link to Home Page
Part IV Financial Data
Complete the financial statements for the current year and for each of the 3 years immediately before it. If in existence less than 4 years, complete the statements for each year in existence. If in existence less than 1 year, also provide proposed budgets for the 2 years following the current year.

A. Statement of Revenue and Expenses
Current year3 prior years or proposed budget 2 years
(a) 1997(b) 1998(c) 1999(d) 19__(e) Total
R1 Gifts, grants and contributions received (not including unusual grants - see pages 5 and 6 of the instructions)$1,000$2,680$9,680$13,360
e2 Membership fees received
v3 Gross investment income (see instructions for definition)
e4 Net income from organization's unrelated business activities not included on line 3
n5 Tax revenue levied for and either paid to or spent on behalf of the organization
u6 Value of services or facilities furnished by a governmental unit to the organization without charge (not including the value of services or facilities generally furnished the public without charge)
e7 Other income (not including gain or loss from sale of capital assets) (attach schedule)
8. Total (add lines 1 through 7)$1,000$2,680$9,680$13,360
9. Gross receipts from admissions, sales of merchandise or services, or furnishing of facilities in any activity that is not an unrelated business within the meaning of section 513. Include related cost of sales on line 22.
10 Total (add lines 8 and 9)$1,000$2,680$9,680$13,360
11 Gain or loss from sale of capitol assets (attach schedule)
12 Unusual grants
13 Total revenue (add lines 10 through 12)$1,000$2,680$9,680$13,360
E14 Fundraising expenses$817$721$571
x15 Contributions, gifts, grants, and similar amounts paid (attach schedule)$1,750$8,750
p16 Disbursements to or for benefit of members (attach schedule)
e17 Compensation of officers, directors, and trustees (attach schedule)
n18 Other salaries and wages
s19 Interest
e20 Occupancy (rent, utilities, etc.)
s21 Depreciation and depletion
22 Other (attach schedule)
23 Total expenses (add lines 14 thru 22)$817$2,471$9,321
24 Excess of revenue over expenses (line 13 minus line 23)$183 $209 $359