Place bar code label here
1. T3010 Charity Information Return
Registered
Protected B when completed
Section A: Identification
•
To help you fill out this form, refer to Guide T4033 (13), Completing the Registered Charity Information Return. It can be found on our Web pages at
www.cra.gc.ca/charities, under "Charities-related forms and publications."
•
The Privacy Act protects all personal information given on this form, which is kept in personal information bank CRA PPU 200. The Canada Revenue
Agency (CRA) will make this form and all attachments available to the public on the Charities Directorate Web site, except for information or data
identified as confidential. All of the information collected on this form may be shared as permitted by law (for example, with certain other government
departments and agencies).
Note: Even if a charity is inactive, an information return must be filed to maintain its registered status.
If you did not receive a barcode label to attach to the return, complete the following:
1. Charity name:
CAMBRIDGE SHELTER CORPORATION
2. Return for fiscal period ending:
Year
Month
3. BN/registration number:
4. Web address (if applicable):
Day
2 0 1 3 / 1 2 / 3 1
89025 9419 RR 0001
cambridgesheltercorp.ca
A1 Was the charity in a subordinate position to a parent organization? . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
If yes, give the name and BN/registration number of the organization.
Name:
1510
Yes
X No
BN (if applicable)
A2 Has the charity wound-up, dissolved, or terminated operations? . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
1570
Yes
X No
A3 Is your charity designated as a public foundation or private foundation? . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
1600
Yes
X
No
If yes, you must complete Schedule 1, Foundations. Refer to Form TF725, Registered Charity Basic Information Sheet, to confirm the designation.
(Form TF725 is part of the return.)
Section B: Directors/trustees and like officials
B1 All charities must complete Form T1235, Directors/Trustees and Like Officials Worksheet. Only the public information section of the worksheet is
available to the public. Charities subject to the Ontario Corporations Act must also complete Form RC232-WS, Director/Officer Worksheet and Ontario
Corporations Information Act Annual Return.
Section C: Programs and general information
C1 Was the charity active during the fiscal period? . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
If no, explain why in the "Ongoing programs" space below at C2.
1800
X Yes
No
C2 In the space below, describe all ongoing and new charitable programs the charity carried on this fiscal period to further its purpose(s) (as defined in its
governing documents). "Programs" includes all of the charitable activities that the charity carries out on its own through employees or volunteers as well
as through qualified donees and intermediaries. The charity may also use this space to describe the contributions of its volunteers in carrying out its
activities, for example, number of volunteers and/or hours. Do not include the names of employees or volunteers. Grant-making charities should
describe the types of organizations they support. Do not describe fundraising activities in this space.
Do not attach additional sheets of paper or annual reports.
Ongoing programs:
- Provided overnight shelter to the homeless, transitional supportive housing
- Provided medical services to the homeless, addiction programming
- Provided food, clothing, furniture to the homeless
New programs:
T3010 E (14)
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Page 1 of 9
Place bar code label here
Registered Charity Information Return
Protected B when completed
Section A: Identification
•
To help you fill out this form, refer to Guide T4033 (13), Completing the Registered Charity Information Return. It can be found on our Web pages at
www.cra.gc.ca/charities, under "Charities-related forms and publications."
•
The Privacy Act protects all personal information given on this form, which is kept in personal information bank CRA PPU 200. The Canada Revenue
Agency (CRA) will make this form and all attachments available to the public on the Charities Directorate Web site, except for information or data
identified as confidential. All of the information collected on this form may be shared as permitted by law (for example, with certain other government
departments and agencies).
Note: Even if a charity is inactive, an information return must be filed to maintain its registered status.
If you did not receive a barcode label to attach to the return, complete the following:
1. Charity name:
2. Return for fiscal period ending:
Year
Month
3. BN/registration number:
4. Web address (if applicable):
Day
A1 Was the charity in a subordinate position to a parent organization? . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
If yes, give the name and BN/registration number of the organization.
Name:
1510
Yes
No
BN (if applicable)
A2 Has the charity wound-up, dissolved, or terminated operations? . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
1570
Yes
No
A3 Is your charity designated as a public foundation or private foundation? . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
1600
Yes
No
If yes, you must complete Schedule 1, Foundations. Refer to Form TF725, Registered Charity Basic Information Sheet, to confirm the designation.
(Form TF725 is part of the return.)
Section B: Directors/trustees and like officials
B1 All charities must complete Form T1235, Directors/Trustees and Like Officials Worksheet. Only the public information section of the worksheet is
available to the public. Charities subject to the Ontario Corporations Act must also complete Form RC232-WS, Director/Officer Worksheet and Ontario
Corporations Information Act Annual Return.
Section C: Programs and general information
C1 Was the charity active during the fiscal period? . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
If no, explain why in the "Ongoing programs" space below at C2.
1800
Yes
No
C2 In the space below, describe all ongoing and new charitable programs the charity carried on this fiscal period to further its purpose(s) (as defined in its
governing documents). "Programs" includes all of the charitable activities that the charity carries out on its own through employees or volunteers as well
as through qualified donees and intermediaries. The charity may also use this space to describe the contributions of its volunteers in carrying out its
activities, for example, number of volunteers and/or hours. Do not include the names of employees or volunteers. Grant-making charities should
describe the types of organizations they support. Do not describe fundraising activities in this space.
Do not attach additional sheets of paper or annual reports.
Ongoing programs:
- Provided a variety of programming including literacy counselling, housing searches, job searches
- Advocated with social services, the courts and probation and parole on behalf of clients
- Provided volunteer placements and job skills training
New programs:
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Registered charities may make gifts to qualified donees. Qualified donees are other registered Canadian charities, as well as certain other
organizations described in the Income Tax Act.
C3
Did the charity make gifts or transfer funds to qualified donees or other organizations? . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
2000
Yes
X
No
2100
Yes
X
No
If yes, you must complete Form T1236, Qualified Donees Worksheet/Amounts Provided to Other Organizations.
C4
Did the charity carry on, fund, or provide any resources through employees, volunteers, agents, joint ventures,
contractors, or any other individuals, intermediaries, entities, or means (other than qualified donees) for any
activity/program/project outside Canada? . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
If yes, you must complete Schedule 2, Activities Outside Canada.
C5
Political Activities
A registered charity may pursue political activities only if the activities are non-partisan, related to its charitable purposes, and limited in extent.
A political activity is any activity that explicitly communicates to the public that a law, policy or decision of any level of government inside or
outside Canada should be retained, opposed, or changed.
(a) Did the charity carry on any political activities during the fiscal period, including making gifts to qualified
donees that were intended for political activities? . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
If yes, you must complete Schedule 7, Political Activities.
2400
(b) Total amount spent by the charity on these political activities. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
5031 $
(c) Of the amount at line 5030, the total amount of gifts made to qualified donees.
(d) Total amount received from outside Canada that was directed to be spent on political activities. . . . . . . . . . . . . . . . . . . .
If you entered an amount on line 5032 you must complete Schedule 7, Political Activities, Table 3.
Yes
5030
$
5032
$
X
No
C6 If the charity carried on fundraising activities or engaged third parties to carry on fundraising activities on its behalf, tick all fundraising methods that it
used during the fiscal period:
2500
Advertisements/print/radio/
TV commercials
2570
Sales
2620
Telephone/TV solicitations
2510
Auctions
2575
Internet
2630
Tournament/sporting events
2530
Collection plate/boxes
2580
Mail campaigns
2640
Cause-related marketing
2540
Door-to-door solicitation
2590
Planned-giving programs
2650
Other
2600
Targeted corporate
donations/sponsorships
2660 Specify:
2610
Targeted contacts
2550
2560
Draws/lotteries
X Fundraising dinners/galas/concerts
C7 Did the charity pay external fundraisers? . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
If yes, you must complete the following lines, and complete Schedule 4, Confidential Data, Table 1.
