Part V — 0121 Inst 1024-A (PDF)

Part V	Part V. Financial Data
A. Line	A. Statement of Revenue and Expenses You must complete the Statement of Revenue and Expenses for a total of 3 years including the current year. Completed less than 1 year. If you existed less than 1 year, provide projections of your likely income and expenses for your current year and next 2 years based on a reasonable and good faith estimate of your finances for a total of 3 years financial information. Completed at least 1 year but fewer than 3. If you’ve existed for more than 1 year but fewer than 3 years, provide your actual income and expenses for the current year and 1 year prior and projected income and expenses for next year for a total of 3 years financial information. Completed more than 3 years. If you’ve existed more than 3 years, provide your actual income and expenses for the current year and 2 years prior for a total of 3 years financial information. CAUTION! We may request financial data for more than 3 years. Preparing the statement. Prepare the statement using the method of accounting you use in keeping your books and records. Place financial information for the year you’re filing this form in the column marked Current tax year. Prepare the statement using the accounting period you entered on Part I, line 11. Enter “0” if a particular revenue or expense doesn’t apply to you. Your financial information should reflect your activities described in this application.	A. Statement of Revenue and Expenses You must complete the Statement of Revenue and Expenses for a total of 3 years including the current year. Completed less than 1 year. If you existed less than 1 year, provide projections of your likely income and expenses for your current year and next 2 years based on a reasonable and good faith estimate of your finances for a total of 3 years financial information. Completed at least 1 year but fewer than 3. If you’ve existed for more than 1 year but fewer than 3 years, provide your actual income and expenses for the current year and 1 year prior and projected income and expenses for next year for a total of 3 years financial information. Completed more than 3 years. If you’ve existed more than 3 years, provide your actual income and expenses for the current year and 2 years prior for a total of 3 years financial information. CAUTION! We may request financial data for more than 3 years. Preparing the statement. Prepare the statement using the method of accounting you use in keeping your books and records. Place financial information for the year you’re filing this form in the column marked Current tax year. Prepare the statement using the accounting period you entered on Part I, line 11. Enter “0” if a particular revenue or expense doesn’t apply to you. Your financial information should reflect your activities described in this application.	A. Statement of Revenue and Expenses You must complete the Statement of Revenue and Expenses for a total of 3 years including the current year. Completed less than 1 year. If you existed less than 1 year, provide projections of your likely income and expenses for your current year and next 2 years based on a reasonable and good faith estimate of your finances for a total of 3 years financial information. Completed at least 1 year but fewer than 3. If you’ve existed for more than 1 year but fewer than 3 years, provide your actual income and expenses for the current year and 1 year prior and projected income and expenses for next year for a total of 3 years financial information. Completed more than 3 years. If you’ve existed more than 3 years, provide your actual income and expenses for the current year and 2 years prior for a total of 3 years financial information. CAUTION! We may request financial data for more than 3 years. Preparing the statement. Prepare the statement using the method of accounting you use in keeping your books and records. Place financial information for the year you’re filing this form in the column marked Current tax year. Prepare the statement using the accounting period you entered on Part I, line 11. Enter “0” if a particular revenue or expense doesn’t apply to you. Your financial information should reflect your activities described in this application.	A. Statement of Revenue and Expenses You must complete the Statement of Revenue and Expenses for a total of 3 years including the current year. Completed less than 1 year. If you existed less than 1 year, provide projections of your likely income and expenses for your current year and next 2 years based on a reasonable and good faith estimate of your finances for a total of 3 years financial information. Completed at least 1 year but fewer than 3. If you’ve existed for more than 1 year but fewer than 3 years, provide your actual income and expenses for the current year and 1 year prior and projected income and expenses for next year for a total of 3 years financial information. Completed more than 3 years. If you’ve existed more than 3 years, provide your actual income and expenses for the current year and 2 years prior for a total of 3 years financial information. CAUTION! We may request financial data for more than 3 years. Preparing the statement. Prepare the statement using the method of accounting you use in keeping your books and records. Place financial information for the year you’re filing this form in the column marked Current tax year. Prepare the statement using the accounting period you entered on Part I, line 11. Enter “0” if a particular revenue or expense doesn’t apply to you.
Your financial information should reflect your activities described in this application.

