Summary Of Financial Activities Of A Charitable Organization Filing A 990/990ez

Division of Charitable Solicitations and Gaming

Office of Tennessee Secretary of State Tre Hargett

312 Rosa L. Parks Avenue, 8th Floor

Nashville, Tennessee 37243

615-741-2555

Summary of Financial Activities of a Charitable Organization Filing a 990

WARNING: False or misleading statements subject to maximum $5,000 civil penalty. T.C.A. § 48-101-514

Instructions: Complete this two page form with financial information from the most recently

completed accounting year. The form must be signed by two authorized officers, one of whom shall be

the Chief Fiscal Officer. A 990 or 990EZ form must be attached.

Name of the organization:

COID:

FEIN:

Accounting period end date:

(mm/dd/yy)

Has the accounting period changed since your last registration?

 Yes  No

1. Gross Revenue [From Page 9 of 990]

A. Public Contributions [1H Minus 1E] . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .$

B. Government Grants [1E] . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .$

C. Program Service Revenue [2G]. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .$

D. Special Events and Activities [8A] . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .$

E. Gross Sales of Inventory [10A]. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .$

F. Other Revenue [3+4+5+6A +/- 7D+9A+11E] . . . . . . . . . . . . . . . . . . . . . . . . . . . .$

G. otal Revenue [Add Line 1A Through Line 1F] . . . . . . . . . . . . . . . . . . . . . . $

2. Expenses [From Page 9 and 10 of 990]

A. Total Program Expenses [25, Column B] . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .$

B. Direct Expenses from Special Events [Page 9, Line 8B]. . . . . . . . . . . . . . . . . . .$

C. Cost of Goods Sold [Page 9, Line 10B] . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .$

D. Management and General Expenses [25, Column C] . . . . . . . . . . . . . . . . . . . .$

E. Fund Raising Expenses [25, Column D] . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .$

F. Other Expenses [Page 9, Lines 6B+9B] . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .$

G. Total Expenses [Add Line 2A Through Line 2F] . . . . . . . . . . . . . . . . . . . . . . . .$

H. Excess / Deficit for the year [Line 1G Minus Line 2G] . . . . . . . . . . . . . . . . . . . .$

3. Changes in Net Assets or Fund balances [From Page 1 of 990]

A. Net assets / fund balances at beginning of year [22] . . . . . . . . . . . . . . . . . . . . .$

B. Other changes in net assets or fund balances

[Sch. D, Part XI Or Pg.12, Lines 5-9] . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .$

C. Net assets / fund balances [Add Line 2H Through Line 3B] . . . . . . . . . . . . .$

D. Total Assets [20]. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .$

E. Total Liabilities [21] . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .$

F. Net assets / fund balances [Line 3D Minus Line 3E] . . . . . . . . . . . . . . . . . . . . .$

4. Accounting method used:  Cash  Accrual  Other

SS-6002 (Rev. 12/14), RDA 2994

Page: 1

Summary Of Financial Activities Of A Charitable Organization Filing A 990/990ez - 2014

Related Articles

Related forms

Related Categories