumer@ag.state.ia.us
Please notice that the registration requirement is only for professional commercial fund
raisers as defined in Iowa Code Chapter 13C. Charitable oreanizations as defined in this
Chapter are not required to register.
Professional commercial fund-raisers must also complete the attached form, "Charitable
Organization Financial Information Disclosure Form," for EACH charity for which you
raise funds.
I. Name of Professional Commercial Fund-raiser, including any d/b/a and trade names:
PUBLIC SAFETY COUNCIL, LLP dba Public Safety Council, PSC, Safety Associates
2. Address and telephone number of each office, chapter, branch or affiliate. Indicate the principal
place of business:
13120 COUNTY ROAD 6, MINNEAPOLIS, MN 55441
763-509-0400
-1
LIMITED LIABILITY PARTNERSHIP
3. Form of business
----------------------------------------------------
(Individual, Partnership, Business Corporation, Nonprofit Corporation, etc.)
6. Name, address, telephone number and title of the following person(s) for the professional
commercial fund-raiser:
ATTACHED
b. The person(s) responsible for the day-to-day operations of the professional commercial fund
raiser:
ATTACHED
c. The person(s) who directs and controls the activities of the professional commercial fund
raiser:
ATTACHED
d. The person(s) responsible for custody of the professional commercial fund-raiser's records:
ATTACHED
e. The person(s) responsible for custody of all funds raised by the professional commercial fund
raiser:
ATTACHED
-2
f. All persons managing or supervising fund-raising activities in or from Iowa:
N/A
7. Has the professional fund-raiser or any of the persons listed in response to Numbers 5 or 6 ever
been a party to any litigation, criminal or civil, involving claims of theft, fraud, unfair or
deceptive trade practices, conversion, mismanagement of funds, breach of fiduciary duty, or any
other claim involving alleged dishonesty?
~Yes DNo If yes, attach detailed explanation as to agency involved, date, court, claim and
disposition. Attach copies of all complaints, petitions, settlement agreements, plea agreements,
assurances, consent judgments, final judgments, convictions, and/or other agreements or orders
resolving the matter. PREVIOUSLY FILED
8. Name, address and telephone number of the registered agent for service of process in Iowa:
N/A
10. Has the professional fund-raiser's right to solicit funds ever been denied, suspended, revoked or
enjoined by any state or by any court, or are there any such proceedings pending?
II. Has the professional fund-raiser been the subject of a legal, administrative, or other proceeding
regarding any solicitation or registration as a solicitor or fund-raiser? Ifso, state the date,
location and nature of each such proceeding and the outcome of the proceeding.
ATTACHED
12. Does the professional fund-raiser have custody of or access to contributions from a solicitation at
any time?
~Yes DNo
13. Does registrant anticipate that any of the services it will provide to charitable organizations will
be provided by another entity under a subcontractor arrangement?
~Yes DNo If yes, please identify the charity and the subcontractor below: (Attach a
list ifmore room is needed.)
-3
Charity Subcontractor Name & Address
ATTACHED
Is registrant's contract with subcontractor filed with the office of the Iowa Attorney General?
14. Complete a Financial Information Disclosure form for each charitable organization for which you
will be soliciting money in or from Iowa.
Note: If additional contracts are entered into after the filing of this registration statement, submit a copy
of the new contract at that time.
Note: All information and documentation provided as part of this registration, including this form are
public records and all or some may be open to public inspection pursuant to the Iowa public
records law, Iowa Code chapter 22, and the Iowa Attorney General's Administrative Rules
relating to public records, 61 lAC chapter 2.
SIGNATURE
I hereby certify that I am authorized to sign this Registration and that the information provided is
true and complete to the best of my knowledge.
Date_-----1(,....,2
t"-_ - ....:....
l _L£-=----------"-l-=-_ __
Name (Print)
G~ iJ
Signature
State of (n :1\f\8SotQ
County of he(\N?p;t\..
Signed and sworn to (or affirmed) before me on OG-~b« ''1,d OlO (date) by
-4
(Seal)
:e
'-,
MELODY-A NAI'IIf
Notary Public
MInnesota
MYCOmmissionEXPiresJanUary31,2015
~ (Sign~ P~i~<f2!va
~ I :,:") I I
. . . . , . , -:5 ,- ~
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My commIssIon expIres _ _ _ _ _______
-5
Attachment to Application for Registration Permit as a Professional Commercial Fund-Raiser Under Iowa
Code Chapter 13C
#5 .
Partners
Telstar Communications, Inc., 13120 County Road 6, Minneapolis, MN 55441--763-509-0400
T.A.G.R. Enterprises, 12100 West Marion, #6202, Minnetonka, MN 55305
Officers
Robert T. Callan, President
13120 County Road 6, Minneapolis, MN 55441--763-509-0400
1. Michael Callan, Vice President, Secretary, Treasurer
13120 County Road 6, Minneapolis, MN 55441--763-509-0400
7.
• Telstar Communications, Inc . a partner of Public Safety Council, LLP, was named as a defendant in a
lawsuit commenced by the state of Wisconsin in 1990. The matter was resolved by a voluntary settlement
among the parties and a consent judgment was entered July 9, 1991, with no fmding of wrongdoing by any
of the defendants .
See also #11 .
II.
• Public Safety Council was named as a party to a civil lawsuit, along with other parties, filed by the state
of Arkansas in July 1991. In March of 1994, the Chancery Court of Pulaski County signed a Consent
Decree which vacated any and all prior orders affecting the parties. The Consent Decree resolved all
disputed claims by compromise settlement and stipulated no wrongdoing by any party. The parties agreed
• 1. Michael Callan and Robert T. Callan were named as defendants in a proceeding commenced by the
state of Colorado in 1986. The trial court, on motion of defendants, dismissed the charges on a finding that
the Colorado charitable fraud statute was unconstitutional. The Colorado Supreme Court unanimously
• Public Safety Council is currently in negotiation with the Iowa Attorney General's office concerning
13.
Iowa Peace Officers Association (formerly Iowa Association of Chiefs of Police and Peace Officers, Inc.
CONTRACT
THIS AGREEMENT, made and entered into as of November 1, 2010 by and between
Public Safety Council, LLP (hereinafter referred to as "Client), and Safety Services, LLC
(hereinafter referred to as "Contractor"):
WHEREAS, Client desires to retain Contractor to complete a specific public awareness and
sponsor qualifying function as described herein;
NOW, THEREFORE, in consideration of the mutual covenants and agreements herein
contained, and for other good and valuable consideration, the receipt and sufficiency of which is
hereby acknowledged, the parties hereby represent and agree as follows:
1. Activities of Parties to this Agreement.
Client activities include securing, developing and managing Sponsor Program
Agreements with organizations, developing related public awareness messages, and contracting
with specialty companies to make sponsor qualifying contacts, process related data, and account
for, and report on, revenues and expenditures. Making qualifying sponsorship contacts with public
awareness messages is not a part of the regular activity of client.
Contractor's activity includes making qualifying contacts with public awareness
messages to potential sponsors. Contractor stipulates and Client acknowledges that Contractor
is available to be engaged by clients for the performance of services offered by Contractor. Neither
this Agreement nor Client limit in any fashion the engagement of Contractor by either existing or
new clients.
Contractor's location, facilities and equipment are those of Contractor's choosing.
Investment, risk of loss, development efforts, depreciation or appreciation are Contractor's. Client
shall have no responsibility or control over Contractor's facilities or operation including hours,
schedules or personnel. Contractor has complete control over the means of completing its activity.
Client shall provide no training to Contractor.
2. Contract Service to be Provided. Client desires that Contractor complete and
Contractor agrees to complete a specific function which is as follows: distribution to the general
public, by telephone, of public awareness messages relating to and about IOWA PEACE
OFFICERS ASSOCIATION (formerly The IOWA ASSOCIATION of CHIEFS of POLICE and
PEACE OFFICERS) and qualifying potential ISPA sponsors at sponsorship levels subject to
determination and variation by Contractor. Sponsorship levels are acknowledged by written
confirmations but are not binding obligations of potential sponsors. Sponsorships are not
completed until the receipt and acceptance by Client of written sponsor remittances. Contractor
represents that Contractor's business possesses the high level of skill necessary to complete said
function and that it has the initiative, judgment and foresight to be successful in completing its
activity in open market competition.
3. Independence of Parties. Contractor is and shall remain an independent contractor
and is not and shall not be deemed to be an employee, joint venturer, partner or franchisee of
Client for any purpose whatsoever. Contractor shall be exclusively responsible for the manner in
which Contractor performs its function hereunder and shall not be subject to the control of Client.
Contractor does not and will not have the power to bind Client. Contractor will not be authorized
to make representations on behalf of Client. Client will not be responsible for the acts or
representations of the Contractor. Contractor will not and cannot create a fiduciary relationship with
third parties for Client. Government legislation, agencies, regulators and/or the courts have and
will establish guidelines for Contractor actions. Contractor has no power to bind the Client by
misrepresentations, and Client does not wish Contractor to make untrue statements.
4. Terms of Payment. Client shall pay Contractor according to the following terms and
conditions: mutually agreed commissions based on collections of sponsorship revenues from
sponsors qualified by Contractor ("Regular Commissions"). Regular Commissions are not earned
by, or payable to, Contractor unless and until said sponsorships have been paid by sponsors and
received and accepted by Client. Contractor acknowledges that significant time and effort may be
expended and expenses incurred from which no commission revenue may result. Contractor
accepts this as a normal risk of loss to its operation. Commissions may be adjusted from time to
time by mutual agreement of Client and Contractor.
5. Term of Agreement. This Agreement shall be effective on November 1, 2010. The
term of this Agreement shall continue until the effective date of any cancellation or termination
pursuant to sections 14 or 15 herein below or by mutual agreement of the parties.
6. Additional Consideration. As additional consideration to Client for awarding this
contract to Contractor, during the period of this Agreement and for one year thereafter, whether
terminated by either party or by mutual consent, Contractor (including any officer or owner thereof)
and any successor or assign shall not directly or indirectly, either as principal, agent, employee,
officer, stockholder, or in any other capacity, engage or have any financial interest or any activity
connected in any fashion with IOWA PEACE OFFICERS ASSOCIATION without first obtaining
prior written consent of Client. It is specifically agreed that for a period of one year, the provisions
of this paragraph shall survive the termination or expiration of this Agreement. In furtherance of
and not in limitation of the foregoing, it is expressly agreed that, should the duration, geographical
extent, or activities covered by this non-competition agreement be in excess of that which is valid
or enforceable under applicable law, such provision shall be construed to cover only that duration,
geographical extent or activities that may be enforceably covered.
