Clone of CY 2024 Annual Certification

ILLINOIS NEW MARKETS TAX CREDIT PROGRAM 2025 ANNUAL REPORT
Each qualified Community Development Entity (CDE) shall submit an annual report to the Department within 45 days after the beginning of each calendar year during the compliance period. No annual report shall be due prior to the first anniversary of the initial credit allowance date. A qualified CDE is not required to provide the annual report set forth in this Section for qualified low-income community investments that have been redeemed or repaid except for the year in which the investment was redeemed or repaid.
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CONTACT INFORMATION
Contact Name*

PrefixFirst NameLast Name
Contact Title*
Contact Phone*
Contact Email*
CDE INFORMATION

COMMUNITY DEVELOPMENT ENTITY
Reporting Year*
CDE Name*
CDE Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
CDE Federal EIN #*
Total Allocation*
Initial Credit Allowance Date*

MonthDayYear
(The date the first QEI was made.)
Did this CDE receive allocations for both 1st and 2nd rounds in 2019?*

YesNoThis report is for 2020 allocationThis report is for 2024 allocationThis report is for 2025 allocation
Initial Credit Allowance Date for 2019 2nd Round

MonthDayYear
(The date the first QEI was made.)
Total Credit Available for the Reporting Year*
SUB-CDE INFORMATION

SUB-COMMUNITY DEVELOPMENT ENTITY
Number of Sub-CDEs*
SUB-CDE #1
Name of Project
Sub-CDE Name
Sub-CDE Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Sub-CDE Federal EIN #
SUB-CDE #2
Name of Project
Sub-CDE Name
Sub-CDE Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Sub-CDE Federal EIN #
SUB-CDE #3
Name of Project
Sub-CDE Name
Sub-CDE Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Sub-CDE Federal EIN #
SUB-CDE #4
Name of Project
Sub-CDE Name
Sub-CDE Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Sub-CDE Federal EIN #
SUB-CDE #5
Name of Project
Sub-CDE Name
Sub-CDE Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Sub-CDE Federal EIN #
QALICB INFORMATION

QUALIFIED ACTIVE LOW-INCOME COMMUNITY BUSINESS
Number of QALICBs*
QALICB #1
Name of Project
QALICB Name
QALICB Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
QALICB Federal EIN #
QALICB Census Tract #
QALICB NAICS Code
Brief description of the QALICB:
1-2 sentences
Brief description of the Project:
1-2 sentences
Expanded description of the Project:
Description of the community benefits of the QALICB:
Current Project Status:
Will a bank seek credit for the QLICI under the Community Reinvestment Act?

YesNo
Describe and list the amount and source of any other public subsidy related to the Project (e.g., grants, tax abatements or credits, Opportunity Zone investments, etc.)
Detail any changes with respect to the taxpayers entitled to claim tax credits with respect to QEIs issued by the CDE since its last report.
Number of persons employed by QALICB at time of initial investment:
Number of employment positions maintained by QALICB at end of prior year:
Average annual salaries of maintained positions at QALICB:
Total number of employment positions created and retained at QALICB as a result of QLICI:
Average annual salaries of positions created and retained at QALICB as a result of QLICI:
QLICI INFO FOR THIS QALICB
Number of QLICIs into this QALICB
QLICI #1
Amount
Date

MonthDayYear
CDE
QLICI #2
Amount
Date

MonthDayYear
CDE
QLICI #3
Amount
Date

MonthDayYear
CDE
QLICI #4
Amount
Date

MonthDayYear
CDE
QLICI #5
Amount
Date

MonthDayYear
CDE
Bank Statements or Wire Transfers for QLICIs

Cancelof
QALICB #2
Name of Project
QALICB Name
QALICB Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
QALICB Federal EIN #
QALICB Census Tract #
QALICB NAICS Code
Brief description of the QALICB:
1-2 sentences
Brief description of the Project:
1-2 sentences
Expanded description of the Project:
Description of the community benefits of the QALICB:
Current Project Status:
Will a bank seek credit for the QLICI under the Community Reinvestment Act?

