CFS 596-QRev u2012

Name ofAgency:

State of I11inois

Department of C皿dren and Fan皿y Services

Annual Report for IIlinois Licensed Adoption Agenc王es

Date: July21’2016

ABC F()r Adoption

Corporate Address* : 175 Olde Half Day Road

Suite lOO-7

Illinois DCFS

License仲rovider ID nunber: 492043 Tel ephone : 847-82工-2901

License Effective date: 03!22成O 1 5　　　　　to 03122120 1 9

The reporting period and answers to a11 questions for this report relate to血e agency’s most recent fiscal

6/30/1 5-7Il/ 1 6year. Specify血e dates ofyour agency’s fiscal year and reporting period for拙s report:

*If the agency operates satellite or branch o純oesI Please attach a separate sheet listing complete

addresses of a‖ other o飾ces.

TIds report is to be completed by agencies providing adoption services and shall be珊ed wi血the

DepaItment Of C皿dren and Fanily Services and with瓜e Illinois Attomey General’s O餓ce.血addition,

each licensed agency血at malntaius a website shall provide this report on its website・ The report shall be

糾ed amua11y, nO later than the 45血day following an adoption agency’s liceuse anhiversary date・ Failure

to provide the amual report or disclose certain infomation required in the report may result in the

suspeusion of an agency’s license for a period of 90 days・ Sul)Sequent Violations may result in a

revocation ofthe liceuse. [Rule 401.530]

This report applies onIy to the provision of ado】Ption services and includes agencies providing foster

care conversion services.

Question nunber l (A - M) pertaius only to domestic and intemational agency-aSSisted adoption services,and home study services-Only programs. Question number l (A-M) does not pertain to foster cae

conversion adoptio鵬. Agencies that provide adoption services only through foster care cooversIOus must

answer questions 2 - 12’but need not answer question number l.

Please respond to the following questious with a yes or no answer on the left and provide additional detail

as requested:

1. Non-identifying infomation for the past year conceming adoption is attached:

Domestic A里enCV-Assisted AdoDtions

A.　The nunber of adoptive fam班es who have submitted an agency application but who

arenotyetlicensed: O

B.　The nunber of adoptive families who are licensed and awaiting domestic placement

as ofthe agency’s fiscal year end」_王_

C.　The nunber of bioIogical parents who the agency provided services to during the

reporting period for domestic adoption: __」

D.　The nunber of children placed in adoptive homes during the year:

Adoptive parents/families who are Illinois Residents : __」

Adoptive parents/finlies who are non皿1inois Residents : _」」

l

巴.

F.

The nunber of adoptions initiated during the year:

Adoptive parents侃milies who are Illinois Residents: _」

Adoptive parents低milies who are non-Illinois Residents: 〇〇〇壬_

The肌mber of adoptions finalized during the year:

Adoptive parents侃milies who are I11inois Resideuts: -i_

Adoptive parents侃milies who are non-Illinois Residents : 」」

G. The number of adoptive placement disruptions: _g_

H. The nunber of domestic adoption dissolutions this year: _Q_

垣termtio山田AdoI)tio鵬(either bv direct D賞acements/refdrrah or throu血hom〇・studr二

塁聖垂cs-O血量vI

Check the boxes血at apply to the intercountry adoption services the agency provides:

□ c皿d refe柑al/matching placement services;

□ Adoption home study/post placement services (utilized by families who are

working with another agency for瓜eir referral/match);

□None.

The則mber of adoptive鹿田Iilies who have submitted an agency application but who are not

yet approved or licensed‥ _

The nu血ber of adoptive families who are licensed or approved and awaiting intemational

Placement: _

The nunber of intemational adoptive placements made during the year: -

List the countries with which you have accredited intemational adoption programs:

The肌mber of intemational adoptions finalized this year in血e U.S., SPeCifying the countries

Of orig血:

The number of finalizations in o血er countries, SPeCifying血e countries of origin:

The number of intemational adoptive placement disruptions ‥ _

聖」 2. Hastheagency:

● lost the right to provide adoption services in any state or country,

●　had it’s liceuse suspended for cause, Or

●　WaS the agency the subject of o血er sanctions by any court, gOVerrmental agency, Or

govemmental regulatory body relating to the provision of adoption services?