7. Confidentiality Contractor shall carefully guard and keep secret all information
which shall or may concern the business and affairs of Client (including without limitation, leads,
list of contributors or sponsors, company financial information, business plans, and Client
procedures and policies) acquired, developed or to which Contractor has access in connection with
this Contract and Contractor shall at no time, either while under Contract with Client or after
termination of contract(s) with Client, directly or indirectly disclose any such information or provide
such material to any person or entity, unless Contractor shall first secure Client's written consent
8. Contractor's Expenses. Client shall not be liable to Contractor for any expenses
paid or incurred by Contractor. Contractor is independent of Client. Contractor is not an employee
of Client. None of Contractor's expenses are to be paid by Client. These expenses include but are
not limited to the cost of insurance, travel, office, telephone, personnel and taxes, whether federal,
state or local. Contractor is solely responsible for these and all other expenses of Contractor.
9. EqUipment. Tools and Supplies. Contractor shall supply, at Contractor's sole
expense, all equipment, tools, materials and/or supplies to accomplish the contract service to be
provided Client. Contractor shall be solely responsible for any maintenance or repairs to
Contractor's equipment. Because of the third party influences of government regulations and
agency review of sponsorships generated in the name of public safety associations, it is necessary
that sponsor confirmations, promotional materials, letters or information and other related items be
provided by Client in order to be assured of proper content and form. Regulation and scrutiny by
local, state and federal government agencies further necessitate the addition of Guidelines
Concerning Public Awareness and Sponsorship Campaigns to Contractor's practices.
10. Notice to Contractor Regarding Tax Duties and Liabilities. Contractor understands
that Contractor is responsible to pay, according to law, Contractor's income taxes. Contractor
further understands that Contractor is liable for social security tax, to be paid by Contractor
according to law. Neither federal, state nor local income tax, nor payroll tax of any kind, shall be
withheld or paid by Client on behalf of Contractor, its contractors or its employees. Neither
Contractor nor individuals retained by Contractor shall be classified or considered employees of
Client with respect to services provided hereunder or for federal or state tax purposes.
19. Non-Waiver. The failure of either party to exercise any of its rights under this
Agreement for a breach thereof shall not be deemed to be a waiver of such rights or a waiver of
20. Severability. If any part of this Agreement shall be held unenforceable, the rest of
this Agreement will nevertheless remain in full force and effect.
21. Choice of Law. Any dispute under this Agreement or related to this Agreement shall
be decided in accordance with the laws of the State of Minnesota.
23. How Notices Shall be given. Any notice given in connection with this Agreement
shall be given in writing and shall be deemed delivered when received, if hand delivered, or sent
by telefax, or two (2) days after depositing, if placed in the U.S. mail for delivery by first class mail,
postage prepaid and addressed to the parties at the addresses set forth hereinabove. Any party
may change its address stated herein by giving notice of the change in accordance with this
paragraph
Signature
Minneapolis. MN
Accepted at
A. Contractor who contacts any individual for purposes of public awareness and sponsorship shall:
(1) Clearly identify the sponsoring organization in whose name the contact is being made;
(2) Accurately describe the sponsoring organization and complete the public awareness message;
(3) Advise the individual contacted that an additional purpose of the contact is to seek sponsorship
commitments in the name of the sponsoring organization and in close proximity to that request,
advise the individual that sponsorships are not tax deductible.
(4) Provide complete and accurate information in response to all questions or inquiries of prospective
sponsors. Information to be disclosed shall include, if requested, an information source for the
amount or percentage of the sponsorship to be received or ultimately retained by the sponsoring
organization if requested .
(5) Include in each presentation any oral disclosures which are required by applicable state law.
B. A Contractor who contacts an individual for purposes of public awareness and sponsorship shall not under
any circumstances:
(1) Represent, either directly or indirectly, that the contractor is a member of the sponsoring
organization if such is not the fact;
(2) Represent, either directly or indirectly, that the contractor is a law enforcement officer, fire fighter,
or veteran if such is not the fact;
(3) Represent, either directly or indirectly, that the individual has been a sponsor on a prior occasion if
such is not the fact;
(4) Represent, either directly or indirectly, that the sponsoring organization is endorsed or otherwise
supported by local police or fire officials if such is not the fact;
(5) Represent, either directly or indirectly, that the proceeds from sponsorships will be used for
purposes other than funding the sponsorship effort, the organization s general fund, member
services and any specific, ongoing programs or activities of the sponsoring organization;
(6) Represent, either directly or indirectly, that a sponsor will obtain any special privileges from
members of the sponsoring organization by reason of the sponsorship commitment.
(7) Send to the individual or request that a third party send to the individual a sponsor confirmation
order or statement for same unless the individual has clearly and unequivocally expressed his
agreement to provide said sponsorship.
C. In addition to the foregoing, all Contractors completing campaigns by telephone are prohibited from
engaging in any of the following practices:
(1) Representing that the telephone call is originating from within an individual s state if such is not
the fact;
(2) Representing that the telephone call is originating from a local police or fire department if such is
not the fact.
CONTRACTOR HAS READ AND FULLY UNDERSTANDS THE FOREGOING GUIDELINES AND HEREBY
ACCEPTS THEM IN ALL RESPECTS. CONTRACTOR ACKNOWLEDGES THAT THESE GUIDELINES DO NOT
CONSTITUTE CONTROL OVER CONTRACTOR S BUSINESS OR BUSINESS ACTIVITIES BUT RATHER ARE
MANDATED BY THE THIRD PARTY INTERESTS OF GOVERNMENT REGULATIONS AND AGENCIES RELATING
TO PUBLIC AWARENESS AND SPONSORSHIP CAMPAIGNS. CONTRACTOR WILL PROVIDE THESE
GUIDELINES TO EACH REPRESENTATIVE AND WILL OBTAIN EACH REPRESENTATIVE'S
ACKNOWLEDGMENT AND ACCEPTANCE OF THESE GUIDELINES.
President
Title
(You are describing the program here so you will want to speed your pace a little bit and sound genuinely
excited about the program so that the customer will listen and become excited as well)
I’m sure you are busy so I’ll be brief. As you know, your support still helps Special
Olympics make these games possible by providing things such as equipment, training ,
public awareness, education materials at no charge to these athletes. It is important to
note that Special Olympics offers each eligible person the chance to compete.
(Slow your pace and lower your voice tone to convey the needs and situation of Special Olympics and
create a responsibility to help the athletes with the customer)
Right now the athletes are preparing for the (state upcoming event and location
If you know someone that would like to volunteer or an individual eligible to participate
please call (515) 986-5520.
Unfortunately…. Special Olympics Iowa receives very little governmental
funding…. So, it is only through the continued support from individuals like you that
make these games possible.
(Your pace and tone should become professional and business like at this point. You are giving the
customer the choices of gift amounts. Remember it isn’t WILL the customer give it is WHICH ONE would
they prefer)
Like always there are several levels so that everyone can help. We start with the
Gold at (3 X Most Recent Gift) dollars, silver is (2 X Most Recent Gift) and the bronze is
(1.5 X Most Recent Gift). Please remember that for so long society has focused on
what the handicapped can not do, Special Olympics turns that around and focuses
on what they can do. Mr. /Ms. I always like to ask on behalf of the athletes if there is
anyway we could encourage you to help with the gold or silver this year??…pause, wait
customer response then, if no or hesitation by the donor then go into…or would the
Bronze be better for you?
VERIFICATION
YES- What credit or debit card would you like to process that gift by?
(Special Olympics Iowa offers Visa & MasterCard)
Great! Please run over your mailing address so that we make sure the receipt gets to you.
And what is your e-mail address? My billing coordinator will get that credit card
information from you and thank you again for your support.
NO TO CREDIT CARD:
The reason we ask is because it cuts down on printing and postage and more importantly
the athletes get to benefit from your support right away. We still send you the receipt so
that you know Special Olympics has received your support. So, could we encourage you
to support by credit card today?
Great! Please run over your mailing address so that we make sure the receipt gets to you.
And what is your e-mail address? My billing coordinator will get that credit card
information from you and thank you again for your support.
NO TO CREDIT CARD:
In order to save more money for the program, what is your email address so that we can
send your bill to you that way? (Remember to get correct spellings and remember that
email addresses are case sensitive)
YES TO EMAIL:
1. And what is your correct mailing address in case we have trouble sending you an
email?
2. What is your complete name so that we can print it correctly on the mailing?
3. You did feel comfortable committing to the SIZE for PRICE, is that correct?
Great, that email invoice will reach you in about 24 hours and we just ask you to send
your gift back 7-10 days after you receive it. Thank you very much for your support with
Special Olympics. Real quickly, I need to put my manager on the line to verify this
information. Here's Manager Name.
NO TO EMAIL:
We can process your gift by mail. I just need to get some information from you.
1. What is the correct billing address you would like that sent to including the PO Box or
apartment number?
2. What is your complete name so that we can print it correctly on the mailing?
3. You did feel comfortable committing to the SIZE for PRICE, is that correct?
4. Great, that bill will reach you in 3-5 days and we just ask you to work that back 7-10
days after you receive it. Thank you very much for your support with Special Olympics.
Real quickly, I need to put my manager on the line to verify this information. Here's
Manager Name.
Attorney General Tom Miller
515-281-5926
E-mail: consumer@a2.state.ia.us
DISCLOSURE FORM
PLEASE NOTE IMPORTANT OPEN RECORDS INFORMATION TOWARDS THE END OF THIS FORM.
2. Identify the charitable organization for which you will be soliciting money within the
State of Iowa during this registration period. (If more than One charitable organization,
file a separate Financial Infonnation Disclosure fonn for each.)
f
r .
Johnston, IA 50131-1902
rl .
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c. Name, title, address and telephone number of the contact person(s) for thecS f\
charitable organization:
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Page 1 of 5
6. If persons will be contacted by telephone and mail, how will the initial contact be made?
Tele phon@1 ai O
7. If soliciting will be conducted by telephone, provide the following regarding the location
from which calls will be made. (If more than two locations, continue on a separate sheet):
Room I
Room 2
a. Address of telephone room (Include street, city and state): _ _ _ _ _ _ _ _ _ __
8. Will the solicitation campaign involve the sale of goods or services? YeDolXI
Page 2 of 5
If yes, check one or more of the following that apply:
YeffiorJ
If "No," describe how the funds will be collected. _ _ _ _ _ _ _ _ _ _ _ _ _ __
10. If contributions will be made by mail, identify all addresses to which the mail will be sent.
If any of the addresses are different than the addresses listed in response to question 2B,
please state: (1) whether the address is that of a post office box, commercial mail service,
bank ofthe professional fund-raiser or the address of a charitable organization; (2) the
Po DOt. CfJl(
Di.lJ\J{ (\ pud ',}of\ 5).~) _ovI ole(
identity ofthe individual or entity responsible for collecting mail containing contributions.