YesNo
Describe and list the amount and source of any other public subsidy related to the Project (e.g., grants, tax abatements or credits, Opportunity Zone investments, etc.)
Detail any changes with respect to the taxpayers entitled to claim tax credits with respect to QEIs issued by the CDE since its last report.
Number of persons employed by QALICB at time of initial investment:
Number of employment positions maintained by QALICB at end of prior year:
Average annual salaries of maintained positions at QALICB:
Total number of employment positions created and retained at QALICB as a result of QLICI:
Average annual salaries of positions created and retained at QALICB as a result of QLICI:
QLICI INFO FOR THIS QALICB
Number of QLICIs into this QALICB
QLICI #1
Amount
Date

MonthDayYear
CDE
QLICI #2
Amount
Date

MonthDayYear
CDE
QLICI #3
Amount
Date

MonthDayYear
CDE
QLICI #4
Amount
Date

MonthDayYear
CDE
QLICI #5
Amount
Date

MonthDayYear
CDE
Bank Statements or Wire Transfers for QLICIs

Cancelof
QALICB #3
Name of Project
QALICB Name
QALICB Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
QALICB Federal EIN #
QALICB Census Tract #
QALICB NAICS Code
Brief description of the QALICB:
1-2 sentences
Brief description of the Project:
1-2 sentences
Expanded description of the Project:
Description of the community benefits of the QALICB:
Current Project Status:
Will a bank seek credit for the QLICI under the Community Reinvestment Act?

YesNo
Describe and list the amount and source of any other public subsidy related to the Project (e.g., grants, tax abatements or credits, Opportunity Zone investments, etc.)
Detail any changes with respect to the taxpayers entitled to claim tax credits with respect to QEIs issued by the CDE since its last report.
Number of persons employed by QALICB at time of initial investment:
Number of employment positions maintained by QALICB at end of prior year:
Average annual salaries of maintained positions at QALICB:
Total number of employment positions created and retained at QALICB as a result of QLICI:
Average annual salaries of positions created and retained at QALICB as a result of QLICI:
QLICI INFO FOR THIS QALICB
Number of QLICIs into this QALICB
QLICI #1
Amount
Date

MonthDayYear
CDE
QLICI #2
Amount
Date

MonthDayYear
CDE
QLICI #3
Amount
Date

MonthDayYear
CDE
QLICI #4
Amount
Date

MonthDayYear
CDE
QLICI #5
Amount
Date

MonthDayYear
CDE
Bank Statements or Wire Transfers for QLICIs

Cancelof
QALICB #4
Name of Project
QALICB Name
QALICB Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
QALICB Federal EIN #
QALICB Census Tract #
QALICB NAICS Code
Brief description of the QALICB:
1-2 sentences
Brief description of the Project:
1-2 sentences
Expanded description of the Project:
Description of the community benefits of the QALICB:
Current Project Status:
Will a bank seek credit for the QLICI under the Community Reinvestment Act?

YesNo
Describe and list the amount and source of any other public subsidy related to the Project (e.g., grants, tax abatements or credits, Opportunity Zone investments, etc.)
Detail any changes with respect to the taxpayers entitled to claim tax credits with respect to QEIs issued by the CDE since its last report.
Number of persons employed by QALICB at time of initial investment:
Number of employment positions maintained by QALICB at end of prior year:
Average annual salaries of maintained positions at QALICB:
Total number of employment positions created and retained at QALICB as a result of QLICI:
Average annual salaries of positions created and retained at QALICB as a result of QLICI:
QLICI INFO FOR THIS QALICB
Number of QLICIs into this QALICB
QLICI #1
Amount
Date

MonthDayYear
CDE
QLICI #2
Amount
Date

MonthDayYear
CDE
QLICI #3
Amount
Date

MonthDayYear
CDE
QLICI #4
Amount
Date

MonthDayYear
CDE
QLICI #5
Amount
Date

MonthDayYear
CDE
Bank Statements or Wire Transfers for QLICIs

Cancelof
QALICB #5
Name of Project
QALICB Name
QALICB Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
QALICB Federal EIN #
QALICB Census Tract #
QALICB NAICS Code
Brief description of the QALICB:
1-2 sentences
Brief description of the Project:
1-2 sentences
Expanded description of the Project:
Description of the community benefits of the QALICB:
Current Project Status:
Will a bank seek credit for the QLICI under the Community Reinvestment Act?

