Form Ss-6002 Summary Of Financial Activities Of A Charitable Organization

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Division of Charitable Solicitations and Gaming
Tre Hargett, Secretary of State
WA R N IN G :
False o r mislead in g st atemen ts Subject to
maximum $5,000 civil penalty. T.C.A. §48-101-514
SUMMARY OF FINANCIAL ACTIVITIES
OF A CHARITABLE ORGANIZATION
State of Tennessee
312 Rosa L. Parks Avenue, 8th Floor
Nashville, Tennessee 37243
615-741-2555
Fax: 615-253-5173
NSTRUCTIONS: Complete this form with financial information from the most recently completed accounting
I
year. The form must be signed by two (2) authorized officers, one of whom shall be the Chief Fiscal Officer.
Please see the sample Summary of Financial Activities for the corresponding lines on page 9 and 10 of the
IRS Form 990.
Name of Organization:
Address:
City:
State:
Zip Code:
Federal ID:
State ID:
Telephone:
Accounting Year End:
Has your accounting year changed? Yes
No
A. Gross Revenue
1.
Public Contributions ..............................................................$ _______________________________
2.
Government Grants .............................................................$ _______________________________
3.
Program Service Revenue.....................................................$ _______________________________
4.
Special Events and Activities .................................................$ _______________________________
5.
Gross Sales of Inventory .......................................................$ _______________________________
6.
Other Revenue ......................................................................$ _______________________________
7.
Total Revenue [Add Line 1 Through Line 6] ......................... $ _______________________________
B. Expenses
8.
Total Program Expenses........................................................$ _______________________________
9.
Direct Expenses from Special Events....................................$ _______________________________
10.
Cost of Goods Sold................................................................$ _______________________________
11.
Management and General Expenses ....................................$ _______________________________
12.
Fund Raising Expenses .........................................................$ _______________________________
13.
Other Expenses .....................................................................$ _______________________________
14.
Total Expenses [add line 8 through line 13] .......................... $ _______________________________
15.
Excess / Deficit for the year [line 7 minus line 14] ................. $ _______________________________
C. Changes in Net Assets or Fund balances
16.
Net assets / fund balances at beginning of year .................... $ _______________________________
17.
Other changes in net assets or fund balances ...................... $ _______________________________
18.
Net assets / fund balances [add line 15 through line 17] ....... $ _______________________________
19.
Total Assets............................................................................$ _______________________________
20.
Total Liabilities .......................................................................$ _______________________________
21.
Net assets / fund balances [line 19 minus line 20] ................ $ _______________________________
D. Accounting Method Used:
CASH:
ACCRUAL:
OTHER:

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