(\\ervJ..a ~ (e 0 (Mt"-
~
11 . State which of the following has the authority to withdraw the funds from any banking
account (check all that apply):
Page 3 of 5
FINANCIAL INFORMATION
State the following information and indicate the applicable time period and dates (either the last
completed fiscal year or the previous twelve months):
get Atr~.fI/vl&J7
b. Itemize the source(s), and dollar amounts per source, of all funds collected on
behalf of the charitable organization: (contributions or donations; payments for
tickets to events, government grants, private charities, foundations, etc.):
(2) Total not given to charitable organization but expended on behalf of the
charitable organization: Itemize by dollar amount based on the following and any
other applicable categories: salaries/commissions/compensation; rent/mortgage;
transportation; professional services (attorneys, accountants, etc.);
advertising/promotion, etc.:
(3) State the total dollar amount billed to the charitable organization by the
professional commercial fund-raiser and itemize each such billing by purpose and
amount:
Page 4 of 5
Note: All information and documentation provided as part of this registration, including this
form are public records and all or some may be open to public inspection pursuant to the
Iowa public records law, Iowa Code chapter 22, and the Iowa Attorney General's
Administrative Rules relating to public records, 61 lAC chapter 2.
Note: Any changes or additions to the information provided in this notice must be reported
immediately.
SIGNATURE:
)
) ss.
County of -------'----= )
I, -:;-:;t /1 (~ b "0 <1 ..../___ , being first duly sworn on oath, depose and state that I am a
managing agent of the professional fund-raiser; that I have read the contents of this Charitable
Organization Financial Disclosure Form; that I know the contents thereof; and that each
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Page 5 of 5
LIST OF PHONE ROOM MANAGERS
John C. Braune
19220 Kanis Road
Little Rock AR 72211
The Heritage Company, Inc.
Printed: 04/02/2008
CAMPAIGN FINANCIAL REPORT
EXPENSES
SALARIES, WAGES, COMMISSIONS 14,957.88
PROMOTIONAL FEES 2,015.12
POSTAGE 811.46
TELEPHONE 11,103.45
RENT 4,273.68
SUPPLIES 459 .83
LICENSES, PERMITS 757 .36
ADVERTISING 946.70
ACCOUNTING/DATA PROCESSING 5,328.57
LIST PREPARATION 419.25
OTHER:
10/29/2008
AGREEMENT
between
dba
GUARDIAN PUBLISHERS
And
For and in consideration of the mutual promises and mutual benefits derived by the parties hereto, this
Agreement is made and entered into by and between THE HERITAGE COMPANY, dba GUARDIAN
PUBLISHERS, 2402 Wildwood Avenue, Suite 500 Sherwood, Arkansas 72120, hereinafter referred to as
Guardian and the ENLISTED ASSOCIATION NATIONAL GUARD OF IOWA, P. O. Box 608, Boone, IA
50036, hereinafter referred to as EANGI. This Agreement shall extend for a period of three (3) years from
June 1, 2008 to May 31, 2011 for the production of the 2009, 2010and 2011 conference programs. This
Agreement shall bind the parties hereto and their successors and assigns and is subject to final approval
by Guardian Publishers Corporate headquarters in Sherwood, Arkansas. It is expressly understood by
EANGI that a part of the consideration for this agreement is the expectation by EANGI that this agreement
will continue for the full term.
I. PURPOSE
Guardian will: 1; Conduct a statewide Public awareness and advertising sales campaign
on behalf of EANGI by telephone and by direct mail. 2; Guardian and its representatives
will conduct all business operations ethically and in a businesslike manner, creating public
awareness, support and production of a conference publication. 3; Produce EANGI a
high quality publication for distribution at the 2009,2010 and 2011 conferences. In return,
EANGI will acknowledge supporters in the conference book.
B. Guardian representatives will offer advertising space in the conference program book
to the businesses and professionals contacted . Guardian agrees to provide all
advertisers with a letter of appreciation from EANGI , and a sales confirmation slip .
Guardian will not accept for publication advertisements that are in conflict with the
principles of the EANGI. Advertisements must in all cases reflect acceptable
standards of good taste.
EANGI agrees to complete a Guardian client questionnaire to provide all current and
updated information as well as provide EANGI newsletters, articles and add itional
literature three months prior to the campaign date.
Guardian will submit all material and scripts to EANGI for its written approval before use
in any campaign. EANGI will not unreasonably withhold approval or a change to scripts
and written materials and will respond in writing within ten (10) business days after receipt
by EANGI. EANGI agrees that a lack of response in this specified time frame will warrant
acceptance and approval of the script and all materials.
Guardian may make minor changes in scripts and printed materials during the course of
the campaign without the prior approval of EANGI for the purposes of improving the clarity
and effectiveness of such communication. Minor changes shall be deemed to be a
change in punctuation or word usage that does not materially affect the meaning of the
sentence.
Guardian recognizes the importance of EANGl's public awareness message and agrees
to require its telephone representatives to adhere closely to the approved scripts .
Guardian agrees to take prompt corrective action whenever it becomes aware that one of
its representatives is not adhering to the approved script.
EANGI agrees to notify in writing state and local representatives of the campaign so they
will be well informed as to the campaign and when it begins. EANGI agrees to furnish
Guardian with names of two persons in their Association, which Guardian may use as
referrals if questioned
Agreement
Page 3
C. PUBLICATION CONTENTS
1. EditOrial Content
EANGI agrees to furnish Guardian up to 20 pages of editorial copy no later
than 60 days before the delivery date requested by EANGI. Additional
editorial pages may be added by written agreement between Guardian and
EANGI at a price agreed upon between Guardian and EANGI annually.
2. Late Copy
In the event any editorial copy is turned into Guardian past the agreed
deadline, EANGI agrees to pay Guardian for any additional late charges
incurred as a result of the delay at a rate of $100.00 per day.
3. Proofs and Bluelines
a) Guardian agrees to furnish proofs of the editorial pages as soon as
possible after receipt of the materials. Guardian will also provide ripped
proofs of the complete publication for approval by EANGI before final
production begins. All changes and corrections shall be made on the
proofs. Bluelines will only be for proper picture and page placement.
There will be a $30.00 charge per page for blueline changes, when
changes are necessitated by EANGI.
b) Guardian will return all photographs and other editorial copy to EANGI at
the completion of production . All other materials used to conduct
advertising sales and to produce the printed program book shall remain
the property of Guardian.
Agreement
Page 4
V. DATABASE/DONOR LIST
EANGI acknowledges that Guardian maintains a proprietary master composite file
containing the name, address and other information of those individuals and businesses
who have or may contribute to charitable non-profit organizations. Information regarding
contributors as well as information pertaining to contributions made to any organization is
included in this master file for the mutual benefit to all organizations. EANGI
acknowledges that Guardian may use the master file in its performance of telemarketing
services for other clients.
Should another publisher offer a proposal which would net EANGI more money than
offered by Guardian, EANGI hereby agrees to allow Guardian the right to meet the offer.
Guardian agrees to obtain all licenses and permits with respect to professional
fundraising to be performed hereunder and to pay all fees and cost in connection
therewith. In addition, Guardian shall , as part of its expense, assume and pay all taxes
that may be charged or assessed upon the pay of its employees and the sale or use of
materials used by Guardian , unless such materials are furnished by EANGI.
IX. CANCELLATION/BREACH/ARBITRATION
Either party may terminate this Agreement with a thirty day (30) written notice to be
received under certified receipt requested mail. In the event that EANGI should cancel
this Agreement without cause, Guardian will be allowed to continue collection efforts by
sending twelve reminder statements to recover any monies owed to Guardian as a result
of any advanced campaign costs or unpaid telemarketing costs.
In addition thereto, either party shall have the nght to terminate this Agreement on thirty
(30) days written notice to the other, only as the result of a material breach of any term or
condition set forth in this Agreement, which is not cured within time period set forth under
following circumstances
A. The injured party will provide a written statement to the breaching party, specifically
describing the nature of the alleged default or breach, and what affirmative steps
must be taken to cure same. If the breaching party takes the steps required to effect
said cure within fifteen (15) days of the notice, then the default or breach shall be
deemed cured, provided such default or breach is actually cured within thirty (30)
days of such notice.
B. If either party gives notice of alleged breach or default and disputes that a cure has
been commenced within the fifteen (15) day period, or has been cured with the thirty
(30) days period, then in that event, the parties shall submit this matter to binding
arbitration in accordance with the rules of the American Arbitration Association . The
sites of the arbitration shall be Little Rock, AR, or such other location as may be
mutually agreed upon. The arbitrator shall be given the right to assess costs as
he/she may so determine, and the parties further agree that the decision of the
arbitrator shall be binding and final, and entitled to the full force and effect as if
rendered by a court of competent jurisdiction. The right to grant costs shall expressly
include the right to grant the prevailing party a reasonable attorney fee
It is the express understanding of the parties herein , that all disputes which cannot be
resolved between them, arising from or pertaining to this Agreement, shall be
submitted to binding arbitration.
X COLLECTION OF RECEIPTS
EANGI agrees that all proceeds from the sale of advertisements for the publication shall
be mailed to P.O. Box924,Davenport,IA 52805 held in the name of EANGI. EANGI
agrees that the postmaster will be authorized to send all mail received at this post office
box, express mail twice a week to Heritage Corporate Headquarters in Sherwood,
Arkansas.
Agreement
Page 6
EANGI acknowledges and agrees that Guardian will receive, process, and deposit
payments in the name of EANGI. All funds received shall be deposited with Metropolitan
National Bank, Little Rock, Arkansas in Account Number 67903 By these premises,
EANGI deSignates Guardian as its agent to receive, process, and deposit payments to the
Account. EANGI agrees to indemnify the Bank against, and to hold the Bank harmless
from all losses, damages, costs and expenses, incurred by EANGI with respect to any
deposit of funds to the Account.
In the event of natural disaster, substantial economic down turn, or other incident or
occurrence outside the control of either of the parties hereto, or if there shall be a
substantial change in the economic situation, the amounts and schedules shall be
readjusted by mutual agreement of the parties hereto. In the event that a mutual
agreement cannot be reached by the parties as to any proposed adjustments, the parties
agree to submit the matter for determination to binding arbitration.
XI. INDEMNIFICATION
A. By Guardian. Guardian agrees to hold harmless and indemnify EANGI from and
against any and all costs, expenses, claims, actions, causes of action, damages,
judgments, demands, suits and liability including, without limitation, reasonable
attorney's fees and costs, arising out of, under or relating to, directly or indirectly, the
services, business or conduct at Guardian or its employees or agents in connection
with this Agreement, including, but not limited to any suits, actions, causes of action,
damages, judgments, demands or claims made by vendors, suppliers or creditors of
Guardian, or made by any person alleging harassment or invasion of privacy, or
resulting directly or indirectly from any misrepresentation or breach of warranty by
Guardian contained in this Agreement.