2700
(a) Enter the gross revenue collected by the fundraisers on behalf of the charity. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
5450
$
(b) Enter the amounts paid to and/or retained by the fundraisers. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
5460
$
Yes
X No
(c) Tick the method of payment to the fundraiser:
2730
Commissions
2750
Finder's fee
2770
Honoraria
2740
Bonuses
2760
Set fee for services
2780
Other
2790 Specify:
(d) Did the fundraiser issue tax receipts on behalf of the charity? . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
2800
Yes
C8 Did the charity compensate any of its directors/trustees or like officials or persons not at arm's length from the
charity for services provided during the fiscal period (other than reimbursement for expenses)? . . . . . . . . . . . . . . . . . . . . . . .
3200
Yes
C9 Did the charity incur any expenses for compensation of employees during the fiscal period? . . . . . . . . . . . . . . . . . . . . . . . . . .
3400
X Yes
3900
Yes
No
X
No
No
If yes, you must complete Schedule 3, Compensation.
C10 Did the charity receive any donations or gifts of any kind valued at $10,000 or more from any donor that
was not resident in Canada and was not any of the following: . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
•
•
•
•
X
No
a Canadian citizen, nor
employed in Canada, nor
carrying on a business in Canada, nor
a person having disposed of taxable Canadian property?
If yes, you must complete Schedule 4, Confidential Data, Table 2, for each donation of $10,000 or more.
13102
Page 2 of 9
C11 Did the charity receive any gifts in kind (non-cash gifts) for which it issued tax receipts? .....................................
If yes, you must complete Schedule 5, Gifts in kind.
4000
C12 Did the charity acquire a non-qualifying security? . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
Yes
No
5800
Yes
X No
C13 Did the charity allow any of its donors to use any of its property? (except for permissible uses) . . . . . . . . . . . . . . . . . . . . . . .
5810
Yes
X
No
C14 Did the charity issue any of its tax receipts for donations on behalf of another organization? . . . . . . . . . . . . . . . . . . . . . . . . . .
5820
Yes
X
No
X
Section D: Financial Information
Complete Section D only if you do not have to complete Schedule 6, Detailed Financial Information.
Complete Schedule 6 if any of the following applies to the charity:
(a) The charity's revenue exceeds $100,000.
(b) The amount of all property (for example, investments, rental properties) not used in charitable activities is more than $25,000.
(c) The charity has permission to accumulate funds during this fiscal period.
Do not complete Section D if you must complete Schedule 6.
Show all amounts to the nearest single Canadian dollar. Do not enter "See attached financial statements." All relevant fields must be filled out.
4020
Accrual
Did the charity own land and/or buildings? . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
4050
Yes
No
Total assets (including land and buildings) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
4200
$
Total Liabilities . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
4350
$
Did the charity borrow from, loan to, or invest assets with any non-arm's length persons? . . . . . . . . . . . . . . . . . . . . . . . . . . . .
4400
Yes
No
Did the charity issue tax receipts for gifts? . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
4490
Yes
No
If yes, enter the total eligible amount of all gifts for which the charity issued tax receipts . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
Total amount of 10 year gifts received . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 4505 $
4500
$
Total amount received from other registered charities . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
4510
$
Total other gifts received for which a tax receipt was not issued by the charity
(excluding amounts at lines 4575 and 4630) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
4530
$
Did the charity receive any revenue from any level of government in Canada? . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
4565
Yes
No
If yes, total amount received . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
4570
$
Total non tax-receipted revenue from all sources outside of Canada (government and non-government) . . . . . . . . . . . . . .
4575
$
Total non tax-receipted revenue from fundraising . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
4630
$
Total revenue from sale of goods and services (except to any level of government in Canada) . . . . . . . . . . . . . . . . . . . . . . . .
4640
$
Other revenue not already included in the amounts above . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
4650
$
Total revenue (add lines 4500, 4510 to 4570, and 4575 to 4650) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
4700
$
Professional and consulting fees . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
4860
$
Travel and vehicle expenses . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
4810
$
All other expenditures not already included in the amounts above (excluding gifts to qualified donees) . . . . . . . . . . . . . . . .
4920
$
Total expenditures (excluding gifts to qualified donees) (add lines 4860, 4810, and 4920) . . . . . . . . . . . . . . . . . . . . . . . . . . .
4950
$
Total amount of gifts made to all qualified donees . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
5050
$
Total expenditures (add lines 4950 and 5050) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
5100
$
D1 Was the financial information reported below prepared on an accrual or cash basis? . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
Cash
D2 Summary of financial position:
Using the charity's own financial statements, enter the following:
D3 Revenue:
Total tax-receipted revenue from all sources outside of Canada
4571
(government and non-government) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
$
D4 Expenditures:
Of the amount at line 4950:
(a) Total expenditures on charitable activities . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
5000
$
(b) Total expenditures on management and administration . . . . . . . . . . . . . . . . . . . . .
5010
$
13102
Page 3 of 9
Section E: Certification
This return must be signed by a director/trustee or like official of the registered charity who has authority to sign on behalf of the charity. It is a serious
offence under the Income Tax Act to provide false or deceptive information.
I certify that the information given on this form, the basic information sheet, and any attachment is, to the best of my knowledge, correct, complete,
and current.
Signature:
Name (print):
Christine Kecser
Position in charity:
Date:
Telephone number:
EXECUTIVE DIRECTOR
2014/06/25
519 624-9305
Section F: Confidential data
F1 Enter the physical address of the charity and the address in Canada for the charity's books and records. Post office box numbers and rural routes
are not sufficient.
Physical address of the charity
Address for the charity's books and records
Complete street address
26 SIMCOE STREET
26 SIMCOE STREET
City
CAMBRIDGE
CAMBRIDGE
Province or territory and postal code
ON
N1R 8P2
ON
N1R 8P2
F2 Name and address of individual who completed this return.
Name:
Tim Sullivan
Company name (if applicable):
Graham Mathew Professional Corporation
Complete street address:
150 Pinebush Road PO Box 880
City, province or territory, and postal code:
N1R 5X9
ON
Cambridge
Telephone number:
Yes
Is this the same individual who certified in Section E?
519 623-1870
Foundations
X
No
Schedule 1
1
Did the foundation acquire control of a corporation? . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
100
Yes
No
2
Did the foundation incur any debts other than for current operating expenses, purchasing or selling investments,
or in administering charitable activities? . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
110
Yes
No
120
Yes
No
130
Yes
No
For private foundations only:
3
Did the foundation hold any shares, rights to acquire shares, or debts owing to it that meet the definition of a
non-qualified investment? . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
4
Did the foundation own more than 2% of any class of shares of a corporation? . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
If yes, you must complete and attach Form T2081, Excess Corporate Holdings Worksheet.
Activities outside Canada
Schedule 2
For more information about carrying on activities outside of Canada, go to www.cra.gc.ca/charities, select "Policies and guidance," then
"Operating a registered charity" and see Guidance CG-002, Canadian Registered Charities Carrying Out Activities Outside Canada.
1
Total expenditures on activities/programs/projects carried on outside Canada, excluding gifts to qualified donees .......
200
2
Were any of the charity’s financial resources spent on programs outside of Canada under any kind of an
arrangement including a contract, agency agreement, or joint venture to any other individual or organization
(excluding gifts to qualified donees)? . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
210
$
Yes
No
If yes, enter the amounts of the total reported on line 200 transferred to these individuals/organizations as required in the following table:
Name of individual/organization
Using the country codes at the end
Amount ($)
of Schedule 2, enter the code where Show amounts to the nearest
the activities were carried out.