揮e answer ’o a砂′ pOr房on Qrthis錐eStio痛yes, a物Ch af誰and co7卿/ete statement 4’

explanation・

2

一望- 3'　During the past year, Were any actions related to licensure initiated against the ngency by a

liceusing or accrediting body?

ゲ脇e c棚We橘ye& a物Ch a comp巌e脇tement Qreやわna寂on.

」r 4. During the past year, has瓜e agency been a named party in any civil ∞urt actions in rela患on

to the provision of foster care or adoption services?

ゲ脇e cJnSWer i亘’eS, C,触Ch a c鋤?Plete s観ement Qrexp肋綿宙On.

」里_ 5. Is the ageney ourrently the s一埴ect ofa pending investigation by federal or state authorities?

げ脇e an鋤er is y穂, a細h a coJやわ短ねtement Q/e堆舶na#on.

--聖書6. Were也ere any criminal charges, Child abuse changes, malpractice complaints, Or lawsuits

related to the provision of adoption services against the agency or arry of it’s employees,

O純cers’or directors during the past year?

ゲ履物鋤er is J倒a脇ch G COmp融e stdement Q塙p巌窃on c,nd i彊basおor雌yα殖巌m

d協e actions.

-一里9- 7. Was the agency found liあle for ay civil or administrative violation or found guilty of or

Pled guifty to any criminal or ndministrative violation that relates to the provision of adoption

Services under federal, State Or foreign law?

r脇e a榔WerおyeS, a細h a con2〆料語細tement Q/‘鍬p楊nation.

○○曇L 8. Was any empIoyee, O純cer or director ofthe agency found guilty ofany crime or detemined

to have violated a civi=aw or admihis融ve rule relating to the provision of adoption

Services under federal’state Or foreign law?

矛的e c!n鋤erねyes, a#ach a coJxplete s柵ement q/中鉢椛a訪on.

」聖- 9. Was any civil or administra農ve proceeding rela宙Ig tO adoption services instituted by the

agency during the year (excluding uncontested adoption proceedings and proceedings刷ed

PurSua競to Section 12a ofthe Adoption Act)?

ゲ砺e an鋤erおyes,脇ach a co7#p廟摘a絶ment qrexpl鋤atわn、

1O.珊e agency’s website address is: ABC For Adoption Nfy

」空輸1 1. An　’froancial statement for血e prior fiscal year’including a general description of

fees亘るges’Salaries and other compensation described in Rule 40l.565(a) certified by an

independe血pubhe accountant, is a請ached.

」聖- 12. This Amual Report with紺achments and financial statement, ∞rtified dy an

independent public accountant, has been posted on the website listed in item 9.

_望L 13. Eifective August 15, 2005, Amual Reports紺e availal〕le upon request.

Infomation contained in this report is sl坤ect to the applicable con鎚end聞ty requirements of the Child

Care Act and the Adoption Act.

I certify that血e above statemeuts紺e true and accurate, based on infomation available to me at this time.

Julie He血e血gton LCSW

Ma組ing血stnlctions on the back

藷々録音喜一喜一

This report is to be mailed to the child we愉re agency’s A&I licensing Unit and the I11inois Attomey

General,s O組ce:

O珊ce ofthe Attomey General

State of Illinois

Charitable Trust Division

lOO W. RandoIph Street, 1 1th FIoor

Chicago, IL 60601

3 12-814-3000

DCFS Agency and Intuitional Licensing Units:

豊里旦k Co巾

A&I Licensing Unit

筑豊霊慧葦Fl.C龍c鵠0, Ⅲ 60616

C○○k Co. Re車0坦

1921 S, IndianaAve.一9血Fl.

Chicago, IL 60616

Northem Re象ion

A&I Liceusing Unit

A&I Licensing SupervlSOr

200 S〇両h WⅥⅢ皿SL

Rockford, IL 61 101

諾‡輩藷Rookford, IL 61 107

雪印億al Re窒主唾

A&I Liceusing Unit

謡豊欝豊嵩ⅥSOrRock Island, Il. 61201

Central Re盛vn

4500 S. Sixth St. Road

Sp血gfield, IL 62703

Southem Re正調

A&I Lice朋ing Unit

A&I Liceusing SupervISOr

2309 West Maln St.

M紺ion, n. 62959

Sou瓜em Re血on

401 W. Indus億ial Dr- Ste B

E綿ngham, EL 62401