B. By EANGI. EANGI agrees to hold harmless and indemnifying Guardian from any and
all costs, expenses, claims, actions, causes of action, damages, judgments,
demands, suits and liability, including, without limitation reasonable attorney's fees
and costs, arising out of, under or relating to, directly or indirectly, the loss by EANGI
of federal tax-exempt status, or the inaccuracy of any written information provided by
EANGI to Guardian pursuant to this Agreement, including, but not limited to, copyright
infringement or claims that such information is libelous or slanderous, or resulting
directly or indirectly from any misrepresentation or breach of warranty by EANGI
contained in this Agreement.
Agreement
Page 7
XIII. NOTICES
There may be no modification of this agreement except in writing and sent certified return
requested enacted with the same formality as this Agreement and sent to:
Marilyn Michie
Vice President
The Heritage Company
2402 Wildwood Avenue, Suite 500
ShenNood, Arkansas 72120
Guardian will act as an Independent Contractor and will hold EANGI harmless from any liability
which might arise as a result of any violation of law, Federal, State, or Local, or any misdealings
incurred by Guardian .
The waiving of anyone or more of the covenants herein contained shall be limited to the particular
instance and shall not be deemed a waiver of any other breaches of covenants .
Other than the foregoing, failure by either party to comply with any and all terms, conditions and
deadlines contained herein shall constitute a breach . The other party shall be required to notify
the breaching party within ten days of a breach. The breaching party must act within thirty days to
correct the breach or failing to act, this Agreement will be considered null and void.
IN WITNESS WHEREOF, the parties hereunder set their hand and seal, with the date of
execution by Organization specified to be the day and year first above written, and by GUARDIAN
PUBLISHERS on the date set forth below.
APPROVED:
THE HERITAGE COMPANY, dba ENLISTED ASSOCIATION
GUAR~N PUBLISHERS NATI~L GUARD OF IOWA
/ /);1 /' /}-. l)A ,D/?
BY: BY:
JAIJ 69
ENLISTED ASSOCIATION
NA~~A
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November 7, 2008 -
'-
Department of Justice
Consumer Protection Division
Hoover Building
Des Monies, LA 50319
Re: The Heritage Company, Inc_ / Enlisted Association National Guard of Iowa
The above referenced organization is a £rofessional fund raiser currently r egistered with
your office. The Heritage Company, Inc. has recently entered into a contract with the above
referenced charitable organization. They have ashed that I forward this contract to yo u.
pleas e mahe this contract a part of the registration file for The H eritage Company, Inc.
Thanl~ you for your attention to this matter. Please feel free to contact me should you have
any questions regarding this matter.
:rITlW
Enclosure
rose@cclzc-law.coIn
Washinglon DC Office: 1900 L STREET, SUITE 2 15. WASHINGTON, D.C . 20036 • (202) 861·0740 • FAX (202) 331-9841 • E-MAlL copcandc @aol.com
Attorney General Tom Miller
515-281-5926
E-mail: consumer@ag.state.ia.us
DISCLOSURE FORM
PLEASE NOTE IMPORTANT OPEN RECORDS INFORMATION TOWARDS THE END OF THIS FORM.
2. Identify the charitable organization for which you will be soliciting money within the
State ofIowa during this registration period. (If more than one charitable organization,
file a separate Financial Information Disclosure form for each.)
Grimes, IA 50111
c. Name, title, address and telephone number of the contact person(s) for the
charitable organization:
ilia NoIJ 3., ' 0Hd H]4/nSNO::
(,f\(A( l ~ttd If(fbW,.} IL tD !
4. Is the contract between the professional fund-raiser and the charitable organization on file
with the office of the Iowa Attorney General?
6. If persons will be contacted by telephone and mail, how will the initial contact be made?
Telephon~ailD
7. If soliciting will be conducted by telephone, provide the following regarding the location
from which calls will be made. (If more than two locations, continue on a separate sheet):
Room 1
Room 2
8. Will the solicitation campaign involve the sale of goods or services? Yeo-0lxl
Page 2 of 5
If yes, check one or more of the following that apply:
YeOolZ]
If "No," describe how the funds will be collected. f\t~ c.. L.J --6 f () IS" 1
10. If contributions will be made by mail, identify all addresses to which the mail will be sent.
If any of the addresses are different than the addresses listed in response to question 2B,
please state: (1) whether the address is that of a post office box, commercial mail service,
bank of the professional fund-raiser or the address of a charitable organization; (2) the
rD 6o'f-- 4f,1} -
DCU'\<f\PlX ~, 1-11 SJ. '8'{)~ '; t\,.-,,~ ()~~L..c '\5Df
identity of the individual or entity responsible for collecting mail containing contributions.
C\~(1o\t: t ~{l (he, n
11. State which of the following has the authority to withdraw the funds from any banking
account (check all that apply):
12. State whether contributions to the charitable organization are tax deductible:
Yes~ NoD
13. On an attached sheet, describe the charitable program for which the solicitation campaign is
being carried out.
Page 3 of 5
FINANCIAL INFORMATION
State the following infonnation and indicate the applicable time period and dates (either the last
completed fiscal year or the previous twelve months):
b. Itemize the source(s), and dollar amounts per source, of all funds collected on
behalf of the charitable organization: (contributions or donations; payments for
tickets to events, government grants, private charities, foundations, etc.):
(2) Total not given to charitable organization but expended on behalf of the
charitable organization: Itemize by dollar amount based on the following and any
other applicable categories: salaries/commissions/compensation; rent/mortgage;
transportation; professional services (attorneys, accountants, etc.);
advertising/promotion, etc.:
(3) State the total dollar amount billed to the charitable organization by the
professional commercial fund-raiser and itemize each such billing by purpose and
amount:
Page 4 of 5
Note: All information and documentation provided as part of this registration, including this
form are public records and all or some may be open to public inspection pursuant to the
Iowa public records law, Iowa Code chapter 22, and the Iowa Attorney General's
Administrative Rules relating to public records, 61 lAC chapter 2.
Note: Any changes or additions to the information provided in this notice must be reported
immediately.
SIGNATURE:
State of M4\(\SlJ) )
) ss.
County of 0V\..lt< ~\t-; )
I, JC)~f\C, t)(CllA""- , being first duly sworn on oath, depose and state that I am a
managing agent of the professional fund-raiser; that I have read the contents of this Charitable
Organization Financial Disclosure Form; that I know the contents thereof; and that each
crt ()~~
Subscribed and sworn to before me on
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Page 5 of 5
08179- ~ ~8- ~ 09
O~~U ~'v' 'P OOMJa 4S
°aA'v' pOOMPI!M W17~
auneJ8 <) u40r
Printed : 11/01/2010
CAMPAIGN FINANCIAL REPORT
EXPENSES
SALARIES, WAGES, COMMISSIONS 104,648.06
PROMOTIONAL FEES 14,098.16
POSTAGE 5,677.11
TELEPHONE 77,681.79
RENT 29,899.45
SUPPLIES 3,217.03
LICENSES, PERMITS 5,298.64
ADVERTISING 6,623.30
ACCOUNTING/DATA PROCESSING 37,279.69
LIST PREPARATION 2,933.17
OTHER:
12/16/2010
BUSINESS AND RESIDENTIAL AGREEMENT BETWEEN
doing business as
MEDALLION PRODUCTIONS
And
For and in consideration of the mutual promises of, and mutual benefits derived
by the parties hereto, and other considerations, this Agreement is made and entered into
by and between The Heritage Company doing business as Medallion Productions, 2402
Wildwood Avenue, Suite 500, Sherwood, AR. 72120 or P. O. Box 16325 Little Rock,
AR. 72231, hereinafter referred to as Medallion, and Special Olympics Iowa, Inc., 551
SE Dovetail Rd, PO Box 620 Grimes, IA. 50111 (hereinafter referred to as SOIA).
This Agreement shall extend for a period from January 1, 2011 until December
31, 2011. It is the stated intent of both parties at the time of execution to continue this
Outreach Program for its full term.
1. PURPOSE
Medallion will conduct by telephone an Outreach Program from its
facilities in Arkansas, to ask businesses, professionals and residents throughout the state
of Iowa, to take an independent action to help SOIA accomplish its program service
mission. Medallion and its representatives shall conduct all business operations ethically
and in a businesslike manner. The Outreach Program shall begin January 1, 2011 and
shall continue through December 31, 2011.
A. CALL TO ACTION
Medallion will contact by telephone those businesses and professionals
throughout the State of Iowa who have been identified as having an interest and the
ability to take one or more specific actions to further the program services of SOIA or the
need or the reasonable potential to use the program services of SOIA, it is the intent of
SOIA to contact all businesses based on the belief that all employees could have a need
or interest in SOIA program and mission. Also, Medallion will send out additional
information about SOIA to those who request the same. In the course of all such contacts,
Medallion representatives will define SOIA, explain its objectives, and encourage support
Agreement
Page 2
on the local levels, by way of attendance at athletic events, seek identification of potential
program participants, and request financial assistance by relating the history and
objectives of SOIA on a one-to-one basis (collectively referred to herein as the Outreach
Programs). All those who respond to the contact who wish to donate merchandise,
volunteer personal services or identify potential program participants will be referred
directly to the designated representative of SOIA
B. IMPLEMENTATION AND APPROVALS
Before the Outreach Program begins, SOIA agrees to provide to
Medallion all information necessary to implement a statewide call to action program.
SOIA shall have approval of all telephone presentations, letters of information, and letters
of appreciation used by Medallion in the Outreach Program. Any suggested material
changes in any written material or script or any other item used in conjunction with this
program shall be provided to SOIA in a timely fashion in advance of usage with the right
to review and approve. Approval of such items shall not be unreasonably withheld and
shall be given or denied no longer than five (5) business days of receipt of such items by
SOIA. SOIA also agrees to finish Medallion with the names of two (2) persons in SOIA
whom Medallion may use as referrals for verification and follow up on additional
Outreach requests.
From time to time SOIA will make available to Medallion updated
program education and event information, which upon reasonable approval by SOIA may
be incorporated into the primary statewide Outreach Program.
SOIA agrees to provide sample copies for internal use of the following
necessary information for a successful campaign. This includes:
• Written and printed signature of President/CEO or persons designated to sign
thank-you letters, Certificates of Appreciation, information letters and/or other
creative material designed by Medallion and approved by SOIA
• Newsletters, video tapes, news release and/or other related materials pertaining to
the progress of the SOIA's objectives
• Current updates of state events to include the dates and locations(s) and the
number of athletes participating.
• Non-profit bulk mailing status approval from U. S. Postal Service
Agreement
Page 3
General Business
Communi!Y, ResJ!onders Total
Nwnber of hours worked Number of hours worked Number of hours worked
Total dollars pledged Total dollars pledged Total dollars pledged
Total number of pledges Total number of pledges Total number of pledges
Total dollars collected Total dollars collected Total dollars collected
Total number of paid donor's Total number of paid donors Total number of paid donors
D. ACCOUNTING
Respondents to the phone call will send their remittance to SOIA to a post office
box. SOIA agrees that the postmaster will be authorized to send once a week all mail
received by Special Olympics Iowa to Medallion at its corporate headquarters in North
Little Rock, Arkansas. Medallion will open mail, record payment to the SOIA account,
prepare deposit slip and deposit monies into the SOIA bank account. A copy of the
deposit slips will be forwarded to SOIA on a weekly basis. All funds received shall be
deposited with Metropolitan National Bank in Little Rock, Arkansas in SOIA's bank
account. Medallion will disburse fees each week owed to SOIA from receipts held in
SOIA's account.
