Form Ss-6002 - Summary Of Financial Activities Of A Charitable Organization
ADVERTISEMENT
1
2OFFICE USE ONLY
Date Stamped
SUMMARY OF FINANCIAL
Charitable Solicitations
ACTIVITIES OF A
312 Eighth Avenue North
8th Floor, William R. Snodgrass Tower
CHARITABLE ORGANIZATION
Nashville, TN 37243-0308
(615) 741-2555
INSTRUCTIONS:
A charitable organization must use this form to report financial activities for its most recently completed fiscal year.
Amounts entered below must correspond with entries on the organization's Internal Revenue Service Form 990. (Refer
to IRS Form 990 line items in parentheses). This completed financial statement must be signed by two (2) separate
authorized officers in the presence of a Notary Public and filed with the Secretary of State within six (6) months of the
end of the fiscal year. A copy of the filed IRS Form 990, and any other forms required to be filed with the IRS, must
accompany this form. Organizations with gross revenue in excess of two hundred fifty thousand dollars ($250,000)
must also submit an audit report prepared by an independent public accountant or certified public accountant.
Name of Organization: ...............................................................................................................................................
Address: ....................................................................................................................................................................
Fiscal Year Ending: ....................................................................... [If fiscal year has changed, mark (x)] ________
Federal ID# ............................................ State ID# _____________ Telephone# ____________________________
A.
Gross Revenue
1.
Public Contributions (IRS Form 990, Lines 1a and 1b) ......... $ _______________________________
2.
Government grants (Line 1c) ................................................. $ _______________________________
3.
Program service fees (Line 2) ............................................... $ _______________________________
4.
Special events and activities (Line 9a) ................................... $ _______________________________
5.
Gross sales of inventory (Line 10a) ....................................... $ _______________________________
6.
Other Revenue (Lines 3, 4, 5, 6c, 7, 8d,11) .......................... $ _______________________________
7.
Total Revenue [add 1 through 6] .......................................... $ _______________________________
B.
Expenses
Statement of Program Service Accomplishments
The organization's primary purpose .............................................................................................................
.....................................................................................................................................................................
8.
Program A (Part III,a) ........................................................... $ _______________________________
.....................................................................................................................................................................
.....................................................................................................................................................................
___________________________________________________________________________________
9.
Program B (Part III,b) ........................................................... $ _______________________________
.....................................................................................................................................................................
.....................................................................................................................................................................
___________________________________________________________________________________
10.
Program C (Part III,c) ........................................................... $ _______________________________
.....................................................................................................................................................................
.....................................................................................................................................................................
___________________________________________________________________________________
11.
Other Program Services (Part III, d&e) ................................. $ _______________________________
12.
Total Program Expenses [add 8 thru 11] (Line 13&Part III,f) .. $ _______________________________
13.
Direct Expenses from Special Events (Line 9b) ..................... $ _______________________________
14.
Cost of goods sold (Line 10b) ............................................... $ _______________________________
15.
Management and general expenses (Line 14) ....................... $ _______________________________
16.
Fund raising expenses (Line 15) ........................................... $ _______________________________
17.
Payments/services to affiliates (Line 16) ............................... $ _______________________________
18.
Total Expenses [add 12 thru 17] .......................................... $ _______________________________
19.
Excess/Deficit for the year [7 minus 18] (Line 18) .............. $ _______________________________
C.
Changes in Net Assets or Fund balances
20.
Net assets/fund balances at beginning of year (Line 19) ....... $ _______________________________
21.
Other changes in net assets or fund balances (Line 20) ........ $ _______________________________
22.
Net assets/fund balances [add 19 thru 21] (Lines 21&73) ... $ _______________________________
23.
Total assets (Line 59) ............................................................ $ _______________________________
24.
Total liabilities (Line 66) ......................................................... $ _______________________________
25.
Net assets/fund balances [23 minus 24] (Lines 21&73) ...... $ _______________________________
ADVERTISEMENT
0 votes
Related Articles
Related forms
Form Ss-6022 - Summary Of Financial Activities Of A Professional Solicitor For A Solicitation Campaign - Departament Of State, State Of Tennessee
Legal
Form Ss-6007 - Application To Renew Registration Of A Charitable Organization - Department Of State, State Of Tennessee
Legal
Related Categories
Parent category: Legal