Canadian dollar
13102
Page 4 of 9
3
Using the list below, enter the country code where the charity itself carried on programs or devoted any of its resources.
4
Are any projects undertaken outside Canada funded by the Canadian International Development Agency (CIDA)? . . . . .
220
If yes, what was the total amount the charity spent under this arrangement? . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
230
5
Were any of the charity's activities outside of Canada carried out by employees of the charity? . . . . . . . . . . . . . . . . . . . . . . .
6
7
Yes
No
240
Yes
No
Were any of the charity's activities outside of Canada carried out by volunteers of the charity? . . . . . . . . . . . . . . . . . . . . . . . .
250
Yes
No
Is the charity exporting goods as part of its charitable activities? . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
260
Yes
No
$
If yes, list the items being exported, their value (in Canadian dollars), their destination and the country code.
Item
Value
Destination (city/region)
Country code
Country codes
AF-Afghanistan
AL-Albania
DZ-Algeria
AO-Angola
AR-Argentina
AM-Armenia
AZ-Azerbaijan
BD-Bangladesh
BY-Belarus
BT-Bhutan
BO-Bolivia
BA-Bosnia and Herzegovina
BW-Botswana
BR-Brazil
BN-Brunei Darussalam
BG-Bulgaria
BI-Burundi
KH-Cambodia
CM-Cameroon
CF-Central African Republic
TD-Chad
CL-Chile
CN-China
CO-Columbia
KM-Comoros
CD-Democratic Republic of Congo
CG-Republic of Congo
CR-Costa Rica
CI-Côte d’Ivoire
HR-Croatia
CU-Cuba
CY-Cyprus
DK-Denmark
DO-Dominican Republic
EC-Ecuador
EG-Egypt
SV-El Salvador
ET-Ethiopia
FR-France
GA-Gabon
GM-Gambia
GE-Georgia
DE-Germany
GH-Ghana
GT-Guatemala
GY-Guyana
HT-Haiti
HN-Honduras
IN-India
ID-Indonesia
IR-Iran
IQ-Iraq
IL-Israel
PS-Israeli Occupied Territories
IT-Italy
JM-Jamaica
JP-Japan
JO-Jordan
KZ-Kazakhstan
KE-Kenya
KP-North Korea
KR-South Korea
KW-Kuwait
KG-Kyrgyzstan
LA-Laos
LB-Lebanon
LR-Liberia
MK-Macedonia
MG-Madagascar
MY-Malaysia
ML-Mali
MU-Mauritius
MX-Mexico
MN-Mongolia
ME-Montenegro
MZ-Mozambique
MM-Myanmar (Burma)
NA-Namibia
NL-Netherlands
NI-Nicaragua
NE-Niger
NG-Nigeria
OM-Oman
PK-Pakistan
PA-Panama
PE-Peru
PH-Philippines
PL-Poland
QA-Qatar
RE-Réunion
RO-Romania
RU-Russia
RW-Rwanda
SA-Saudi Arabia
RS-Serbia
SL-Sierra Leone
SG-Singapore
SO-Somalia
ES-Spain
LK-Sri Lanka
SD-Sudan
SY-Syrian Arab Republic
TJ-Tajikistan
TZ-United Republic of Tanzania
TH-Thailand
TL-Timor-Leste
TR-Turkey
UG-Uganda
UA-Ukraine
GB-United Kingdom
US-United States of America
UY-Uruguay
UZ-Uzbekistan
VE-Venezuela
VN-Vietnam
YE-Yemen
ZM-Zambia
ZW-Zimbabwe
Use the following codes for countries not listed above:
QS-Other countries in Africa
QR-Other countries in Asia and Oceania
QM-Other countries in Central and South America
QP-Other countries in Europe
QO-Other countries in the Middle East
QN-Other countries in North America
13102
Page 5 of 9
Compensation
1
Schedule 3
(a) Enter the number of permanent, full-time, compensated positions in the fiscal period. This number should
represent the number of positions the charity had including both managerial positions and others, and should
not include independent contractors. Do not enter a dollar amount. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
300
23
(b) For the ten (10) highest compensated, permanent, full-time positions enter the number of positions that are
within each of the following annual compensation categories. Do not tick the boxes, use numbers.
2
3
305
$1 – $39,999
310
320
$120,000 – $159,999
325
$160,000 – $199,999
330
$200,000 – $249,999
335
$250,000 – $299,999
340
$300,000 – $349,999
345
$350,000 and over
09 $40,000 – $79,999
315
01 $80,000 – $119,999
(a) Enter the number of part-time or part-year (for example, seasonal) employees the charity employed during
the fiscal period. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
(b) Total expenditure on compensation for part-time or part-year employees in the fiscal period. . . . . . . . . . . . . . . . . . . . . .
370
15
380
$
158,261
Total expenditure on all compensation in the fiscal period. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
390
$
1,332,134
Confidential data
Schedule 4
The information in this schedule is for the CRA's use and may be shared as permitted by law (for example, with certain other government
departments and agencies).
1. Information about fundraisers
Enter the name(s) and arm's length status of each external fundraiser.
Name
At arm's length? Yes/No
2. Information about donors not resident in Canada
Complete this schedule to report any gift of any kind valued at $10,000 or more received from any donor that was not resident in Canada and was not
any of the following:
•
•
•
•
a Canadian citizen, nor
employed in Canada, nor
carrying on business in Canada, nor
a person having disposed of taxable Canadian property.
Enter the name of each donor and the value of the gift in the chart below. Tick whether the donor was an organization (for example a business, corporate
entity, charity, non-profit organization), a government or an individual.
Name
Value
Organization Government Individual
Gifts in kind
1
Tick all types of gifts in kind received for which a tax receipt was issued:
500
Artwork/wine/jewellery
525
Ecological properties
550
Publicly traded securities/
commodities/mutual funds
505
Building materials
530
Life insurance policies
555
Books
535
Medical equipment/supplies
560
Other
565
510
2
Schedule 5
X Clothing/furniture/food
515
Vehicles
540
Privately-held securities
520
Cultural properties
545
Machinery/equipment/
computers/software
Specify:
Enter the total amount of tax-receipted gifts in kind . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
13102
580
$
10,255
Page 6 of 9
Detailed financial information
Schedule 6
Complete Schedule 6 if any of the following applies:
(a) The charity's revenue exceeds $100,000.
(b) The amount of all property (for example, investments, rental properties) not used in charitable activities is more than $25,000.
(c) The charity has permission to accumulate funds during this fiscal period.
Do not complete Section D: Financial Information, if you must complete Schedule 6.
Was the financial information reported below prepared on an accrual or cash basis? . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
4020
X
Accrual
Cash
Statement of financial position
Show all amounts to the nearest single Canadian dollar. Do not enter "see attached financial statements." All relevant fields must be filled out.
Liabilities:
Assets:
Cash, bank accounts, and short-term investments
4100
$
Amounts receivable from non-arm's length persons
4110
$
Accounts payable and accrued liabilities . . . .
4300
$
Deferred revenue . . . . . . . . . . . . . . . . . . . . . . . . .
4310
$
Amounts owing to non-arm's length persons
4320
$
Other liabilities . . . . . . . . . . . . . . . . . . . . . . . . . . . .
4330
$
74,090
2,480,582
127,000
1,208,415
Amounts receivable from all others . . . . . . . . . . . . . .
4120
$
Investments in non-arm's length persons . . . . . . . . .
4130
$
Long-term investments . . . . . . . . . . . . . . . . . . . . . . . . . .
4140
$
Total liabilities (add lines 4300 to 4330) . .
4350
Inventories . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
4150
$
$
3,890,087
Land and buildings in Canada . . . . . . . . . . . . . . . . . . .