Agreement
Page 4
E. TRAINING
Medallion shall train its representatives to be knowledgeable about SOIA and
such representatives will be trained by Medallion to have expe11ise in SOIA mission,
programs, and objectives and to answer questions regarding SOIA. In regard SOIA shall
provide Medallion reasonable guidance and materials. Both parties herein affirm their
dedication to fulfill the objective and missions of SOIA through the implementation of
the paragraph and this Agreement.
charities by the various state and federal regulatory agencies . THC subscribes to the state
run lists, The Direct Marketing Association and the Telephone Preference Service from
THC also maintains an internal suppression list made up of individuals who have
made a direct request, either through contact by phone, e-mail or mail, directly to SOIA
or to THe. All requests will be honored for a period of five (5) years.
SOIA agrees it is their responsibility to obtain the name, address and telephone
number of the individual requesting to be placed on their do not call list. SOIA shall
letter. THe shall not be held responsible for any request received by SOIA and not
forwarded to THC.
The parties mutually acknowledge and agree that passage, either at the state or
federal level, of a do-not-calJ law, which does not exempt calls made on behalf of
nonprofit organizations, will inevitably impact the ability of Medallion to meet its
financial guarantee.
The parties therefore agree that Medallion shall have the sole and exclusive option
of terminating the guarantee at any time following the effective date such law. In the
event Medallion exercises its option, the guarantee will be prorated to the date of
election.
set forth as stated in the letter of Agreement. Failure by Medallion to exercise its option
prior to the effective date of the do-not-call law shall not constitute a waiver. The option
shall be available at any time throughout the term of the Agreement or any extension
thereof.
IV INDEMNIFICATION
A. By Medallion. Medallion agrees to hold harmless and indemnify SOIA
from and against any and all costs, expenses, claims, actions, causes of action, damages,
judgments, demands, suits, and liability including, without limitation, reasonable
attorney's fees and costs, arising out of, under or relating to, directly or indirectly, the
services, business, or conduct of Medallion or its employees or agents in connection with
this Agreement, including, but not limited to any suits, actions, causes of action,
damages, judgments, demands, or claims made by vendors, suppliers, or creditors of
Medallion, or made by any person alleging harassment or invasion of privacy, or
Agreement
Page 6
V. COMPENSAnON
SOIA shall compensate Medallion for its efforts under this Agreement at the rate
of thirty ($30.00) Dollars per hour inclusive of Coaches/Trainer training hours for the
period of January 1, 2011 through December 31, 2011. Medallion shall provide invoices
on a timely basis to SOIA for review. If overall collected revenue does not exceed the
cost, Medallion agrees to absorb the loss.
SOIA is to pay weekly to Medallion the agreed upon hourly fee . Payment will be
transferred directly into the Medallion account 0067903, ADA # 082001247 at the
Metropolitan National Bank in Little Rock, Arkansas on Thursday of each week.
As a material condition to include SOIA to enter into this Agreement,
Medallion has represented to SOIA that it will issue a statement providing a guarantee of
minimum level performance under the terms of this Agreement. Failure to issue this
guarantee of minimum level performance shall entitle SOIA to terminate this Agreement
on the 30th day after commencement of the term of this Agreement.
VI LIST OWNERSHIP
Medallion agrees to provide, upon request and at the expiration or termination
of this contract, a list including contact names who have responded positively to SOIA
call for an affirmative act. Medallion shall provide to SOIA the survey of the calls to
Agreement
Page 7
VII DATABASE
Donor List Requirements shall include the following:
1. SOIA acknowledges that Medallion maintains a proprietary master composite
file containing the name, address and other information of businesses that have
or may respond positively to direct response outreaches by charitable
organizations.
2. Donor names, addresses, phone numbers and contributions provided to
Medallion by SOIA will not be included in this master file for the mutual benefit
of other Organizations.
3. Medallion will regularly update the donor file for the purpose of list
maintenance. These revisions shall be forwarded to SOIA on an as needed basis
4. Maintenance of a reasonable "Do Not Contact" file for direct mail and
telemarketing are to be reported to a representative of Medallion responsible for
list maintenance.
5. Medallion shall route all names of individuals who request no solicitation to
SOIA upon request.
Agreement
Page 9
XV RENEWAL OPTION
This Agreement shall automatically be extended for one additional (1) year unless
either party shall give notice of its intention to allow the contract to terminate not less
than ninety (90) days prior to their expected date of the primary term.
IN WITNESS WHEREOF, the parties have hereunder set their hand and seal,
with the date of execution by Special Olympics Iowa specified to be the day and year first
above written, and by Medallion on the date set forth below.
APROVED:
BY: BY:+~
7\C "'>
,/ ,67451 vEAJ r ~ EO
TIT__ TITLE
TITLE
DATE: ,-, l
.-
COPILEVITZ & -CANTER, LLC
ATTORNEYS AT LAW
SUITE 300
The above referenced organization is a professional fund raiser currently registered with
your office. The Heritage Company, Inc. entered into a contract with the above referenced
charitable organization. They have asl~ed that I forward this contract to you.
Thank you for your attention to this matter. please feel free to contact me should you have
any questions regarding this matter.
Rose M. Whitsitt
Legal Assistant
For the Firm
:rmw
Enclosure
rose@cckc-law.com
WashinglOn D .C. Office: 1900 L STREET. SUITE 2 15. WAS HINGTON , D .C. 20036 • (202) 86 1-0740 • FAX (202) 33 1-984 1 • E-MAIL copcandc@aol.com
Attorney General Tom Miller
515-281-5926
E-mail: consumer@ag.state.ia.us
Please notice that the registration requirement is only for professional commercial fund
raisers as defined in Iowa Code Chapter 13e. Charitable or~anizations as defined in this
Chapter are not required to register.
Professional commercial fund-raisers must also complete the attached form, "Charitable
Organization Financial Information Disclosure Form," for EACH charity for which you
raise funds.
1. Name of Professional Commercial Fund-raiser, including any d/b/a and trade names:
2. Address and telephone number of each office, chapter, branch or affiliate. Indicate the principal
place of business:
Sherwood, AR 72120
501-835-5000 "
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3. Formofbusiness~C~o~r~p~o~ra~t~io~n~_____________________________________________
(Individual , Partnership, Business Corporation, Nonprofit Corporation, etc.)
5. Full name, title, address and telephone number of each officer, director, partner or managing
agent of the professional commercial fund-raiser:
6. Name, address, telephone number and title of the following person(s) for the professional
commercial fund-raiser:
John C. Braune
c. The person(s) who directs and controls the activities of the professional commercial fund
raiser:
U~E A~ Mo(l~
d. The person(s) responsible for custody of the professional commercial fund-raiser's records:
Jamt: ~ M.ov£
e. The person(s) responsible for custody of all funds raised by the professional commercial fund
raiser:
J~ fib It&tI£
-2
f. All persons managing or supervising fund-raising activities in or from Iowa:
Please refer to attached list of Phone Room Directors.
7. Has the professional fund-raiser or any of the persons listed in response to Numbers 5 or 6 ever
been a party to any litigation, criminal or civil, involving claims of theft, fraud, unfair or
deceptive trade practices, conversion, mismanagement of funds, breach of fiduciary duty, or any
other claim involving alleged dishonesty?
oYes'&No If yes, attach detailed explanation as to agency involved, date, court, claim and
disposition. Attach copies ofall complaints, petitions, settlement agreements, plea agreements,
assurances, consent judgments, final judgments, convictions, and/or other agreements or orders
resolving the matter.
8. Name, address and telephone number of the registered agent for service of process in Iowa:
10. Has the professional fund-raiser's right to solicit funds ever been denied, suspended, revoked or
enjoined by any state or by any court, or are there any such proceedings pending?
11. Has the professional fund-raiser been the subject of a legal, administrative, or other proceeding
regarding any solicitation or registration as a solicitor or fund-raiser? If so, state the date,
location and nature of each such proceeding and the outcome of the proceeding.
/ilIff
12. Does the professional fund-raiser have custody of or access to contributions from a solicitation at
any time?
OYes l'§i:INo
13. Does registrant anticipate that any of the services it will provide to charitable organizations will
be provided by another entity under a subcontractor arrangement?
DYes XlNo If yes, please identifY the charity and the subcontractor below: (Attach a
list if more room is needed.)
-3
Charity Subcontractor Name & Address
Is registrant's contract with subcontractor filed with the office of the Iowa Attorney General?
14. Complete a Financial Information Disclosure form for each charitable organization for which you
will be soliciting money in or from Iowa.
Note: Ifadditional contracts are entered into after the filing of this registration statement, submit a copy
of the new contract at that time.
Note: All information and documentation provided as part of this registration, including this form are
public records and all or some may be open to public inspection pursuant to the Iowa public
records law, Iowa Code chapter 22, and the Iowa Attorney General's Administrative Rules
relating to public records, 61 lAC chapter 2.
SIGNATURE
T hereby certify that Tam authorized to sign this Registration and that the information provided is
true and complete to the best of my knowledge.
Date «;/(' )
/'(J John C. Braune
Name (Print)
President/CEO
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i ture
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The Heritage Company, Inc. FEIN:
Sherwood, AR 72120
Sherwood, AR 72120
Sherwood, AR 72120
501-821-6480
# ansas Children's Hospital Foundation, 800 Marshall Street, Slot 661, Little Rock, AR 72202
/ Campaign Period: 05-04-2010 to 04-04-2011
Aildren's Wish Foundation International, Inc., 8615 Roswell Road, Atlanta, GA 30350
Campaign Period: 01-01-2007 to 12-31-2010
~listed Association National Guard oflowa, Camp Dodge, 7700 N.W. Beaver Drive, Johnston, IA
50131-1902
/ Campaign Period: 11-14-2008 to 05-31-2011
V£nlisted Association of the National Guard of the United States, 3133 Mount Vernon Ave., Alexandria,
VA 22305
Campaign Period: 01-01-2010 to 08-31-2011
~thers Against Drunk Driving, 511 E. John Carpenter Freeway" Suite 700, Irving, TX 75062
Campaign Period: 07-01-2005 to 06-30-2011,07-01-2005 to 06-30-2011
~ltiple Sclerosis Association of America, Inc., 706 Haddonfield Road, Cherry Hill, NJ 08002
/' Campaign Period: 07-01-2008 to 06-30-2011
vNational Caregiving Foundation, 801 N. Pitt Street, # 116, Alexandria, VA 22314-1765
/ Campaign Period: 02-23-2009 to 12-31-2012
Yromenade Nationale Corporation, 777 N. Meridian Street, Suite 300, Indianapolis, IN 46204-1420
/ Campaign Period: 10-20-2009 to 09-30-2011
~ecial Olympics Iowa, P.O. Box 620, Grimes, IA 50111
Campaign Period: 01-01-2009 to 12-31-2011
~National Children's Cancer Society, Inc., One South Memorial Drive, Ste. 800, St. Louis, MO 63102
, / Campaign Period: 01-01-2010 to 12-31-2012
JJ11ited Breast Cancer Foundation, Inc., 223 Wall Street, Suite 368, Huntington, NY 11743
Campaign Period: 03-18-2010 to 02-24-2015
CHARITABLE ORGANIZATION FINANCIAL INFORMATION DISCLOSURE FORM
2. Identify the charitable organization for which you will be soliciting money within the
State of Iowa during this registration period. (Ifmore than one charitable organization,
file a separate Financial Information Disclosure form ·for each.)