Part V	Part V. Financial Data
1	Enter the total gifts, grants, and contributions you receive. Include items of value that you receive as gifts, grants, or contributions. Do not include membership dues reported in line 2.	Enter the total gifts, grants, and contributions you receive. Include items of value that you receive as gifts, grants, or contributions. Do not include membership dues reported in line 2.	Enter the total gifts, grants, and contributions you receive. Include items of value that you receive as gifts, grants, or contributions. Do not include membership dues reported in line 2.	Enter the total gifts, grants, and contributions you receive. Include items of value that you receive as gifts, grants, or contributions. Do not include membership dues reported in line 2.
2	Enter the amount you receive from members to provide support to the organization. Do not include payments from members, or on behalf of members, to purchase admissions, merchandise, services, or use of facilities.	Enter the amount you receive from members to provide support to the organization. Do not include payments from members, or on behalf of members, to purchase admissions, merchandise, services, or use of facilities.	Enter the amount you receive from members to provide support to the organization. Do not include payments from members, or on behalf of members, to purchase admissions, merchandise, services, or use of facilities.	Enter the amount you receive from members to provide support to the organization. Do not include payments from members, or on behalf of members, to purchase admissions, merchandise, services, or use of facilities.
3	Enter your gross income from dividends, interest, payments received on securities, loans, rents, and royalties that are held for investment purposes.	Enter your gross income from dividends, interest, payments received on securities, loans, rents, and royalties that are held for investment purposes.	Enter your gross income from dividends, interest, payments received on securities, loans, rents, and royalties that are held for investment purposes.	Enter your gross income from dividends, interest, payments received on securities, loans, rents, and royalties that are held for investment purposes.
4	Enter your net income from unrelated business activities. Unrelated business income generally is income from any trade or business activity that is regularly carried on, not conducted with substantially all (at least 85%) volunteer labor, and not related to your exempt purposes. (You can take this amount from Form 990-T, if filed.) See Pub. 598 for additional information regarding unrelated business income.	Enter your net income from unrelated business activities. Unrelated business income generally is income from any trade or business activity that is regularly carried on, not conducted with substantially all (at least 85%) volunteer labor, and not related to your exempt purposes. (You can take this amount from Form 990-T, if filed.) See Pub. 598 for additional information regarding unrelated business income.	Enter your net income from unrelated business activities. Unrelated business income generally is income from any trade or business activity that is regularly carried on, not conducted with substantially all (at least 85%) volunteer labor, and not related to your exempt purposes. (You can take this amount from Form 990-T, if filed.) See Pub. 598 for additional information regarding unrelated business income.	Enter your net income from unrelated business activities. Unrelated business income generally is income from any trade or business activity that is regularly carried on, not conducted with substantially all (at least 85%) volunteer labor, and not related to your exempt purposes. (You can take this amount from Form 990-T, if filed.) See Pub. 598 for additional information regarding unrelated business income.
5	Enter amounts any local tax authority collects from the public on your behalf.	Enter amounts any local tax authority collects from the public on your behalf.	Enter amounts any local tax authority collects from the public on your behalf.	Enter amounts any local tax authority collects from the public on your behalf.
6	Enter the value of services or facilities a governmental unit furnishes to you. Use the fair market value of the services or facilities. Don’t include the value of services or facilities generally provided to the public without charge.	Enter the value of services or facilities a governmental unit furnishes to you. Use the fair market value of the services or facilities. Don’t include the value of services or facilities generally provided to the public without charge.	Enter the value of services or facilities a governmental unit furnishes to you. Use the fair market value of the services or facilities. Don’t include the value of services or facilities generally provided to the public without charge.	Enter the value of services or facilities a governmental unit furnishes to you. Use the fair market value of the services or facilities. Don’t include the value of services or facilities generally provided to the public without charge.
7	Enter the total income from all sources not reported on lines 1 through 6, or lines 9 and 11. Provide an itemized list showing each type and amount of income included on this line. Also, briefly describe each type of income.	Enter the total income from all sources not reported on lines 1 through 6, or lines 9 and 11. Provide an itemized list showing each type and amount of income included on this line. Also, briefly describe each type of income.	Enter the total income from all sources not reported on lines 1 through 6, or lines 9 and 11. Provide an itemized list showing each type and amount of income included on this line. Also, briefly describe each type of income.	Enter the total income from all sources not reported on lines 1 through 6, or lines 9 and 11. Provide an itemized list showing each type and amount of income included on this line. Also, briefly describe each type of income.