4155
$
Other capital assets in Canada . . . . . . . . . . . . . . . . . .
4160
$
Capital assets outside Canada . . . . . . . . . . . . . . . . . .
4165
$
Accumulated amortization of capital assets . . . . . . .
4166
$
(584,040)
Other assets . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
10 year gifts . . . . . . . 4180 $
4170
$
77,235
4250
$
Total assets (add lines 4100 to 4170) . . . . . . . . . .
4200
$
4,236,989
4500
$
117,066
Total amount received from other registered charities . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
4510
$
121,599
Total other gifts received for which a tax receipt was not issued by the charity (excluding amounts at lines 4575 and 4630) . . . . .
4530
$
Total revenue received from federal government. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
4540
$
Total revenue received from provincial/territorial governments . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
4550
$
Total revenue received from municipal/regional governments . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
4560
$
Total tax-receipted revenue from all sources outside of Canada (government and
4571 $
non-government) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
Total non tax-receipted revenue from all sources outside Canada (government and non-government) . . . . . . . . . . . . . . . . . . . . . . . . . .
4575
$
Total interest and investment income received or earned . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
Gross proceeds from disposition of assets . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 4590 $
4580
$
Net proceeds from disposition of assets (show a negative amount with brackets) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
4600
$
Gross income received from rental of land and/or buildings . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
4610
$
Total non tax-receipted revenues received for memberships, dues and association fees . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
4620
$
Total non tax-receipted revenue from fundraising . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
4630
$
Total revenue from sale of goods and services (except to any level of government in Canada) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
4640
$
Other revenue not already included in the amounts above . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
Specify type(s) of revenue included in the amount reported at 4650 4655 Sundry
4650
$
2,030
Total revenue (add lines 4500, 4510 to 4560, 4575, 4580, and 4600 to 4650) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
4700
$
2,072,030
338,857
111,832
150,000
4,025,899
117,206
Amount included in lines 4150, 4155,
4160, 4165 and 4170 not used in
charitable activities . . . . . . . . . . . . . . . . . . . . . .
Statement of operations
Revenue:
Total eligible amount of all gifts for which the charity issued tax receipts . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
Total eligible amount of tax-receipted tuition fees . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 5610 $
Total amount of 10 year gifts received . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
4505
$
13102
7,222
16,154
1,543,365
99,267
165,327
Page 7 of 9
Expenditures:
Advertising and promotion . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
4800
$
Travel and vehicle expenses . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
4810
$
Interest and bank charges . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
4820
$
Licences, memberships, and dues . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
4830
$
Office supplies and expenses . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
4840
$
Occupancy costs . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
4850
$
Professional and consulting fees . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
4860
$
Education and training for staff and volunteers . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
4870
$
Total expenditure on all compensation (enter the amount reported at line 390 in Schedule 3, if applicable) . . . . . . . . . . . . . . . . . . . . . .
4880
$
Fair market value of all donated goods used in charitable activities . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
4890
$
Purchased supplies and assets . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
4891
$
118,176
Amortization of capitalized assets . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
4900
$
71,197
Research grants and scholarships as part of charitable activities . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
4910
$
All other expenditures not included in the amounts above (excluding gifts to qualified donees) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
Specify type(s) of expenditures included in the amount
4930 Fundraising
reported at 4920 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
4920
$
29,371
Total expenditures before gifts to qualified donees (add lines 4800 to 4920) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
4950
$
1,942,077
Total amount of gifts made to all qualified donees . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
5050
$
Total expenditures (add lines 4950 and 5050) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
5100
$
Enter the amount accumulated for the fiscal period, including income earned on accumulated funds . . . . . . . . . . . . . . . . . . . . . . . . .
5500
$
Enter the amount disbursed for the fiscal period for the specified purpose . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
5510
$
5750
$
The 24 months before the beginning of the fiscal period . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
5900
$
The 24 months before the end of the fiscal period . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
5910
$
88,044
86,379
180,041
30,314
6,421
1,332,134
Of the amounts at lines 4950 and 5031 (reported at C5 Political Activities (c)):
(a) Total expenditures on charitable activities . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
5000
$
(b) Total expenditures on management and administration . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
5010
$
(c) Total expenditures on fundraising . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
5020
$
(d) Total expenditures on political activities, inside or outside Canada, from question C5 (b) . . . .
5030
$
(e) Total other expenditures included in line 4950 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
5040
$
1,570,765
341,941
29,371
1,942,077
Other financial information
Permission to accumulate property:
Only registered charities that have written permission to accumulate should complete this section.
•
•
Permission to reduce disbursement quota:
If the charity has received approval to make a reduction to its disbursement quota, enter the amount for the fiscal period . . . . . . . .
Property not used in charitable activities:
Enter the value of property not used for charitable activities or administration during:
•
•
13102
Page 8 of 9
Political activities
Schedule 7
A registered charity may pursue political activities only if the activities are non-partisan, related to its charitable purposes, and limited in extent. A political
activity is any activity that explicitly communicates to the public that a law, policy or decision of any level of government inside or outside Canada should be
retained, opposed, or changed.
1
2
Describe the charity's political activities, including gifts to qualified donees intended for political activities, and explain how these relate to its
charitable purposes.
Identify the way the charity participated in or carried out political activities during the fiscal period.
Resources used
Tick all the boxes that apply
Staff
Media releases and advertisements
700
Conferences, workshops, speeches, or lectures
701
Publications (printed or electronic)
702
Rallies, demonstrations, or public meetings
703
Petitions, boycotts (calls to action)
704
Letter writing campaign (printed or electronic)
705
Internet (Web site, social media (Twitter, YouTube))
706
Gifts to qualified donees for political activities
707
Volunteers
Financial
Property
Other (specify):
708
Funding from outside of Canada for political activities
3
If the charity entered an amount on line 5032, complete the fields below. Enter the political activity that the funds were intended to support, the amount
received from each country outside Canada, and the corresponding country code (using the codes provided in Schedule 2.) For more information on how
to complete this table, see Guide T4033 (13).
Political activity
Amount
13102
Code
Page 9 of 9
Protected B when completed
Directors/Trustees and Like Officials Worksheet
2. T1235
You must give us complete information for each director/trustee and like official who, at any time during the fiscal period of this return, was a member of the charity's board of directors/trustees. Directors/trustees
and like officials are persons who govern a registered charity. See the reverse for information on filling out this form.
Place bar code label here
11
Total number of directors/trustees and like officials:
Public information
Last name:
◄
Term
Position:
◄
Position:
◄
Position:
◄
Position:
◄
Position:
◄
Position:
◄
Position:
◄
Position:
◄
Position:
6
0
1
2
0
1
2
0
0
5
0
6
First name:
2
0
0
5
0
6
2
0
0
6
0
6
0
First name:
2
0
0
6
0
6
0
2
0
0
5
0
6
0
First name:
2
0
0
5
0
6
Director
0
First name:
2
0
0
5
0
6
0
X
Yes
No
No
Initial: M.
No
J.
Initial:
No
D.
X
Yes
5 1 9
—
7 4 0
—
6 2 2
1
9
N 1 S 3 L 1
5
3
0
2
0
3
5 1 9
—
6 2 2
No
Cambridge
—
8 2 3
Home address – Street number and name:
Cambridge
Telephone number:
6
2
0
7
1
0
—
7 4 0
Cambridge
—
6 5 8
Home address – Street number and name:
Cambridge
Telephone number:
(Ce formulaire existe en français.)