YesNo
Describe and list the amount and source of any other public subsidy related to the Project (e.g., grants, tax abatements or credits, Opportunity Zone investments, etc.)
Detail any changes with respect to the taxpayers entitled to claim tax credits with respect to QEIs issued by the CDE since its last report.
Number of persons employed by QALICB at time of initial investment:
Number of employment positions maintained by QALICB at end of prior year:
Average annual salaries of maintained positions at QALICB:
Total number of employment positions created and retained at QALICB as a result of QLICI:
Average annual salaries of positions created and retained at QALICB as a result of QLICI:
QLICI INFO FOR THIS QALICB
Number of QLICIs into this QALICB
QLICI #1
Amount
Date

MonthDayYear
CDE
QLICI #2
Amount
Date

MonthDayYear
CDE
QLICI #3
Amount
Date

MonthDayYear
CDE
QLICI #4
Amount
Date

MonthDayYear
CDE
QLICI #5
Amount
Date

MonthDayYear
CDE
Bank Statements or Wire Transfers for QLICIs

Cancelof
QALICB #6
Name of Project
QALICB Name
QALICB Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
QALICB Federal EIN #
QALICB Census Tract #
QALICB NAICS Code
Brief description of the QALICB:
1-2 sentences
Brief description of the Project:
1-2 sentences
Expanded description of the Project:
Description of the community benefits of the QALICB:
Current Project Status:
Will a bank seek credit for the QLICI under the Community Reinvestment Act?

YesNo
Describe and list the amount and source of any other public subsidy related to the Project (e.g., grants, tax abatements or credits, Opportunity Zone investments, etc.)
Detail any changes with respect to the taxpayers entitled to claim tax credits with respect to QEIs issued by the CDE since its last report.
Number of persons employed by QALICB at time of initial investment:
Number of employment positions maintained by QALICB at end of prior year:
Average annual salaries of maintained positions at QALICB:
Total number of employment positions created and retained at QALICB as a result of QLICI:
Average annual salaries of positions created and retained at QALICB as a result of QLICI:
QLICI INFO FOR THIS QALICB
Number of QLICIs into this QALICB
QLICI #1
Amount
Date

MonthDayYear
CDE
QLICI #2
Amount
Date

MonthDayYear
CDE
QLICI #3
Amount
Date

MonthDayYear
CDE
QLICI #4
Amount
Date

MonthDayYear
CDE
QLICI #5
Amount
Date

MonthDayYear
CDE
Bank Statements or Wire Transfers for QLICIs

Cancelof
QALICB #7
Name of Project
QALICB Name
QALICB Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
QALICB Federal EIN #
QALICB Census Tract #
QALICB NAICS Code
Brief description of the QALICB:
1-2 sentences
Brief description of the Project:
1-2 sentences
Expanded description of the Project:
Description of the community benefits of the QALICB:
Current Project Status:
Will a bank seek credit for the QLICI under the Community Reinvestment Act?

YesNo
Describe and list the amount and source of any other public subsidy related to the Project (e.g., grants, tax abatements or credits, Opportunity Zone investments, etc.)
Detail any changes with respect to the taxpayers entitled to claim tax credits with respect to QEIs issued by the CDE since its last report.
Number of persons employed by QALICB at time of initial investment:
Number of employment positions maintained by QALICB at end of prior year:
Average annual salaries of maintained positions at QALICB:
Total number of employment positions created and retained at QALICB as a result of QLICI:
Average annual salaries of positions created and retained at QALICB as a result of QLICI:
QLICI INFO FOR THIS QALICB
Number of QLICIs into this QALICB
QLICI #1
Amount
Date