9	Enter income from activities that you conduct to further your exempt purposes (excluding amounts listed on other lines). Also, include as gross receipts the income from activities conducted: • Intermittently (not regularly carried on), such as an occasional auction; • With substantially all (at least 85%) volunteer labor, such as a car wash; • For the convenience of members, students, patients, officers, or employees, such as a parking lot for a school's students and employees; or • With substantially all contributed merchandise, such as a thrift store. See Pub. 598 for additional information regarding income that isn’t from an unrelated trade or business. Gross receipts also includes payment by a governmental unit that may be called a grant but is actually payment for a service or facility for the use of the government payer, rather than for the direct benefit of the public. Example. The state government gives a conservation group a grant to study the effects of a new sewage treatment plant on an ecologically significant woodland area. Although the payment is called a grant, it is actually gross receipts that should be included on Line 9. The payment is by a governmental unit (state) for a study for its own use, not for the direct benefit of the general public. A for-profit consulting company could have done the study rather than by the tax-exempt conservation group. Provide an itemized list of your gross receipts in line 24, describing the sources and amounts of income. For payments by a governmental unit, list the payer, the purpose of the payment, and the payment amount.t.	Enter income from activities that you conduct to further your exempt purposes (excluding amounts listed on other lines). Also, include as gross receipts the income from activities conducted: • Intermittently (not regularly carried on), such as an occasional auction; • With substantially all (at least 85%) volunteer labor, such as a car wash; • For the convenience of members, students, patients, officers, or employees, such as a parking lot for a school's students and employees; or • With substantially all contributed merchandise, such as a thrift store. See Pub. 598 for additional information regarding income that isn’t from an unrelated trade or business. Gross receipts also includes payment by a governmental unit that may be called a grant but is actually payment for a service or facility for the use of the government payer, rather than for the direct benefit of the public. Example. The state government gives a conservation group a grant to study the effects of a new sewage treatment plant on an ecologically significant woodland area. Although the payment is called a grant, it is actually gross receipts that should be included on Line 9. The payment is by a governmental unit (state) for a study for its own use, not for the direct benefit of the general public. A for-profit consulting company could have done the study rather than by the tax-exempt conservation group. Provide an itemized list of your gross receipts in line 24, describing the sources and amounts of income. For payments by a governmental unit, list the payer, the purpose of the payment, and the payment amount.t.	Enter income from activities that you conduct to further your exempt purposes (excluding amounts listed on other lines). Also, include as gross receipts the income from activities conducted: • Intermittently (not regularly carried on), such as an occasional auction; • With substantially all (at least 85%) volunteer labor, such as a car wash; • For the convenience of members, students, patients, officers, or employees, such as a parking lot for a school's students and employees; or • With substantially all contributed merchandise, such as a thrift store. See Pub. 598 for additional information regarding income that isn’t from an unrelated trade or business. Gross receipts also includes payment by a governmental unit that may be called a grant but is actually payment for a service or facility for the use of the government payer, rather than for the direct benefit of the public. Example. The state government gives a conservation group a grant to study the effects of a new sewage treatment plant on an ecologically significant woodland area. Although the payment is called a grant, it is actually gross receipts that should be included on Line 9. The payment is by a governmental unit (state) for a study for its own use, not for the direct benefit of the general public. A for-profit consulting company could have done the study rather than by the tax-exempt conservation group. Provide an itemized list of your gross receipts in line 24, describing the sources and amounts of income. For payments by a governmental unit, list the payer, the purpose of the payment, and the payment amount.t.	Enter income from activities that you conduct to further your exempt purposes (excluding amounts listed on other lines). Also, include as gross receipts the income from activities conducted: • Intermittently (not regularly carried on), such as an occasional auction; • With substantially all (at least 85%) volunteer labor, such as a car wash; • For the convenience of members, students, patients, officers, or employees, such as a parking lot for a school's students and employees; or • With substantially all contributed merchandise, such as a thrift store. See Pub. 598 for additional information regarding income that isn’t from an unrelated trade or business. Gross receipts also includes payment by a governmental unit that may be called a grant but is actually payment for a service or facility for the
use of the government payer, rather than for the direct benefit of the public. Example. The state government gives a conservation group a grant to study the effects of a new sewage treatment plant on an ecologically significant woodland area. Although the payment is called a grant, it is actually gross receipts that should be included on Line 9. The payment is by a governmental unit (state) for a study for its own use, not for the direct benefit of the general public. A for-profit consulting company could have done the study rather than by the tax-exempt conservation group. Provide an itemized list of your gross receipts in line 24, describing the sources and amounts of income. For payments by a governmental unit, list the payer, the purpose of the payment, and the payment amount.t.