319-290-0901
C. Name, title, address and telephone number of the contact person(s) for the
charitable organization:
4. Is the contract between the professional fund-raiser and the charitable organization on file
with the office of the Iowa Attorney General?
7. If soliciting will be conducted by telephone, provide the following regarding the location
from which calls will be made. (Ifmore than two locations, continue on a separate sheet);
Room 1
Page 1 of 5
.- - .
-- /-'.-. l'
\-' - - .
\
Please
a. Address of telephone room (Include street, city and state): _ _ ___ see
_attached
_ _ _ __.
Room 2
8. Will the solicitation campaign involve the sale of goods or services? D Yes Qll No
9. .Will the professional fund-raiser collect donated funds directly from the donor(s) in person?
DYes fiNo
If ''No,'' describe how the funds will be collected. Donorswill be sent all printed materials in thE)
mail with an invoice stating the pledge amount made on the pnone. Pledges Will be sent
to a drop box in the name of the AMVETS, Dept. of Iowa and checks will be made
payable to AMVETS, Dept. of Iowa.
10. If contributions will be made by mail, identify all addresses to which the mail will be sent.
If any of the addresses are different than the addresses listed in response to question 2B,
please state: (1) whether the address is that of a post office box, commercial mail service,
bank of the professional fund-raiser or the address of a charitable organization; (2) the
identity of the individual or entity responsible for collecting mail containing contributions.
Page 2 of 5
Funds are sent to PO Box 42006, Urbandale, IA and then forwarded to our
caging center US Billing, 10012 W. Capitol Drive Milwaukee, WI 53222
The mail is opened, entered into the comPI/ter and deposited in the AMVFTS,
Department of IA bank account .
TCF Bank, 500 W. Brown Deer Rd., Milw., WI 53202 Account # 373066185
11. State which of the following has the authority to withdraw the funds from any banking.
account (check all that apply):
~Yes ONo
13. On an attached sheet, describe the charitable program for which the solicitation campaign is
being carried out.
Page 3 of 5
FINANCIAL INFORMATION
State the following infonnation and indicate the applicable time period and dates (either the last
completed fiscal year or the previous twelve months): . 6-1-07 thru 5-31-08
a. Total amount of money collected by the professional commercial fund-raiser in
any manner on behalf of the charitable organization:
$174 ,130.00
b. Itemize the source(s), and dollar amounts per source, of all funds collected on
behalf of the charitable organization: (contributions or donations; payments for
. tickets to events, government grants, private charities, foundations, etc.):
Donations and Contributions
(2) Total not given to charitable organization but expended on behalf of the
charitable organization: Itemize by dollar amount based on the following and any
other applicable categories: salaries/commissi9!lS/compensation; rent/mortgage;
transportation; professional services (attorneys; accountants, etc.);
advertising/promotion, etc.:
(3) State the total dollar amount billed to the charitable organization by the
professional commercial fund-raiser and itemize each such billing by purpose and
amount:
$154,130.00
Page 4 of 5
Note: Any changes or additions to the information provided in this notice must be reported
immediately.
SIGNATURE:
State of Wisconsin )
) 5S.
County of Milwaukee )
1, Susan.J Wood , being first duly sworn on oath, depose and state that I am a
managing agent of the professional fimd-raiser; that I have read the contents of this Charitable
Organization Financial Disclosure Form; that I know the contents thereof; and that each
Page 5 of 5
CHARITABLE PURPOSE
OSHKOSH OFFICE
323 N. Sawyer Street
Oshkosh, VVI 54902
Phone: 920-236-9058
Fax: 920-236-9059
XENTEL INC. ("XI") and the AMVETS, DEPARTMENT OF IOWA ("Sponsor") hereby enter into this
agreement "(AGREEMENT") on this 23 rd day of April, 2008, and covenant and agree as follows:
1. REPRESENTATIONS BY XI
XI is a corporation duly organized and validly existing in good standing pursuant of the laws of the State
of Delaware. XI is registered as a professional solicitor pursuant to Iowa law, and has all necessary
licenses and permits and full power and authority to carry on its business as contemplated by this
agreement. XI has fuUlegal right, power and authority to enter into this Agreement and to undertake the
actions to be performed under this Agreement. XI may, in its sole discretion, assign this Agreement or
any portion thereof to a bona fide third party contractor provided, however, that such third party provides
such undertakings and assurances as required by the Agreement.
2. REPRESENTATIONS BY SPONSOR
Sponsor is a not for profit Iowa corporation duly organized, validly existing and in good standing
pursuant of the laws of the State of Iowa. Sponsor has full legal right, power and authority to enter into
this Agreement. Sponsor is an organization that is exempt from federal income tax under Section 501
(C) (19) of the Internal Revenue Code of 1986, as amended (the "Code").
3. GRANT OF LICENSE
Subject to the conditions specified in the Agreement. Sponsor grants to XI an exclusive limited license,
during the term of this Agreement, to use the name "AMVETS, Department of Iowa" and the Sponsor's
logo, for use in conducting public awareness programs and/or promotion of the campaign (as defined in
Paragraph 6 below), and for no other purpose. Sponsor agrees not to engage in any residential or
business telesales solicitation campaign within its jurisdiction during the term of this agreement, or any
extension thereof, without first obtaining the written consent of XI. XI may withhold same in its sole
and exclusive discretion.
4. WARRANTY
Sponsor warrants that it has the right to license the use of its name and that XI's use of the Sponsor's
name as described in Paragraph 3 above will not violate the proprietary rights of any third party.
Sponsor further warrants, during the term of this Agreement, not to enter into any other license
agreement with, or otherwise, allow itself, of any third party to use the Sponsor's name in any other
fundraising campaign in connection with the promotion or presentation of any amusement enterprise,
without prior consent of XI. Sponsor warrants that they will provide full cooperation and its goodwill in
the performance of this agreement.
Contract #: 4511
Ent. 4/23/08 DB
5. PROPRIETARY RIGHTS
Sponsor's name and logo, as described in Paragraph 3 above, shall remain the sole and exclusive
property of Sponsor at all times. Without the prior written consent of Sponsor, XI shall not sublicense
the use of Sponsor's name or logo to any individual or entity, or make any use of Sponsor's name or logo
except as expressly authorized in this Agreement. In the course of performing its obligations under the
Agreement, XI may generate or create tangible and intangible data, documents, and other materials
(collectively, "Work Product"). XI shall be the sole and exclusive owner of all of its Work Product and
all proprietary rights (including copyrights) therein. The ownership and right to these Work Products is a
material inducement to XI to enter into this agreement.
XI agrees to supply public awareness services as follows: XI agrees to conduct a public awareness
campaign on behalf of Sponsor throughout the State of Iowa. XI also agrees to publish no less frequently
than five (5) times per year Sponsor's official newspaper The Iowa Amvet (hereinafter sometimes
referred to as "the publication") and the Convention Yearbook.
XI will publish the Publication five (5) times per year in February, April, August, October and December
with not more than 8,500 copies per edition and with distribution of same by XI to Sponsor membership
throughout Iowa. The Convention Yearbook is to be published in June throughout the term. Sponsor
shall make available to XI at no cost to XI, Sponsor's non-profit second class mail permit for said
membership distribution and the cost of such postage shall be at XI's expense. Sponsor shall notify XI
on a timely basis of the Sponsor representative with whom the publication schedule should be discussed.
Sponsor shall, at its own expense, furnish at least sixty (60) days prior to publication: articles
appropriate in length and number to fill each publication with a balance of fifty percent (50%)
commercial acknowledgements and residential sponsor listings.
The publication shall have no more than 50 pictures per issue and shall be no longer than 18 pages in
length. Bulk shipments shall not exceed 25. XI agrees to maintain a 30 day turnaround on production.
XI shall have exclusive control and responsibility for the publishing of the five newspapers and
Convention Yearbook each year, including but not limited to, key lining, typesetting, editing, printing,
layout and design. All editorial development is under the control of Sponsor. XI shall have the right to
write or edit articles submitted by Sponsor for newspaper and yearbook with the exception of printed
materials, excluding advertisements/acknowledgements (subject to fmal approval of Sponsor or
representative of Sponsor who has authority to approve such writings). Sponsor shall designate
authorized representatives to XI prior to the publication deadline.
XI shall bear all costs and expenses of the campaign. XI maintains the right to conduct tele-sales to
businesses and residences. XI will secure all necessary permits, specifically including, but not limited to,
sales tax permits, registrations, and licenses within the jurisdiction where such productions and
solicitation are held. In the event legal expenses are incurred as a result of the solicitation campaign of
the promotion of conduct of the campaign covered by this Agreement as a result of the actions of XI, XI
agrees to indemnify and hold harmless the Sponsor. XI has all responsibility for all costs of the
promotion, conduct, and arrangement of the campaign. XI also assumes all responsibility for complying
with all registration and reporting requirements pursuant to the rules promulgated by the appropriate
state agencies. SPONSOR MAY BE REQUIRED TO REGISTER WITH THE STATE (S) IN
WHICH IT OPERATES. TIDS SHALL BE THE SOLE RESPONSffiILITY OF THE SPONSOR.
7. QUALITY CONTROL
XI agrees to refrain from engaging in any activities that would adversely affect the reputation of Sponsor
or its members or violate any County, State or Federal Laws or regulations relating to the fulfillment of
this Agreement. XI further agrees that its employees and agents shall not at any time represent, directly
or indirectly, that they are Sponsor personnel, and such employees and agents and any printed materials
shall clearly state that XI represents Sponsor. XI and any employees, agents, solicitors or subcontractors
of XI are not agents of Sponsor.
During the term of this agreement, all monies collected from any source whatsoever through the
solicitation campaign shall be made payable to "AMVETS, Department of Iowa" and shall be delivered
and or deposited into a bank account opened by and under the sole control of the Sponsor within the
State of Wisconsin no later than two (2) days after receipt.
