Computation Of Fund-Raising Percentage Form - Short Term Financial Report

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STATE OF WEST VIRGINIA
COMPUTATION OF FUND-RAISING PERCENTAGE FORM
SHORT FORM FINANCIAL REPORT
See reverse side for instructions
Name of Organization: __________________________________________________________________
Report for fiscal year ending: ________________
Information is for:
National
Regional
State
Local
Includes Affiliates:
Yes
No
Part I
Balance at previous fiscal year end:
$______________________________________
Support, revenue and other additions:
Cash Contributions
$______________________________________ 1
In-kind Contributions
______________________________________ 2
Indirect public support
______________________________________ 3
Government Grants
______________________________________ 4
Program related income
______________________________________ 5
Membership dues
______________________________________ 6
Other revenue
______________________________________ 7
Total (lines 1-7)
$______________________________________ 8
Expenses and other deductions:
Management and general
$______________________________________ 9
Public Education
______________________________________ 10
Fund-raising
______________________________________ 11
Program Services
______________________________________ 12
Other
______________________________________ 13
Total (lines 9-13)
$______________________________________ 14
Excess (deficit) for year
$______________________________________ 15
(Line 8 les Line 14)
Part II
Computation of Fund-Raising Percentage
$ ____________________
÷ $ ____________________________ = _____________
Fund-Raising Expenses
Income Derived from Fund-Raising
Percentage
Schedule A
Program Service List
___________________________________
$_______________________________
___________________________________
$_______________________________
___________________________________
$_______________________________
___________________________________
$_______________________________
Total
$_______________________________

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