MonthDayYear
CDE
QLICI #2
Amount
Date

MonthDayYear
CDE
QLICI #3
Amount
Date

MonthDayYear
CDE
QLICI #4
Amount
Date

MonthDayYear
CDE
QLICI #5
Amount
Date

MonthDayYear
CDE
Bank Statements or Wire Transfers for QLICIs

Cancelof
INVESTOR INFORMATION
Number of Investors Receiving Credits:*
INVESTOR #1
Investor Name
Investor's Federal EIN #
Tax Credits to Receive for This Reporting Period:*
INVESTOR #2
Investor Name
Investor's Federal EIN #
Tax Credits to Receive for This Reporting Period:
INVESTOR #3
Investor Name
Investor's Federal EIN #
Tax Credits to Receive for This Reporting Period:
INVESTOR #4
Investor Name
Investor's Federal EIN #
Tax Credits to Receive for This Reporting Period:
INVESTOR #5
Investor Name
Investor's Federal EIN #
Tax Credits to Receive for This Reporting Period:
TOTAL TAX CREDITS TO ISSUE FOR THIS REPORTING PERIOD:*
THE TOTAL TAX CREDITS TO ISSUE DOES NOT EQUAL THE TOTAL CREDIT AVAILABLE FOR THE REPORTING YEAR.

THIS MESSAGE GO AWAY WHEN THE AMOUNTS MATCH.
COMPLIANCE
Has the CDE or any Sub-CDE been the subject of any investigation by a government agency relating to tax credits or financial services during the preceding calendar year?*

YesNo
Please explain.
Is the CDE in compliance with all requirements of the Illinois NMDP including, but not limited to, compliance with the requirements that it has maintained a level of qualified low-income community investments equal to 100% of the cash purchase price of the qualified equity investment throughout the year and maintained its status as a CDE?*

YesNo
Please explain.
Have any of the QEI funded under this allocation been redeemed or repaid?*

YesNo
Please identify the amount and date of redemption.
Was any part of the QLICI sold or repaid during the prior calendar year?*

YesNo
Please identify the amount received and when an equivalent amount was reinvested in another Illinois QALICB.
Have any tax credits been recaptured under Section 45D of the Internal Revenue Code in connection with an investment that was also a qualified equity investment under the Illinois NMDP?*

YesNo
Please identify the amounts and explain the circumstances of the recapture.
THIRD PARTY AUTHORIZATION
Would you like to authorize Illinois Department of Commerce & Economic Opportunity (DCEO) to discuss reporting or tax credit certificate matters with a third party?*

YesNo
How many individuals would you like to authorize?
AUTHORIZED PARTY #1
Name

First NameLast Name
Organization
Email
This individual is authorized to:

Submit and discuss matters related to this Annual ReportDiscuss matters related to tax credit certificates
AUTHORIZED PARTY #2
Name

First NameLast Name
Organization
Email
This individual is authorized to:

Submit and discuss matters related to this Annual ReportDiscuss matters related to tax credit certificates
AUTHORIZED PARTY #3
Name

First NameLast Name
Organization
Email
This individual is authorized to:

Submit and discuss matters related to this Annual ReportDiscuss matters related to tax credit certificates
ADDITIONAL INFORMATION

(Optional)
Please use this section to share any information you feel is relevant that was not captured in this report.
Please use this section to upload any information you feel is relevant that was not captured in this report.

Cancelof
CERTIFICATION
Authorized Signatory
Name*

First NameLast Name
Title*
CDE Name*
Signature*

Clear
Date*

MonthDayYear
Should be Empty:

ILLINOIS NEW MARKETS TAX CREDIT PROGRAM 2025 ANNUAL REPORT

CONTACT INFORMATION

CDE INFORMATION

SUB-CDE INFORMATION

SUB-CDE #1

SUB-CDE #2

SUB-CDE #3

SUB-CDE #4

SUB-CDE #5

QALICB INFORMATION

QALICB #1

QLICI INFO FOR THIS QALICB

QALICB #2

QLICI INFO FOR THIS QALICB

QALICB #3

QLICI INFO FOR THIS QALICB

QALICB #4

QLICI INFO FOR THIS QALICB

QALICB #5

QLICI INFO FOR THIS QALICB

QALICB #6

QLICI INFO FOR THIS QALICB

QALICB #7

QLICI INFO FOR THIS QALICB

INVESTOR INFORMATION

COMPLIANCE

THIRD PARTY AUTHORIZATION

ADDITIONAL INFORMATION

CERTIFICATION