Form 199 - California Exempt Organization Annual Information Return - 2011 Page 2
ADVERTISEMENT
1
2Part II Organizations with gross receipts of more than $25,000 and private foundations regardless of amount of gross receipts —
complete Part II or furnish substitute information. See Specific Line Instructions.
00
1 Gross sales or receipts from all business activities. See instructions . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
1
00
2 Interest . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
2
3 Dividends . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
3
00
Receipts
00
4 Gross rents . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
4
from
00
5 Gross royalties . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
5
Other
Sources
6 Gross amount received from sale of assets (See Instructions) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
6
00
00
7 Other income. Attach schedule . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
7
8 Total gross sales or receipts from other sources. Add line 1 through line 7.
00
Enter here and on Side 1, Part I, line 1 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
8
00
9 Contributions, gifts, grants, and similar amounts paid. Attach schedule . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
9
00
10 Disbursements to or for members . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
10
00
11 Compensation of officers, directors, and trustees. Attach schedule . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
11
00
12 Other salaries and wages . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
12
Expenses
and
00
13 Interest . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
13
Disburse-
00
14 Taxes . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
14
ments
15 Rents . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
15
00
00
16 Depreciation and depletion (See instructions) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
16
00
17 Other Expenses and Disbursements. Attach schedule. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
17
00
18 Total expenses and disbursements. Add line 9 through line 17. Enter here and on Side 1, Part I, line 9 . . . . . . . . . 18
Schedule L
Balance Sheets
Beginning of taxable year
End of taxable year
Assets
(a)
(b)
(c)
(d)
1 Cash . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
2 Net accounts receivable . . . . . . . . . . . . . . . . . . . . . .
3 Net notes receivable. . . . . . . . . . . . . . . . . . . . . . . . . .
4 Inventories . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
5 Federal and state government obligations . . . . . . . . .
6 Investments in other bonds. . . . . . . . . . . . . . . . . . . .
7 Investments in stock. . . . . . . . . . . . . . . . . . . . . . . . .
8 Mortgage loans . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
9 Other investments. Attach schedule . . . . . . . . . . . . .
10 a Depreciable assets . . . . . . . . . . . . . . . . . . . . . . . . .
(
)
(
)
b Less accumulated depreciation . . . . . . . . . . . . . . .
11 Land . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
12 Other assets. Attach schedule . . . . . . . . . . . . . . . . . .
13 Total assets . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
Liabilities and net worth
14 Accounts payable . . . . . . . . . . . . . . . . . . . . . . . . . . .
15 Contributions, gifts, or grants payable . . . . . . . . . . .
16 Bonds and notes payable. . . . . . . . . . . . . . . . . . . . . .
17 Mortgages payable . . . . . . . . . . . . . . . . . . . . . . . . . .
18 Other liabilities. Attach schedule . . . . . . . . . . . . . . . .
19 Capital stock or principle fund . . . . . . . . . . . . . . . . . .
20 Paid-in or capital surplus. Attach reconciliation . . . .
21 Retained earnings or income fund . . . . . . . . . . . . . .
22 Total liabilities and net worth . . . . . . . . . . . . . . . . . . .
Schedule M-1 Reconciliation of income per books with income per return
Do not complete this schedule if the amount on Schedule L, line 13, column (d), is less than $25,000
1
Net income per books . . . . . . . . . . . . . . . . . . . . . . .
7 Income recorded on books this year
2
Federal income tax . . . . . . . . . . . . . . . . . . . . . . . . . .
not included in this return.
3
Excess of capital losses over capital gains . . . . . . . .
Attach schedule . . . . . . . . . . . . . . . . . . . . . .
4
Income not recorded on books this
8 Deductions in this return not charged
year. Attach schedule . . . . . . . . . . . . . . . . . . . . . . . .
against book income this year.
5
Expenses recorded on books this year not
Attach schedule . . . . . . . . . . . . . . . . . . . . . .
deducted in this return. Attach schedule . . . . . . . . .
9 Total. Add line 7 and line 8 . . . . . . . . . . . . . .
6
Total.
10 Net income per return.
Add line 1 through line 5 . . . . . . . . . . . . . . . . . . . . .
Subtract line 9 from line 6 . . . . . . . . . . . . . .
Side 2 Form 199
2011
C1
3652113
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