(a) The Sponsor shall receive fmancial statements from the bank showing all deposits to,
withdrawals from, and other activity within. Except for any required holdback revenue
received shall be transferred to XI weekly.
(b) The Sponsor shall be guaranteed quarterly royalty payments from XI in the amount
of Five Thousand Dollars ($5,000.00) payable on September 1, December 1, March 1 and
June 1 during each year of this Agreement, which shall be payable directly to the Sponsor.
(b) XI shall pay all costs of the events and the solicitation campaign, as outlined in this
agreement, from the bank account maintained by Xl.
(c) Either party reserves the right to renegotiate the guaranteed royalty payments received by
the Sponsor on an annual basis. Upon the Sponsor's written request, XI shall, at its
expense, furnish to the Sponsor copies of fmancial records reflecting the gross and net
sales, percentage of production/collections, and all expenses incurred by each "event" and
for all prior periods during which this contract was in effect.
The Parties acknowledge that 10% of XI revenues will be considered as a consulting fee and the balance
will be considered to off-set the cost of operating overheads including: telephone, wages, printing, event
and venue costs, office rent, etc.
The Sponsor agrees to open a merchant credit card account with the designated credit card processor so
XI may accept credit card payments on the Sponsor's behalf. Credit card payments accepted on the
Sponsor's behalf will be deposited into the Sponsor's bank account by the credit card processor in
accordance with their usual business practices. All ongoing monthly charges and transaction fees
including chargeback fees, ACH Reject Fees, account maintenance fees, internet gateway fees, rejection
fees, and any other credit card account related charges relating to the Sponsor's credit card accounts will
be at the Sponsor's expense and charged directly by the credit card processor.
The Royalty as set out in paragraph 8 herein, is contingent upon the continued cooperation of the
Sponsor and shall be subject to re-negotiation in the event of the following:
(a) Either party shall become the subject of adverse media publicity that results in a
significant demonstrable reduction in sales;
(b) A regulatory body publicly releases a decision in an adjudicated case that a violation has
occurred in the conduct of the campaign that results in a significant demonstrable
reduction in sales;
(c) The occurrence of an unforeseen event such as but not limited to a labor strike, natural
disaster, act of war or terrorism, or any other cause beyond XI's control that results in a
significant demonstrable reduction in sales;
(d) Any law or licensing provision shall be modified as to materially affect the conduct of
business as contemplated herein.
The parties hereto intend that the payment under Paragraph 8 shall be treated as a royalty under Section
512 (b )(2) of the Code. To maintain compliance with the Code, Sponsor reserves the right to amend or
revoke this Agreement in the event of administrative or judicial fmdings inconsistent with the reporting
of Sponsor as a result of the Agreement.
(a) Sponsor shall provide XI written notice of its intent sixty (60) days before the effective
date of such amendment or revocation, which period shall begin on the date of mailing.
If Sponsor chooses to amend the Agreement, said amendment must be agreed upon by
XI.
(b) Should any Event arrangement be commenced before the sixty (60) day notice, this
Agreement, as written, shall remain in effect until there has been full contract
performances necessary for completion of such Event, including payment of all
expenses.
This Agreement contains the entire agreement between the parties and may not be amended or
supplemented except by written agreement executed by XI and Sponsor. There is no verbal
understanding that would alter or amend this Agreement.
In the event that there is any dispute concerning the terms and conditions of this Agreement, the parties
agree to submit to binding arbitration pursuant to the rules of the American Arbitration Association and
the prevailing party in any arbitration shall be entitled to an award of reasonable attorney's fees and
costs.
Until signed, this contract constitutes an offer to provide services. In order for XI to properly license this
Agreement and execute it's responsibilities in a timely manner this offer must be accepted and returned
by , 2008. In the event that such acceptance is not forthcoming by this date, then
XI reserves the right to withdraw this offer.
14. TERM
This agreement shall be in force for a period of 36 months commencing June 1, 2008 and expiring May
31,2011.
A leader since 1944 in preserving the freedoms secured by America's Anoed Forces, AMVETS
provides, not only support for veterans and the active military in procuring their earned entitlements, but
also community services that enhance the quality of life for this nation's citizens.
16. CANCELLATION
This Agreement shall be canceled and terminated upon the happening of any of the following events:
b) In the event that XI determines that available revenue is not sufficient to make campaign
economically viable, XI shall have the right to cancel and terminate this AGREEMENT effective ninety
(90) days following delivery to Sponsor, personally or by certified mail, of written notice of such
cancellation.
c) In the event that XI shall be in breach of any of the terms and provisions of this AGREEMENT
and shall not take affirmative action to correct the same within thirty (30) days following receipt of
written notice of such breach, Sponsor shall thereupon have the right to cancel and terminate this
Agreement, by majority vote of its Board of Directors, upon delivery, personally or by certified mail, of
60 days written notice of such cancellation.
d) Following notice of cancellation or termination, XI may continue to solicit support until the
effective date of such cancellation or termination, or until such earlier date as XI shall determine.
Following cancellation or termination, XI shall continue to account for and pay any and all royalties in
the manner set forth in numbered section 8 of this Agreement attributable to support sold prior to the
effective date of cancellation or termination to the extent that such revenues are ultimately collected and
duly paid by respective supporters.
e) Upon termination of this Agreement for any reason whatsoever, XI shall continue to bill contributors
for 90 days on sales made prior to the termination. Collections resulting from sales made prior to
termination shall be processed in the usual manner as prior to termination for a period of 180 days after
the termination date.
17. NOTICES
Notices pursuant to this Agreement shall be sent certified U.S. Mail, return receipt requested, to the
following addresses:
Omaha, NE 68167-1303
Tel.#: 402-896-8044
IN WITNESS WHEREOF, the parties hereunto affixed their hands on this _ _ day of
_ _ _ _ _-', 2008.
XENTELINC.
Da~
BY~
Witness
Witness
By: ~dL~2--'
Verne H. Drews, Finance Officer
1420 South 320d Street
Clinton, IA 52732
563-243-3769 res
563-243-3252 fax
Ruthverne@mchsi.com
STATH OF IOW~ ~ ret
IN THB IOWA DlSTlUCT COURTFORPOlX COUNTY
:T."'TJ
THOMAS J. MILLlIR, } !£! ("')
ATIORNBY GIlNERAL O}l IOWA, ) or Col)
99AG25112, ) E ~J'T1
..0
Assistant Attorney General Steve 81: Clair with ibis Conscot Judgment and having reYiewed the
IDom this matter, determines that fiDaljucJameut MouJd be eatered bm:io, and find. 8S follows:
1. Plaintiff State of Iowa ex rd. Tboma& 1. Mitter. Iowa Attorney General. has filed a
Petition in EquIty aaahW Xem~ lno. C~ pwwant to Iowa ~ § 114.16 (2003). the
Iowa Consumer Fraud A~ asking tb& Coort to ooter this Consent Judgment, wJIlth has been
approved by both PJaintltt and De&ndant.
3. De1bndant denies wrongdoing or tiab~ ofany kind, but has ssreed to eDtty ofthis
Coment Jud8lllen1 in order to resolve its dispute with plalntilf. TbiJ ConllMt 1udsmem aball nm
be u&ed as any evidence ofwrongdo1n8 or liability on the part ofDefmdant.
Defendant IWd its principals, employees, agents, servants, representatives, subsidiaries. affilJates,
- 1•
successors, mans. parent or oontrolling entities, and an other persons, COrpomtiOllB and other
entitles miDg in concert or participating YIith De&ndant who have actual or oonstruotlvo notfco
Qr the Court'. htfunctlon are eIli~ ftum ongaslns In the acts and practices set £oJ11l In the
lettered subparagraphs below, to tho oxtw the conduct 10 qtre$11on Is directed to an Iowa resident
or performed by a person in Iowa In tho «lUt$O ofDefendMt', iUndraising. For p!UlI06e8 ofthls
injunctive paragraph and the lettered subparasraplJs:
"FtmtlroI.rIn[f means any and all fonns of ootl.citfng donations and/or mlatng
fUnds tor a donee organization, pursuant to aa agreement that provides iorer aUa
for how the proceeds offundtaising are to be divided between Defendant ad the
"TSK' stands for Telephone Sales RepresentatIve. and includes each person who
8CC8 for Defendant, whetfIeI" as an employee of D6~ as an independent
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such support Is so1i(;ited, whether or not the person in fact provides IUlY BUpport.
fundralslng.
A. Indkatlng that a TSR. js a membft ofa doDefl orsanJ!ation, or fs anytb.Ins other than a
paId prcfuslonal ihodfaiwwitb no oilier coonectIon to such entity.
B. Iodfoating that a substantial portion of a donatfon will go to the donee cuganhatiOJl, or
for acharftablo or other pwpose for wbi~h funds lIfO soHclted, .ifIn fact less than so % ot donated
funds go to IIQcb eSJtity or purpose after ~ has received its share. Without IimitfJIa tb8
ibregoiJlg. a repmentation by a TSR that a donor's cbeok or donation will be sent directly to the
donee organization, or that tho doDee orgauization controls the fimds. is misleadJns unless
accompanied by woo addiOOnaJ explanation or tho iOOJal distribution of donated funds 81 is
necwaIJ to S1a1o bow the .funds are divided.
C. Indioadng that the TSR. is oalliDg from some location ollIer than the IooatiOD from
0.. AttemptioB to co.llect from a consumer on a supposed pledae when in ftIct the Xentd
tepre.sentalive(s) ~ such Ilttempllmcw or should havo known that tho co~er did not
make the pledge in questIon unless it is estabUshed tblt 8uob attempt to collect was tho result ola
good £aith error.
H. Falling to state during a il.uldmlsing call nnd prior to any sollcltatlon offunds, that tho
C4Iler ill 8Il mlployee ofXente1 and that Xentel fB a profess.looal furuirajser.
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I. FundnIJs1o& OD behalf' or a 8lOOP that holds itselfout as oue represenlin& assistJD& or
as"ociDted with jlro flghters. In tho area served by a me departmen1, ff the head of such
department (typlca1Jy the Seo dUd) provlously bu submitted to De&adant a written request that
DeRmdant (or the donee ol'glUllzadon In question) not ralao funds there. PJaJntift" agrees not to
initiate contact with any department or Us oftlclaJs for the purpose of so!ldtlna the making of
written requms as referred to bernini however, notJllns herem ~ prevent Plaintiff from
otherwi!e lnfurtnina anyone ofany oftbo1cImS ofthfs Consent J'udgment
1. To 111& ment 1hat fundraJslnS is undertaken on bebalfofa group that holds ftself out as
one represerrtin& assisting, or associated with a particular oalegocy t)f law eafon:emem Of
emcrgenllY aemces (e.g., sherlff3J, sherifra deputies, pollee, state troopers. highway patro~
services agency in tba same category, if tho heIuJ of sueh agency previously bas submitted to
l>eftodam bused on aood and proper WIse It written request that DefbuIant (or the donee
organization in question) not rals" funds thero. Ptalntiff 8Bfee8 not to Jnitiate comact with any
aaatcy or Jts offida}s for the purpose of eo1lclting the making ofwritten request! as reftm:d to
herelo; however, nothfng beJein shaD pteVeIII Pia.lntltf tl'om otberwlse Intarmlng anyauo of MY
oftbo terms oftbi8 Con&mt Judgment.