—
5 1 9
6 2 3
9
Postal code:
Date of birth (Y/M/D):
ON
0 4 1 5
1
9
N 1 S 4 Y 1
5
1
0
4
1
0
Postal code:
Date of birth (Y/M/D):
1
9
N 1 R 2 H 7
5
0
0
2
2
2
2 Jenkings Court
—
ON
0 6 7 8
Postal code:
Date of birth (Y/M/D):
1
9
N 0 B 1 L 0
4
3
1
0
1
1
43 Brooke St
—
ON
5 0 1 0
Postal code:
Date of birth (Y/M/D):
1
9
N 1 R 4 C 2
5
1
0
2
2
0
26 Dundonald
—
ON
0 0 6 4
Postal code:
Date of birth (Y/M/D):
1
9
N 1 S 3 H 3
4
5
0
2
1
9
39 Queen St.
—
ON
4 6 1 5
Postal code:
Date of birth (Y/M/D):
1
9
N 3 C 1 G 2
6
2
0
7
2
8
48 Aberdeen
Prov/Terr:
—
1
154 Concession
Prov/Terr:
5 1 9
Postal code:
ON
0 1 0 1
Prov/Terr:
5 1 9
Home address – Street number and name:
Telephone number:
—
Prov/Terr:
5 1 9
ON
11 Farmstead Place
Prov/Terr:
13102
T1235 E (13)
Postal code:
Date of birth (Y/M/D):
Date of birth (Y/M/D):
Prov/Terr:
5 1 9
Branchton
Telephone number:
City:
End date (Y/M/D):
At arm's length with other Directors?
4 2 3 3
Prov/Terr:
Cambridge
Telephone number:
City:
End date (Y/M/D):
X Yes
Cambridge
Telephone number:
City:
End date (Y/M/D):
Initial:
ON
—
Home address – Street number and name:
City:
Yes
—
Home address – Street number and name:
End date (Y/M/D):
X
—
Prov/Terr:
Home address – Street number and name:
Initial:
X Yes
6 2 1
Cambridge
Telephone number:
City:
Mel
1
No
End date (Y/M/D):
At arm's length with other Directors?
Rose
No
Initial:
Robert
1
Yes
5 1 9
—
Home address – Street number and name:
City:
X
Barbara
1
W.
Initial: R.
Robb
1
Yes
Prov/Terr:
Telephone number:
City:
X
Sharon
1
No
End date (Y/M/D):
At arm's length with other Directors?
Konduros
Initial:
44 Parkwood Drive
Home address – Street number and name:
End date (Y/M/D):
At arm's length with other Directors?
First name:
X Yes
Cambridge
Telephone number:
City:
Randy
1
No
Initial:
Bruce
1
Yes
End date (Y/M/D):
At arm's length with other Directors?
Director
Director
0
First name:
Harrison
Start date (Y/M/D):
1
Home address – Street number and name:
City:
X
Anne Marie
At arm's length with other Directors?
Director
Start date (Y/M/D):
0
Initial:
End date (Y/M/D):
At arm's length with other Directors?
Bendus
Start date (Y/M/D):
0
First name:
Vice Chair
Start date (Y/M/D):
1
At arm's length with other Directors?
Livingstone
Start date (Y/M/D):
0
First name:
2
Secretary
Last name:
Term
0
Linda
At arm's length with other Directors?
Novak
Start date (Y/M/D):
Last name:
Term
7
Chair
Last name:
Term
0
Johnston
Start date (Y/M/D):
Last name:
Term
0
Director
Last name:
Term
2
Macey
Start date (Y/M/D):
Last name:
Term
First name:
Director
Last name:
Term
Terry
Start date (Y/M/D):
Last name:
Term
Confidential data
—
ON
9 7 5 3
Postal code:
Date of birth (Y/M/D):
1
9
N 1 S 2 X 5
5
1
0
2
2
4
Protected B when completed
Directors/Trustees and Like Officials Worksheet
You must give us complete information for each director/trustee and like official who, at any time during the fiscal period of this return, was a member of the charity's board of directors/trustees. Directors/trustees
and like officials are persons who govern a registered charity. See the reverse for information on filling out this form.
Place bar code label here
Total number of directors/trustees and like officials:
Public information
Last name:
◄
Term
Position:
◄
Position:
Benavidez
Start date (Y/M/D):
Treasurer
0
1
First name:
2
0
0
5
0
6
0
Paul
1
First name:
First name:
First name:
Start date (Y/M/D):
◄
◄
◄
◄
◄
◄
◄
Position:
City:
X Yes
No
Yes
No
No
—
6 5 4
Telephone number:
—
Telephone number:
No
No
—
Telephone number:
Prov/Terr:
—
—
Telephone number:
Prov/Terr:
—
—
No
Telephone number:
Prov/Terr:
—
—
Date of birth (Y/M/D):
Postal code:
Date of birth (Y/M/D):
Postal code:
Date of birth (Y/M/D):
Postal code:
Date of birth (Y/M/D):
Postal code:
Date of birth (Y/M/D):
Postal code:
Date of birth (Y/M/D):
Home address – Street number and name:
City:
No
Initial:
Telephone number:
Prov/Terr:
—
—
Postal code:
Date of birth (Y/M/D):
Home address – Street number and name:
City:
End date (Y/M/D):
No
Telephone number:
Prov/Terr:
—
—
13102
T1235 E (13)
Postal code:
Home address – Street number and name:
End date (Y/M/D):
Yes
9
Home address – Street number and name:
Initial:
Yes
ON
9 5 2 7
Prov/Terr:
—
City:
Yes
—
—
City:
Yes
1
(Ce formulaire existe en français.)
N 1 P 1 C 5
6
9
1
1
2
9
49 Thomas Street
Prov/Terr:
City:
Yes
Postal code:
Date of birth (Y/M/D):
Home address – Street number and name:
End date (Y/M/D):
At arm's length with other Directors?
5 1 9
ON
3 8 0 1
Prov/Terr:
City:
Yes
Initial:
First name:
6 2 4
—
Home address – Street number and name:
End date (Y/M/D):
First name:
5 1 9
City:
Initial:
First name:
Prov/Terr:
—
Cambridge
Telephone number:
330 Christopher Drive
Home address – Street number and name:
End date (Y/M/D):
First name:
Cambridge
Telephone number:
Home address – Street number and name:
Initial:
At arm's length with other Directors?
Last name:
Initial:
End date (Y/M/D):
Start date (Y/M/D):
Position:
No
Initial:
At arm's length with other Directors?
Last name:
Yes
End date (Y/M/D):
Start date (Y/M/D):
Position:
City:
X
Initial:
At arm's length with other Directors?
Last name:
Home address – Street number and name:
End date (Y/M/D):
At arm's length with other Directors?
Start date (Y/M/D):
Position:
Initial:
End date (Y/M/D):
At arm's length with other Directors?
At arm's length with other Directors?
Last name:
Term
6
Start date (Y/M/D):
Position:
Term
0
At arm's length with other Directors?
Last name:
Term
9
Start date (Y/M/D):
Position:
Term
0
Carolyn
At arm's length with other Directors?
Last name:
Term
0
Start date (Y/M/D):
Position:
Term
2
Drouillard
Start date (Y/M/D):
Last name:
Term
First name:
Director
Last name:
Term
Confidential data
Postal code:
Date of birth (Y/M/D):
N 3 C 3 C 6
COMPLETING THE DIRECTORS/TRUSTEES AND LIKE OFFICIALS WORKSHEET
Public information
Confidential data
Information from this column is available to the public.
Information from this column will stay confidential and will not be made
available to the public except in circumstances in which the release of any or
all of the information is required by law or, in certain exceptional
circumstances, permitted by law.
Enter the last name, first name, and initial of the director/trustee or like official.
Term:
Start date: Enter the date the person started in the position.
End date: Enter the date the person left the position. If the person
has not left the position, leave this field blank.