Part V	Part V. Financial Data
11	Enter any net gain or loss on the sale of capital assets. Provide an itemized list by asset category (for example, real estate or securities) showing gross sales, cost or other basis/sales expenses), and gain or loss by asset category in line 24. You may use the format in Figure 2. Figure 2. Net Gain or Loss On Sales of Capital Assets	Enter any net gain or loss on the sale of capital assets. Provide an itemized list by asset category (for example, real estate or securities) showing gross sales, cost or other basis/sales expenses), and gain or loss by asset category in line 24. You may use the format in Figure 2. Figure 2. Net Gain or Loss On Sales of Capital Assets	Enter any net gain or loss on the sale of capital assets. Provide an itemized list by asset category (for example, real estate or securities) showing gross sales, cost or other basis/sales expenses), and gain or loss by asset category in line 24. You may use the format in Figure 2. Figure 2. Net Gain or Loss On Sales of Capital Assets	Enter any net gain or loss on the sale of capital assets. Provide an itemized list by asset category (for example, real estate or securities) showing gross sales, cost or other basis/sales expenses), and gain or loss by asset category in line 24. You may use the format in Figure 2. Figure 2. Net Gain or Loss On Sales of Capital Assets
11		Categories	Categories	Categories
11		(A) Real Estate	(B) Securities	(C) Other
11	1. Gross Sales Price of assets (other than inventory) by category
11	2. Less: Cost or other basis and sales expense
11	3. Gain or (loss). Subtract line 2 from line 1.
11	4. Net gain or (loss) — Add line 3 of columns (A), (B), and (C). Enter here and on Form 1024-A, Part IX-A. Statement of Revenues and Expenses, line 11.	4. Net gain or (loss) — Add line 3 of columns (A), (B), and (C). Enter here and on Form 1024-A, Part IX-A. Statement of Revenues and Expenses, line 11.	4. Net gain or (loss) — Add line 3 of columns (A), (B), and (C). Enter here and on Form 1024-A, Part IX-A. Statement of Revenues and Expenses, line 11.
11
13	Enter the total expenses you incur for soliciting gifts, grants, and contributions included on line 1. Include fees paid to professional fund raisers for soliciting gifts, grants, and contributions.	Enter the total expenses you incur for soliciting gifts, grants, and contributions included on line 1. Include fees paid to professional fund raisers for soliciting gifts, grants, and contributions.	Enter the total expenses you incur for soliciting gifts, grants, and contributions included on line 1. Include fees paid to professional fund raisers for soliciting gifts, grants, and contributions.	Enter the total expenses you incur for soliciting gifts, grants, and contributions included on line 1. Include fees paid to professional fund raisers for soliciting gifts, grants, and contributions.

-10- Instructions for Form 1024-A

Part V	Part V. Financial Data
14	Enter the total amounts you pay out to both individuals and organizations. Provide an itemized list on line 24, identifying recipients (using letter designations such as A, B, C, etc., for individuals) a brief description of the purposes or conditions of payments, and the amounts paid. Maintain (but don’t submit) a list showing the names of recipients associated with each letter designation.
15	Enter total payments you make to or for the benefit of your members. Provide an itemized list in line 25, identifying recipients (using letter designations), a brief description of the purposes or conditions of payment, and the amounts paid. Do not include any amounts reported on line 14. Maintain (but don’t submit) a list showing the names of recipients associated with each letter designation.
16	Enter the total amount of compensation you pay to your officers, directors, and trustees.
17	Enter the total amount of salaries you pay to employees (not reported on line 16 above).
18	Enter your total interest expense for the year. Don’t include mortgage interest treated as an occupancy expense on line 19.