K. ProvidinS to TSRs. or IlIlY employee who direeUy supervises TSRs. any f()tm of
performallCe bonug, suoh as a pay boost, periodic bollus, or other fIlIanctallncentive, based on
tho number ofdonations or dollar vo1un1e of d01llUlons pledged. or tho number or dollar volume
of doDfttions received. unlw the provi9ion of sUclt peribrmanca bonus Is abo expressly
continsent on COmpJiIlllW by the TSR or supervisor receiving the bonus with the requirements of
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1hI, «Instnt judgment. company pollcleB, procedures and pracdces establlshed and purSlWlt
(mcludiDg llISt known addresses and phone numbers, and beginning and endiJl8 date3 of
OOlployment) who left Defe.ndant at any timo In the sixty (60) days preceding ~ of the
request, provided however that such request be mado no ~ often than once ~ch cakndar year
unless triggered by a complaint ftom an lowa resident regardJng Defendant's fundtaiaing
PCKtices.
M. FalliDg to establlsh procedur~ poUcles and practices reasonably designed to ensure
that each telephone aU) made to IUl Iowa co.nswne.r is recorded, and that lIUCh recordings are
preserved intllCl for at least ninety (90) days.
N. Fa.Ulng to provide to the oftk:c of tho Iowa Attorney GentraJ. within five llusiness
days Clf reeelpt ofa written (UlCludins faxed Of o-mPlled) request from that ofIlc&, a fhlthful copy
rep~tive ofDef\lndam. To trigger th1s requ1rement, the Attorney General'" written. request
mlIBt provide tIKI Jl!lDle and telephone IIlm!ber of the Iowa resident, tile substance of the
complaint by the remdem (as close to verbatim a8 pOSIRllo), tlJ~ date of thll solicitation, and, if
pmct1cabl~ the IIPp~e tin:le of'tM solicitation, and JIl:Wt bo teeoived by Defendant (or
Defendan,'s oollnsel) plior to the nInety-first day after the call W88 made.
O. Falling within thirty (30) days of entry of this Consent Judgment to implement a
procedure under whioh Defendant's aupuvisoJY personnel Hsten to no fewer than ()ItEt hundred
(l00) caI1s per mmtth from eIloh «Ill contei' that is engaged in making calls to residents of rowa,
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and take appropriate measures to remedy ~ deviation on the part of TSRs ftom the
reaaonably desiilted to ensure that Defe!Jdantfs employees. subconttactors, 8IId other egents are
in full complianco with 'the iujuncmvo provisions of this Consmt Judgment that apply or may
apply to their conduct; provided, llowmr, that this subparllgfllph aba11l1Ot requlre such a de8l'e8
of control ovet' the policies and pw:t1ces of independent oontractors as would render IRIch
amcWl! provided for by Iowa Code § 114.16 (7), namely $40,000.00. To tho eouem thal Plaintiff
Invokes this provision In C<lnneWOIl with an alleged violation of subpuagraphs A through J
above, it will be a (lOmpleto do1VnsQ to tho imposJdon oftbo penalty des<:ribed In this panl8J1IPb
that the vioJation WIIS isolated and occurred in $pite of procedures and poHcles reasonably
designed to prevenlsuch violation•.
IT IS FURTHBR ORDERlID that Defendant pay to the Treasurer of the Sttrte $30,000
for the oonsumer Jiaud emorcemeDt:fund referred to in lowa Code § 714.I6A (2003) iR thteo
·6 ..
equal JIIOJIthIy Installments of $10.000 commeooin, withln two wee1cs of tho entty of tbts
judgment.
explanation of the provisions of tJlls Consent ludgment contonnl.ns to the dOCUttltnt attae&ed
hereto as ExhibIt A wfthio Bfteen (15) days after the Consent ludsmem b filed to each T~ and
that Deieodanl provide plalntiff wlthbt thIrty (30) days of rums tho affidavit or De&dant's
prealdCllt amstlns to having dono so; for pMSOm who are hired 01 moved into T8R posltlons
after tho fifl.. (15) day~ referred to above. De1Codant sba1I provldo them a copy of the
summary reiWred to above wbhI.n two (2) days of assuming tho position.
It IS PURTRBR. ORDERBP tbat Defendant distributo a copy oftlda COIISeOt 1mfsment
within fifteen (IS) days after its filing to cadl Xentd employee (If Independent conb'actor who
direcdy or JndUecdy 8Up61Vises tile ecdvities otTSRs ('"oovered posfdonf'), and tJJat DeWant
provide Plalntift'VJithin thirty (30) days oftillnS tho a1fidaYit 01 DefMdaDt's pmideut attesting
to Mvin8 exerted best efforts to ensure sueb dlstrlbution; for persons who are hIn:d or moved
Into <:overed posJtlOIl$ eftOf'tho fifteen. (IS) days refmed fO abo\'(\ Defendant 8haIl pro'lide them
Ia copy of the Consem 1udgment referred to above wilbln two (2) days ofasswn.blg the coveted
posiooll.
Dato: I/·';f-or
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EXIIIDITA
515-281-5926
E-mail: consumer@ag.state.ia.us
Please notice that the registration requirement is only for professional commercial fund
raisers as defined in Iowa Code Chapter 13C. Charitable oq:anizations as defined in this
Chapter are not required to register.
Professional commercial fund-raisers must also complete the attached form, "Charitable
Organization Financial Information Disclosure Form," for EACH charity for which you
raise funds.
1. Name of Professional Commercial Fund-raiser, including any d/b/a and trade names:
Xente~, Inc.
2. Address and telephone number of each office, chapter, branch or affiliate. Indicate the principal
place of business:
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3. Form of business Corporation
~~~~~----------------------------------------
(Individual, Partnership, Business Corporation, Nonprotlt Corporation, etc.)
F_e_b_TI_I_aI_1-"-o_2_2...:..,_1_9_9_9_ ____________
Date organized or incorporated__
5. Full name, title, address and telephone number of each officer, director, partner or managing
agent of the professional commercial fund-raiser:
6. Name, address, telephone number and title of the following person(s) for the professional
commercial fund-raiser:
c. The person(s) who directs and controls the activities of the professional commercial fund
raiser:
d. The person(s) responsible for custody of the professional commercial fund-raiser's records :
e. The person(s) responsible for custody of all funds raised by the professional commercial fund
raiser:
Eaeh individual charity has eontrol over their own bank aeeounts
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f. All persons managing or supervising fund-raising activities in or from Iowa:
Please refer to attached list of Phone Room Directors.
7. Has the professional fund-raiser or any of the persons listed in response to Numbers 5 or 6 ever
been a party to any litigation, criminal or civil, involving claims of theft, fraud, unfair or
deceptive trade practices, conversion, mismanagement of funds, breach of fiduciary duty, or any
other claim involving alleged dishonesty?
DYes 00'0 If yes, attach detailed explanation as to agency involved, date, court, claim and
disposition. Attach copies of all complaints, petitions, settlement agreements, plea agreements,
assurances, consent judgments, final judgments, convictions, and/or other agreements or orders
resolving the matter.
8. Name, address and telephone number of the registered agent for service of process in Iowa:
S~~retary of State
10. Has the professional fund-raiser's right to solicit funds ever been denied, suspended, revoked or
enjoined by any state or by any court, or are there any such proceedings pending?
II. Has the professional fund-raiser been the subject of a legal, administrative, or other proceeding
regarding any solicitation or registration as a solicitor or fund-raiser? If so, state the date,
location and nature of each such proceeding and the outcome of the proceeding.
Xent-el, Ine. has entered into voluntary eomplianees in CO, 1\{O, TIT, ND, G~ OR
OR, SC, IA and P A where there was no finding of wI"ongdoing. Please see attaehed
list.
12. Does the professional fund-raiser have custody of or access to contributions from a solicitation at
any time?
DYes ~No
13. Does registrant anticipate that any of the services it wUI provide to charitable organizations will
be provided by another entity under a subcontractor arrangement?
DYes KINo If yes, please identify the charity and the subcontractor below: (Attach a
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Charity
Is registrant's contract with subcontractor filed with the office of the Iowa Attorney General?
14. Complete a Financial Information Disclosure form for each charitable organization for which you
will be soliciting money in or from Iowa. all have been filed
Note: If additional contracts are entered into after the filing of this registration statement, submit a copy
of the new contract at that time.
Note: All information and documentation provided as part of this registration, including this form are
public records and all or some may be open to public inspection pursuant to the Iowa public
records law, Iowa Code chapter 22, and the Iowa Attorney General's Administrative Rules
relating to public records, 61 lAC chapter 2.
SIGNATURE
I hereby certify that I am authorized to sign this Registration and that the information provided is
true and complete to the best of my knowledge.
State of Florida
County of Broward
Signed and sworn to (or affirmed) before me on April 12, 2010 (date) by
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(Seal)
ature of Notary Public)
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#5 Officers and Directors
III ikep@xenlel.colll
(414) 271-2520
davidw@xentel,com
(724) 515-3108
Jlwtt IlI@XellteJ,COIl}
Davie, FL 33328
954·423~3535
joseg@xentel.coJll
Milwaukee, WI 53202
Milwaukee, WI 53202
YEAR 5 (5/1/09 - 4/30/10) Client is guaranteed to receive $275,000.00 per year payable in monthly installments of$22,916.67.
Milwaukee, WI 53202
/
Military Order of the Purple Heart Service Foundation, Inc. Federal ID #39-0983584
7008 Little River Turnpike, Suite I
Annandale, VA 22003
Richard Gallant, President
703-256-6139
Contract Dates: Commencement: 7/1/05 Termination 6/30/06
Contract extended thru 9/30/06 on 6/30/06
Contract extended thru 12/31/06 on 9/30/06
Milwaukee, WI 53217
Newberg, W1 53060
/
American Foundation for Children with Aids, Inc. Federal ID #30-0247823
769 Grant Street Contract cancelled 6/30/07
Lawrenceville, KS 66044
Tanya Weaver, Deputy Director
888-683-8323 717-489-0214 Fax
Contract Dates: Commencement: 6/1/05 Termination 12/31/07
Terms: guaranteed $7,000.00 per month - Client invoiced an all inclusive fee for service of $45.00 per
acquisition line Hour and $58.00 for Retention line hour. Client is guaranteed to receive no less than 10% of the
gross amount of monies collected.
Bank Account: Chase (Bank One) Account #684536295
111 East Wisconsin Avenue
Milwaukee, WI 53202
Milwaukee, WI 53217