Free Operating and Financial Summary - Federal

AC 150/5100-19 (Appendix 1)

FORM APPROVED OMB NO. 2120-0569 11/30/2007

Operating and Financial Summary
Please use Helvetica, 7 point font Airport Name Sponsor Name Sponsor Employer Identification Number Consolidated Report? Enter Yes or No Fiscal year end date Location ID State Date when AIP was last audited as a major program Is this report based on audited information? Please enter Yes or No

Summary of Revenues and Expenses
A. Aeronautical Operating Revenue 1. Landing fees 2. Terminal/international arrival area rental or other charges 3. Apron charges/tiedowns 4. FBO revenue: contract or sponsor-operated 5. Cargo and hangar rentals 6. Aviation fuel tax retained for airport use 7. Fuel sales net profit/loss or fuel flowage fees 8. Miscellaneous (not to exceed 5% of Aeronautical) 9. Other (enter total here and add attachment) Total
$

E. Non-Operating Expenses 1. Interest expense 2. Other Total

$

F. Depreciation

Net

(Total A+B+C Less D, E and F)

Other Financial Information
G. Reporting Year Proceeds
1. Bond proceeds 2. Proceeds from sale of property

B. Nonaeronautical Operating Revenue 1. Land and non-terminal facilities 2. Terminal - food and beverage 3. Terminal - retail stores 4. Terminal - other 5. Rental cars 6. Parking 7. Misc. (Should not exceed 5% of total non-aeronautical) 8. Other (Enter total here and add attachment) Total

3. Contributed capital 4. Other Total

$

H. Reporting Year Expenditures for Projects 1. Airfield 2. Terminal 3. Parking 4. Roadways, rail and transit

$

5. Other Total

$

C. Nonoperating Revenues 1, Interest income - restricted and non-restricted 2. Grant receipts 3. Passenger Facility Charges 4. Other Total J. Indebtedness at End of Year 1. Bonds I. Reporting Year Debt Payments

$

2. Loans 3. Other

D. Operating Expenses 1. Personnel compensation and benefits 2. Communications and utilities 3. Supplies and materials. 4. Repairs and maintenance 5. Contractual services 6. Insurance, claims and settlements 7. Misc (should not exceed 5% of total op expenses) 8. Other Total


Total

$

K. Net Assets

L. Restricted Financial Assets 1. Restricted debt service reserve 2. Restrictions for renewals and replacements 3. Other restricted financial assets Total


$

$
M. Unrestricted Financial Assets including cash

In compliance with section 47107(a) of the Title 49 United States Code and section 111(b) of the Federal Aviation Administration Authorization Act of 1994, please complete this form in order to assist the public in understanding airport finances and the use of airport generated revenue. Airport Mailing Address:

I certify that the information on this form is true and accurate to the best of my knowledge and belief.

Signature

Date Telephone No.

Printed name

Title Paperwork Reduction Act Statement: The information collected on this form facilitates the submission of operating and financial summary data. Section 111(b) requires the Secretary of Transportation to issue a simplified format for reporting data applicable to Airports to assist in public understanding of airport finances and to provide information concerning the amount of revenue surplus, the amount of concession-generated revenue, and other information required by the Secretary. The burden for each response is estimated to be 5 hours. Responses are required to obtain a benefit. No assurance of confidentiality is given. Please note that an agency may not conduct or sponsor, and a person is not required to respond to, a collection of information unless it displays a currently valid OMB number. The OMB control number associated with this collection is 2120-0569. Comments concerning the accuracy of this burden and suggestions for reducing the burden should be directed to the FAA at: 800 Independence Ave SW, Washington, DC 20591, Attn: Information Collection Clearance Officer, ABA-20 .

FAA Form 5100-127

4/01 Previous editions are obsolete