19	Enter the amount you pay for the use of office space or other facilities, heat, light, power, and other utilities, outside janitorial services, mortgage interest, real estate taxes, and similar expenses.
20	Enter the total depreciation, depletion, and similar expenses you incur.
21	Enter the total professional fees you pay. Professional fees are amounts charged by individuals and entities that aren’t your employees. They include fees for professional fundraisers (other than fees included on line 13, above), accounting services, legal counsel, consulting services, contract management, or any independent contractors.
22	Enter any expenses you didn’t include in the lines above, such as for program services. Provide an itemized list in line 24, showing the type and amount of each significant expense.
B, Line	B. Balance Sheet Complete the balance sheet for your most recently completed tax year. If you haven’t completed a full tax year, use the most current information available. Be sure to enter the year-end date for the information provided and not the date you prepare this application. Enter “0” if a particular asset or liability doesn’t apply to you.
1	Enter your total cash in checking and savings accounts, temporary cash investments (money market funds, CDs, treasury bills, or other obligations that mature in less than 1 year), and petty cash funds.
2	Enter your total accounts receivable that arose from the sale of goods and/or performance of services, less any reserve for bad debt.
3	Enter the amount of materials, goods, and supplies you purchased or manufactured and held to be sold or used in some future period.
4	Enter the total amount of bonds or notes you issued that will be repaid to you. Provide an itemized list in line 19 that shows the name of the borrower (using a letter designation), the borrower’s relationship to you, a brief description of the obligation, the rate of return, the due date, and the amount due. Maintain (but don’t submit) a list showing the names of borrowers associated with each letter designation.
5	Enter the total fair market value of corporate stocks you hold. Provide an itemized list of your corporate stock holdings in line 19. For stock of closely held corporations, list the name of the corporation, a brief summary of the corporation's capital structure, the number of shares held, and their value as carried on your books. If such valuation doesn't reflect current fair market value, also include fair market value. For stock traded on an organized exchange or in substantial quantities over the counter, the schedule should show the name of the corporation, a description of the stock and the principal exchange on which it is traded, the number of shares held, and their value as carried on the organization's books.
6	Enter your total amount of loans (personal and mortgage loans) receivable. Provide an itemized list that identifies each borrower name (using a letter designation), the borrower’s relationship to you, purpose of loan, repayment terms, interest rate, and original amount of loan. Report each loan separately, even if more than one loan was made to the same person. Maintain (but don’t submit) a list showing the names of borrowers associated with each letter designation.
7	Enter the total book value of your other investments. Include the total book value of governmental securities (federal, state, and municipal), buildings, and equipment held for investment purposes. Provide an itemized list in line 19 identifying and reporting the book value of each building/item of equipment held for investment purposes.
8	Enter the total book value of buildings and equipment not held for investment purposes. This includes facilities you own and equipment you use in conducting your exempt activities. Provide an itemized listing of these assets held at the end of the current tax year/period, including the cost or other basis.
9	Enter the total book value of land not held for investment purposes.
10	Enter the total book value of any other category of your assets not reported on lines 1 through 9, for example, patents, copyrights, or other intangible assets. Provide an itemized list of each assets in line 19.
12	Enter the total of accounts your accounts payable to suppliers and others, such as salaries payable, accrued payroll taxes, and interest payable.
13	Enter the total unpaid portion of grants and contributions you committed to pay to other organizations or individuals.
14	Enter the total of your mortgages and other notes payable outstanding at the end of the current year/period. Provide an itemized list in line 19 showing each note separately and the lender's name, purpose of loan, repayment terms, interest rate, and original amount.
15	Enter the total amount of any other liabilities not reported on lines 12 through 14. Provide an itemized list in line 19 of these liabilities, including the amounts you owe.
17	Under fund accounting, an organization segregates its assets, liabilities, and net assets into separate funds according to restrictions on the use of certain assets. Each fund is like a separate entity in that it has a self-balancing set of accounts showing assets, liabilities, equity (fund balance), income, and expenses. If you don’t use fund accounting, report only the net assets account balances, which include capital stock, paid-in capital, retained earnings or accumulated income, and endowment funds.

Instructions for Form 1024-A -11-