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PART IV PROGRAM SERVICE REVENUE AND OTHER REVENUE (STATE NATURE) |
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Program |
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Other |
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service revenue |
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revenue |
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(a) Fees from government agencies |
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(b) |
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(c) |
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(d) |
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(e) |
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(f) Total program service revenue (enter here and on line 2) |
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(g) Total other revenue (enter here and on line 11) |
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PART V BALANCE SHEETS |
If line 12, Part 1, and line 59 are $25,000 or less, you should complete only lines 59, 66, and 74 and, if you do not |
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Use fund accounting, line 73. If line 12 or line 59 is more than $25,000, complete the entire balance sheet. |
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Note: Columns (C) and (D) are optional. Columns (A) and (B) must be |
(A) Beginning of |
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End of year |
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completed to the extent applicable. Where required, attach schedules should be |
(B) Total |
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(C) Unrestricted/ |
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(D) Restricted/ |
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year |
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for end-of-year amounts only. |
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Expendable |
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Nonexpendable |
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Assets |
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45 |
Cash — non-interest bearing |
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46 |
Savings and temporary cash investments |
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47 |
Accounts receivable _______ |
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minus allowance for doubtful accounts ____________ |
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48 |
Pledges receivable ________ |
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minus allowance for doubtful accounts ____________ |
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49 |
Grants receivable |
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50 |
Receivable due from officers, directors, trustees and key |
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employees (attach schedule) |
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51 |
Other notes and loans receivable ____________ |
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minus allowance for doubtful accounts ____________ |
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52 |
Inventories for sale or use |
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53 |
Prepaid expenses and deferred charges |
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54 |
Investments — securities (attach schedule) |
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55 |
Investments — land, buildings and equipment: basis ____ |
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minus allowance for doubtful accounts ____________ |
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56 |
Investments — other (attach schedule) |
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57 |
Land, buildings and equipment: basis _________ |
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minus accumulated depreciation ______ (attach schedule) |
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58 |
Other assets _____________ |
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59 |
Total assets (add lines 45 through 58) |
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Liabilities |
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60 |
Accounts payable and accrued expenses |
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61 |
Grants payable |
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62 |
Support and revenue designated for future periods |
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(attach schedule) |
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63 |
Loans from officers, directors, trustees, and key employees |
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(attach schedule) |
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64 |
Mortgages and other notes payable (attach schedule) |
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65 |
Other liabilities ___________ |
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66 |
Total liabilities (add lines 60 through 65) |
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Fund Balances or Net Worth |
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Organizations that use fund accounting, check here |
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and complete lines 67 through 70 and lines 74 and 75. |
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67 a. Current unrestricted fund |
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b. Current restricted fund |
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68 |
Land, buildings and equipment fund |
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69 |
Endowment fund |
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70 |
Other funds (Describe _________ ) |
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Organizations that do not use fund accounting, check here |
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and complete lines 71 through 75. |
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71 |
Capital stock or trust principal |
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72 |
Paid-in or capital surplus |
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73 |
Retained earnings or accumulated income |
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74 |
Total fund balances or new worth |
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75 |
Total liabilities and fund balances/net worth |
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