Annual Financial Report Of Charitable Organization Form - 2011
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4Annual Financial Report of Charitable Organization
This form is to be completed by an organization which does not file an annual federal information return with the Internal Revenue Service.
Name of Organization
State registration number
Address
Employer identification number (EIN)
City, State, ZIP Code
E-mail address
Exempt under IRC Section 501(c)
This report is for the year ended (Month/Day/Year):
Current value of assets at year end:
Part 1 Statement of Support, Revenue, Expenses, and Changes in Net Assets or Fund Balances
Support and Revenue
1
Contributions, gifts, grants, and similar amounts received
2
Government contributions and grants received
3
Program service revenue
4
Membership dues and assessments
5
Net gain or (loss) from the sale of assets other than inventory
6
Interest
7
Dividends
8
Other investment income
9
Other revenue
10 Total revenue
(add lines 1 through 9)
Expenses
11
Program services (from Part 2, line 28, column B)
12
Management and general (from Part 2, line 28, column C)
13
Fundraising (from Part 2, line 28, column D)
14 Total expenses
(add lines 11 through 13)
Net Assets/Fund Balances
15
Excess or (deficit) for the year (subtract line 14 from line 10)
16
Net assets or fund balances at beginning of year (from Part 3, line 29, column A)
17
Other changes in net assets or fund balances (attach explanation)
18
Net assets or fund balances at end of year (add lines 15 through 17)
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