Position: Enter the title of the position being held. Each position is generally
identified in an organization's governing documents (for example, president,
treasurer, secretary). A registered charity may have other officials that have
governing powers similar to those of a director or trustee. For example,
religious leaders often have some governing authority and would be
considered like officials.
At arm's length with other directors: Tick Yes if the person is at arm's
length with all other directors/trustees or like officials.
At arm's length is a concept that describes a relationship in which two
persons act independently of each other and are not related. Related persons
are individuals who are related to each other by blood, marriage or
common-law partnership, or adoption. It is also possible that individuals not
related by a family connection, but with close business relations, may still be
considered not at arm's length. For more information, go to
www.cra.gc.ca/charities, select "Charities-related forms and publications,"
and see IT-419R2, Meaning of Arm's Length.
According to the Income Tax Act, circumstances in which the law requires
or permits such information to be disclosed include a court order, warrant, or
subpoena issued for a criminal proceeding under an act of Parliament or a
legal proceeding relating to the administration or enforcement of the Income
Tax Act, the Canada Pension Plan, the Unemployment Insurance Act, or the
Employment Insurance Act, or any other act of Parliament or law of a
province that allows a tax or duty to be imposed or collected.
Other circumstances in which we are required or permitted by law to
disclose certain records include a request made under the authority of the
Auditor General Act, a warrant issued by the Canadian Security Intelligence
Service Act, and enquiries from the Department of Finance Canada for
information to form or evaluate fiscal policy.
Home address: In the proper spaces, enter the full home address, including
the street number, street name, city (which could be a town, village, or other
municipality), province or territory, and postal code of each director/trustee
or like official.
Telephone number: Enter the telephone number at which the person can be
reached during the day.
Date of birth: Enter the person's date of birth so that the CRA is better able
to identify, with certainty, the individuals who are responsible for managing
the charity.
If the director/trustee or like official lives outside the country, enter the
person's full mailing address, including the country.
Statement of Partnership Income –
Instructions for Recipient
T5013-INST
3. T5013Instructions
Partners that are corporations or trusts
Report the information on a T2 Corporation Income Tax Return or a T3 Trust Income Tax and Information Return, whichever applies.
Partners that are partnerships
A partnership that receives a T5013 slip, Statement of Partnership Income, has to report the information on its financial statements for the fiscal period.
Partners who are individuals
Report the information on your T1 General Income Tax and Benefit Return, (T1 return). Keep one copy of this slip for your records and attach the other copy to
your T1 return. You can get the T1 General Income Tax and Benefit Guide, (T1 guide), schedules, forms and other tax guides at www.cra.gc.ca/forms, or by
calling 1-800-959-8281.
Identification
Canadian and foreign net business income (loss)
Boxes 001 to 006 and 010 to 040: We use this information.
Tax Shelter – If the partnership is a tax shelter, you should only receive a
T5013 slip as the T5013A slip is now obsolete.
Box 006: Under the Income Tax Act (the Act), you have to give your social
insurance number (SIN) on request to any person who prepares an
information slip for you. If you do not have a SIN, you can apply for one at
any Service Canada Centre. For more information, visit the Service Canada
Web site at www.servicecanada.gc.ca.
Multiple jurisdictions – If the partnership allocated income from more than
one province or territory, the second box will show a two-letter province or
territory code. If the income is from a foreign country, the box will show a
three-letter country code.
Box 205: Functional currency code – This is the functional currency code
applicable to the T5013 slip.
Limited partner's net income (loss)
Tax Shelter – If the limited partnership is a tax shelter, you should only
receive a T5013 slip as the T5013A slip is now obsolete.
020
Total business income (loss)
114
Other income – Enter this amount on line 130 of your T1 return.
115
Type of other income – Enter this description in the "Specify" area for
line 130 of your T1 return.
116
Business income (loss) – Enter this amount on line M on page 2
of Form T2125, Statement of Business or Professional Activities, and
report the income on line 135 of your T1 return. The gross amount is in
box 118.
118
Gross business income – Enter this amount on line 162 of your
T1 return.
010
Total limited partner business income (loss)
101
Limited partner's farming income (loss) – Include this amount on
line 141 of your T1 return. You could have a restricted farm loss.
102
Agricultural income stabilization – Include this amount on the
AgriStability and AgriInvest program information and statement of
farming activities that applies to you.
119
Foreign business income that is exempt from Canadian tax due to
a tax convention or agreement – This amount is included in box 116.
Use this amount to calculate your foreign tax credit for the country
named. See line 405 in your T1 guide and forms T2209 and T2036.
103
Limited partner's fishing income (loss) – Include this amount on
line 143 of your T1 return.
120
104
Limited partner's business income (loss) – Enter this amount on
line 122 of your T1 return.
Professional income (loss) – Enter this amount on line M on page 2
of Form T2125, Statement of Business or Professional Activities, and
report the income on line 137 of your T1 return. The gross amount is in
box 121.
121
Gross professional income – Enter this amount on line 164 of your
T1 return.
122
Commission income (loss) – Enter this amount on line M on page 2
of Form T2125, Statement of Business or Professional Activities, and
report the income on line 139 of your T1 return. The gross amount is in
box 123.
123
Gross commission income – Enter this amount on line 166 of your
T1 return.
124
Farming income (loss) – Enter this amount on line d on page 2 of
Form T2042, Statement of Farming Activities, or on the appropriate
AgriStability and AgriInvest form. You could have a restricted farm
loss.
125
Gross farming income – Enter this amount on line 168 of your
T1 return.
126
Fishing income (loss) – Enter this amount on line c on page 2 of
Form T2121, Statement of Fishing Activities.
105
Limited partner's at-risk amount – We use this information. If there is
no amount in this box, we assume the amount is zero and you cannot
claim any losses shown in boxes 101, 103, 104, 107, and 109.
106
Limited partner's adjusted at-risk amount – We use this information.
107
Limited partner's rental income (loss) – Enter this amount on
line 9946 of Form T776, Statement of Real Estate Rentals, and report
the income on line 126 of your T1 return.
108
Limited partner's loss available for carry forward – This is the part
of your current-year limited partnership loss that you cannot deduct on
the current year's T1 return. You can only deduct it from the same
partnership's income in future years if you have a positive at-risk
amount after applying paragraph 111(1)(e) of the Act. You can carry it
forward indefinitely.
109
113
127
Previous loss carryforward eligible in the current year – This is the
limited partnership loss from previous years that you can claim in the
current year. Claim it on line 251 of your T1 return.
Gross fishing income – Enter this amount on line 170 of your
T1 return.
149
Return of capital – This is the capital (including drawings) returned to
you from the limited partnership. Use this amount to reduce the ACB of
your limited partnership interest.
Total business income (loss) from an active business carried on
in Canada – Report the information on a T2 Corporation Income Tax
Return.
150
Canadian manufacturing and processing profits under
subsection 125.1(3) – Report the information on a T2 Corporation
Income Tax Return.
T5013-INST E (13)
(Vous pouvez obtenir ce formulaire en français à www.arc.gc.ca/formulaires ou en composant le 1-800-959-7383.)
Canadian and foreign investments and carrying charges
Tax Shelter – If the partnership is a tax shelter, you should only receive a
T5013 slip as the T5013A slip is now obsolete.
110
111
112
Canadian and foreign net rental income (loss) – Enter this amount
on line e on page 1 of Form T776, Statement of Real Estate Rentals,
and report the income on line 126 of your T1 return.
Foreign net rental income (loss) – These amounts are included in
box 110. Use these amounts to calculate your foreign tax credit for the
country named. See line 405 in your T1 guide and forms T2209 and
T2036.
Foreign net rental income that is exempt from Canadian tax due to
a tax convention or agreement – These amounts are included in
box 110 or in box 107, whichever applies to your partner code. Use
these amounts to calculate your foreign tax credit for the country
named. See line 405 in your T1 guide and forms T2209 and T2036.
