Form K.s.a. 17-4634 - Electric Cooperative Annual Report Page 2
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39. Complete the balance sheet showing the financial condition of the cooperative on the last day of its tax period:
LIABILITIES AND
ASSETS
AMOUNT
TOTAL SHAREHOLDERS' EQUITY
AMOUNT TOTAL
a. Cash
o. Accounts payable
b. Trade notes & accounts receivable
p. Mortgages, notes, bonds
-less allowance for bad debts
payable in less than one year
c. Inventories
q. Other current liabilities
d. Government obligations
r. Loans from shareholders
-U.S. and instrumentalities
s. Mortgages, notes, bonds
-State, subdivisions thereof, etc.
payable in one year or more
e. Other current assets
t. Other liabilities
f. Loans to shareholders
u. Total liabilities
g. Mortgages and real estate loans
v. Capital stock:
h. Other investments
-preferred stock
i. Buildings and other fixed
-common stock
depreciable assets
w. Paid-in or capital surplus
-less accumulated depreciation
x. Retained earnings - appropriated
j. Depletable assets
y. Retained earnings income
-less accumulated depreciation
fund - unappropriated
k. Land (net of any amortization)
z. Less cost of treasury stock
l. Intangible assets (amortizable only)
aa.Net worth (total shareholders' equity)
- less accumulated amortization
m. Other assets
bb.TOTAL LIABILITIES AND
n. TOTAL ASSETS
SHAREHOLDERS' EQUITY
(Lines n. and bb. must be identical)
10. Number of members:
11. I declare under penalty of perjury pursuant to the laws of the state of Kansas that the foregoing is true and correct and that I have
remitted the required fee.
Executed on the ________ of _______________ , _____________ .
Day
Month
Year
Name of signer (printed or typed)
Signature of authorized officer
Phone number
Title/position
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