117
Gross Canadian and foreign rental income – Enter this amount on
line 160 of your T1 return.
128
Interest from Canadian sources – Enter this amount on line 121 of
Schedule 4.
129
Actual amount of dividends (other than eligible dividends) –
This is the actual amount of dividends (other than eligible dividends)
paid by corporations resident in Canada. The taxable amount of these
dividends and the federal dividend tax credit appear in boxes 130 and
131 respectively.
Taxable amount of dividends (other than eligible dividends) –
This is the taxable amount of dividends (other than eligible dividends)
for partners that are individuals resident in Canada (other than a trust
that is a registered charity), including partnerships and trusts that are
eligible for the federal dividend tax credit. Enter this amount on line 180
of Schedule 4.
130
131
Dividend tax credit for dividends other than eligible dividends –
Include this amount on line 425 of Schedule 1.
132
Actual amount of eligible dividends – This is the actual amount of
eligible dividends paid by corporations resident in Canada. The taxable
amount of eligible dividends and the federal dividend tax credit appear
in boxes 133 and 134 respectively.
133
Taxable amount of eligible dividends – This is the taxable amount of
eligible dividends for partners that are individuals resident in Canada
(other than a trust that is a registered charity), including partnerships
and trusts that are eligible for the federal dividend tax credit. Enter this
amount on line 120 of Schedule 4.
134
Dividend tax credit for eligible dividends – Include this amount on
line 425 of Schedule 1.
135
Foreign dividend and interest income – Enter this amount on
line 121 of Schedule 4.
136
Foreign investment income that is exempt from Canadian tax
due to a tax convention or agreement – This amount is included in
box 135. Use the amount to calculate your foreign tax credit for the
country named. See line 405 in your T1 guide and forms T2209 and
T2036.
137
Business investment loss – This amount is your gross business
investment loss reported on line 228 of your T1 return. Use the amount
to calculate your allowable business investment loss deduction for
line 217, using "Chart 6 – How to claim an allowable business
investment loss " in your T4037, Capital Gains guide.
Complete Step 4 in Chart 6 with the following information when you
use box 137 amount to calculate your allowable business investment
loss deduction.
138
Name of the Small Business Corporation
139
Number and class of shares, or type of debt owed by the Small
Business Corporation
140
Insolvency, bankruptcy, or wind-up date
141
Date the partnership bought the shares or acquired the debt
142
Proceeds of disposition
143
Adjusted cost base of the shares or debt
144
Outlays and expenses on the disposition
145
Dividend rental arrangement compensation payments – Enter this
amount on line 221 of Schedule 4.
146
Other investment income – Report this amount in Area II (line 121) of
Schedule 4.
147
Type of investment income – You need this information to calculate
adjusted taxable income for calculating the alternative minimum tax on
Form T691, Alternative Minimum Tax.
210
Total carrying charges – This amount is your share of the carrying
chargesfor earning all investment income. Enter it on line 221 of
Schedule 4.
Footnotes for Box 210 Amounts in boxes 211 to 216 are included in box 210.
211
Carrying charges on interest and dividend income.
212
Carrying charges on rental income.
213
Carrying charges on film property.
214
Carrying charges on resource property and flow-through shares.
215
Carrying charges for acquiring an interest in a partnership of which
you are a limited or non-active partner, or which owns a rental or
leasing property or a film property.
216
Carrying charges – other.
Other amounts and information
Tax Shelter – If the partnership is a tax shelter, you should only receive a
T5013 slip as the T5013A slip is now obsolete.
030
Total capital gains (losses)
151
Capital gains (losses) – Enter this amount on line 174 of Schedule 3.
Footnotes for Box 151 Amounts in boxes 152 to 158 are included in box 151.
152
Last fiscal period's capital gains reserve allocated in the previous
year and brought into income for the current year – Use this
information to complete Form T2017, Summary of Reserves on
Dispositions of Capital Property.
153
Qualified small business corporation shares (QSBCS) capital
gains amount eligible for the $750,000 capital gains exemption –
Use this information to complete Form T657, Part 1, and Part 3a
"Line 107 of Schedule 3," to calculate your capital gains deduction.
154
Qualified farm property (QFP) or qualified fishing property (QXP)
capital gains amount eligible for the $750,000 capital
gains exemption – Use this information to complete Form T657,
Part 1, and Part 3a "Line 110 of Schedule 3," to calculate your capital
gains deduction.
Capital gains (losses) from QFP or QXP mortgage foreclosures
and conditional sales repossessions eligible for the capital gains
deduction – Use this information to complete Form T657, Part 1, and
Part 3a "Line 124 of Schedule 3," to calculate your capital gains
deduction.
155
156
Foreign capital gains (losses) – Use this information to calculate the
foreign tax credits on foreign business and non-business income for
the country identified by the three-letter code for this box. See line 405
in your T1 guide and forms T2209 and T2036.
157
Foreign capital gains exempt from Canadian tax due to a tax
convention or agreement – Use this information to calculate the
foreign tax credits on foreign business and non-business income.
158
Farming and fishing income eligible for the capital gains
deduction from the disposition of eligible capital property that is
QFP or QXP– Use this information to complete Form T657, Part 1 to
calculate your capital gains deduction.
159
Capital gains reserves – Use this amount to complete Form T2017,
Summary of Reserves on Dispositions of Capital Property. For more
information, see guide T4037, Capital Gains.
Footnotes for Box 159 Amounts in boxes 160 to 166 are included in box 159.
2
Other amounts and information (continued)
160
Capital gains reserve from QFP and QXP transferred to your
child – Use this information to complete Part 1, Section A of
Form T2017.
161
Capital gains reserve from QSBCS transferred to your child – Use
this information to complete Part 1, Section B of Form T2017.
162
Capital gains reserve from family farm property other than QFP,
or family fishing property other than QXP, transferred to your
child, or shares of capital stock of a small business corporation
other than QFP, QXP, and QSBCS transferred to your child – Use
this information to complete Part 1, Section C of Form T2017.
163
Capital gains reserve from other property – Use this information to
complete Part 1, Section D of Form T2017.
164
Capital gains reserve (capital property disposed of before
November 13, 1981) – Use this information to complete Part 2 of
Form T2017.
165
Capital gains reserve from non-qualifying securities the
partnership donated to a qualified donee – Use this information to
complete Part 1, Section D of Form T2017.
Capital gains reserve from gifts of non-qualifying securities –
Eligible amount – Use this information to complete Part l, section D of
form T2017.
166
175
Canadian oil and gas property expenses (COGPE) – Use this
amount to calculate your allowable deduction for your cumulative
Canadian oil and gas property expense (CCOGPE) pool on
Form T1229. Add it at the line called "Other resource expenses" in
Area II for your CCOGPE pool. The maximum you can deduct is 10%
of the CCOGPE pool balance.
176
Foreign exploration and development expenses (FEDE) – Add
the amount in Area III on Form T1229 for your cumulative foreign
exploration and development expense pool.
177
Recapture of earned depletion – This is your share of the recapture
of earned depletion that the partnership used to arrive at the net
income (loss) in boxes 114, 116, 120, 124, and 126. We use this
amount. Do not add it to income again.
179
Assistance for Canadian exploration expenses – Use this amount
to calculate your allowable deduction for your cumulative Canadian
exploration expense (CCEE) pool on Form T1229. Add the amount at
the line called "Assistance" in Area II for your CCEE pool.
The maximum you can deduct is 100% of the CCEE pool balance.
180
Assistance for Canadian development expenses – Use this amount
to calculate your allowable deduction for your cumulative Canadian
development expense (CCDE) pool on Form T1229. Add the amount
at the line called "Assistance" in Area II for your CCDE pool.
The maximum you can deduct is 30% of the CCDE pool balance.
181
Assistance for Canadian oil and gas property expenses – Use
this amount to calculate your allowable deduction for your cumulative
Canadian oil and gas property expense (CCOGPE) pool on
Form T1229. Add the amount at the line called "Assistance" in Area II
for your CCOGPE pool.
The maximum you can deduct is 10% of the CCOGPE pool balance.
182
Eligible amount of charitable donations and government gifts –
Enter this amount on line 1 of Schedule 9.
167
Capital gains reserve from gifts of non-qualifying securities –
Advantage – We use this information.
168
Income tax deducted – Enter this amount on line 437 of your
T1 return.
169
Part lX.1 tax
170
Taxable non-portfolio earnings
171
Foreign tax paid on non-business income – Use this amount
to calculate your foreign tax credits on your foreign non-business
income on Form T2209. For details, see line 405 in your T1 guide
and Form T2036.
Foreign tax paid on business income – Use this amount to
calculate your foreign tax credits on your foreign business income
on Form T2209. For more information, see line 405 in your T1 guide.
183
Eligible amount of cultural and ecological gifts – Enter this amount
on line 342 of Schedule 9. For details, see your T1 guide.
184
Eligible amount of federal political contributions – Enter this
amount on line 409 of Schedule 1. You have to provide the following
information to us when you use the amount in box 184 to claim a
federal political contribution tax credit.
Capital cost allowance – This is your share of capital cost allowance
that the partnership used to arrive at the net income (loss) in boxes
114, 116, 120, 122, 124, and 126. Do not deduct this amount again.
Use this amount to calculate your adjusted taxable income for
Form T691, Alternative Minimum Tax.
Capital cost allowance for rental or leasing property – If you also
own other rental property as a proprietor, combine your share of
partnership rental income (loss) with the total of your own rental
income (loss) after expenses, but before CCA. You may then claim
CCA on your own rental buildings only to the extent of the combined
rental income, if any. Calculate your CCA in Area A of Form T776,
Statement of Real Estate Rentals.
185
Eligible amount of provincial and territorial political
contributions – Enter the political contributions on the appropriate
provincial or territorial form.
207
Eligible amount of municipal political contributions – Corporate
partners may be able to claim a municipal tax rebate based on these
contributions. Individual partners who are residents of Quebec may be
able to claim a tax credit on their provincial income tax return for these
amounts.
208
Eligible amount of medical gifts – Corporate partners report this
amount on a T2 Corporation Income Tax Return.
209
Part Xll.2 Tax Credit – Enter this amount on line 456 of your
T1 Return.
186
Investment tax credit – Complete Form T2038(IND), Investment
Tax Credit (Individuals), and attach it to your T1 return. You need the
following information to complete Form T2038(IND) when you use the
amount in box 186 to claim an investment tax credit.
187
Investment tax credit transferred under subsection 127(8.3) –
This is the investment tax credit for the fiscal period that the
partnership transferred to you under subsection 127(8.3).
Note
If you are not a limited partner, you can choose to renounce
the investment tax credit (ITC) for the fiscal period that the
partnership transferred to you under subsection 127(8.3).
If you make this choice, complete Form T932, Election by a
Member of a Partnership to Renounce Investment Tax Credits
Pursuant to Subsection 127(8.4).
188
Excess ITC recapture – Include the excess ITC recapture on the
corresponding line in the section for Recapture of ITC on SR&ED
expenditures in Part A of Form T2038(IND), Investment Tax Credit
(Individuals), or on Form T2SCH31, Investment Tax Credit –
Corporations, whichever applies.
189
ITC Type Code – Use this code when completing Form T2038(IND).
172
040
220
221
Capital cost allowance for film property
173 to 176 and 179 to 181 Use Form T1229, Statement of Resource
173
Expenses and Depletion Allowance.
If your CCOGPE pool has a negative balance, use that amount to
reduce your CCDE pool. If your CCEE or CCDE pools have a negative
balance, report the negative amount as income on line 130 of your
T1 return. For more information, call 1-800-959-5525.
Canadian exploration expenses (CEE) other than Canadian
renewable and conservation expense (CRCE) – Use this amount to
calculate your allowable deduction for your cumulative Canadian
exploration expense (CCEE) pool on Form T1229. Add it at the line
called "Other resource expenses" in Area II for your CCEE pool. The
maximum you can deduct is 100% of the CCEE pool balance.
206
Canadian renewable and conservation expenses – Use this amount
to calculate your allowable deduction for your cumulative Canadian
exploration expense (CCEE) pool on Form T1229. Add it at the line
called "Other resource expenses" in Area ll for your CCEE pool. The
maximum you can deduct is 100% of the CCEE pool balance. For
corporations, add this amount to line 217 called "Add: Canadian
renewable and conservation expenses" of your Schedule 12.
174
Canadian development expenses (CDE) – Use this amount to
calculate your allowable deduction for your cumulative Canadian
development expense (CCDE) pool on Form T1229. Add it at the line
called "Other resource expenses" in Area II for your CCDE pool. The
maximum you can deduct is 30% of the CCDE pool balance.
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Renounced Canadian and development expenses
Use Form T1229, Statement of Resource Expenses and Depletion Allowance,
to calculate your allowable deduction for your resource expense pools.
190
Renounced Canadian exploration expenses – Use this amount to
calculate your allowable deduction for your Canadian exploration
expense (CEE) pool on Form T1229. Add it in Area l for your CEE pool.
191
Renounced Canadian development expenses – Use this amount to
calculate your allowable deduction for your Canadian development
expense (CDE) pool on Form T1229. Add it in Area l for your CDE pool.
192
Assistance for Canadian exploration expenses – Use this amount
to calculate your allowable deduction for your Canadian exploration
expense (CEE) pool on Form T1229. Add it in Area l for your CEE pool.
193
Assistance for Canadian development expenses – Use this amount
to calculate your allowable deduction for your Canadian development
expense (CDE) pool on Form T1229. Add it in Area l for your CDE pool.
194
Expenses qualifying for ITC – Enter this amount in Area l on
Form T1229.
195
Portion subject to an interest-free period (ITC) – Enter this amount
in Area l on Form T1229.
196
Portion subject to an interest-free period (CEE) – Enter this amount
in Area l on Form T1229.
197 to 200
The amounts in boxes 197 to 200 are Canadian exploration
expenses (mining only) that qualify for a provincial tax credit
for individuals. Your province may require you to be a resident
at the end of the calendar year in that province where the
expenses qualify for that credit.
197
Expenses qualifying for a provincial tax credit (BC) – You need this
information to calculate provincial tax credits.
198
Expenses qualifying for a provincial tax credit (SK) – You need this
information to calculate provincial tax credits.
199
Expenses qualifying for a provincial tax credit (MB) – You need this
information to calculate provincial tax credits.
200
Expenses qualifying for a provincial tax credit (ON) – You need this
information to calculate provincial tax credits.
Tax shelter information
Tax Shelter – Other provisions of the Act may apply to reduce any loss from
the tax shelter that you can claim. For example, the at-risk amount provisions
in subsection 96(2.2) of the Act may apply.
Use Form T5004, Claim for Tax Shelter Loss or Deduction, to claim your loss
or deduction shown in the boxes on this slip. Attach Form T5004 and a copy
of this slip to your T1 return.
201
Number of units acquired – This is the number of units in the tax
shelter that you bought in the year.
202
Cost per unit – This is the cost of each unit in the tax shelter that
you bought.
203
Total cost of units – The total cost is the number in box 201 multiplied
by the amount in box 202.
204
Other indirect reductions – We use this information.
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