Free PMF - Kansas


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State: Kansas
Category: Secretary of State
Author: nancyr
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http://www.kssos.org/forms/Administration/CAR.pdf

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Contact Information
Kansas Secretary of State Audit Administrator Memorial Hall, 1st Floor
120 S.W. 10th Avenue
Topeka, KS 66612-1594
(785) 296-1848 audit@kssos.org
www.kssos.org

Please complete the form, print, sign and mail to the Kansas Secretary of State. Selecting 'Print' will print the form and 'Reset' will clear the entire form. KANSAS SECRETARY OF STATE

Cemetery Permanent Maintenance and Merchandise Trust Funds Annual Report
For Fiscal Year Ending _____/______/______ Cemetery I.D. Number: _______________________


CAR

DIRECTIONS: This report must be completed in full (typewritten or printed in ink), signed and filed with the corporate annual report, which is typically due April 15. For the unincorporated cemetery corporation, this report is due by April 15. If you need additional space in answering any questions, please attach the information to this form as an Exhibit. A separate report is required for EACH trust fund. All cemetery organizations must file, except those that are empowered to issue bonds in payment of which taxes may be levied; nonprofits formed for religious purposes and constituting an established church that conveys lots only to members or their relatives; nonprofits existing on March 1, 1968, and located in Johnson County; or those with a permanent maintenance fund of less than $10,000 organized before January 1, 1900, and operated continuously since that date. 1. Please provide the following contact information regarding the Cemetery: ________________________________________________________________________
Name of Legal Owner

___________________________________________________
Mailing Address

__________________________
City

_____
State

_______
Zip

_________________________________________________________
Common Name of Cemetery

_______________________________
County

___________________________________________________
Physical Address

__________________________
City

_____
State

_______
Zip

___________________________________________________
Name of Record Keeper

_________________________
E-mail Address

______________
Phone

___________________________________________________
Mailing Address

__________________________
City

_____
State

_______
Zip

_________________________________________________________
Name of President

_______________________________
Phone

_________________________________________________________
Name of General Manager

_______________________________
Phone

_________________________________________________________
Name of Treasurer

_______________________________
Phone

_________________________________________________________
Name of Secretary

_______________________________
Phone

Check one: The legal owner is a:
Cemetery organized as a for-profit corporation _____
Cemetery organized as a not-for-profit corporation _____
Cemetery organized for religious purposes _____
Cemetery not a corporation _____
Other (explain): __________________________________________

6/15/07 nr K.S.A. 17-1312a; K.S.A. 16-329 1/5

2. Please answer the following Permanent Maintenance Fund questions: a. Number of acres platted: ___________ b. Number of acres NOT platted: ___________ c. Number of burial spaces platted: ___________ d. Number of plotted burial spaces sold PRIOR to this reporting year: ___________ e. Amount due to fund on cash received last year and not deposited until this year: $_________________ f. Fill out chart based on THIS reporting year's sales:
Type *See Key Below Number of Spaces Sold Sale Price Per Space Gross Cash Received Amount Deposited into Fund Amount Due to Fund, Not Deposited until Next Year

Year Total

*S = single space; R = second right of interment (burying cremains with traditional burial); D = double depth; M = mausoleum space

g. What is your trust funding policy on installment payment plans: _____ 15% of each installment payment _____ Total funding from first installment payments (up-front funding) _____ Do not accept installment payment plans--payments must be in full h. Total Maintenance expenses* for the year: $___________________________ *Attach schedule detailing maintenance expenses (includes mowing, road maintenance, landscaping). Do not include administrative costs, audit fees, or capital expenditures for equipment used to maintain parts of cemetery not sold for burial purposes or in use of grave sites. Do not use "miscellaneous" or "other" classifications. Give depreciation method if applicable. i. If any investment is a mortgage(s) on real property, give: 1. Mortgagor's name: ____________________________________ 2. Amount of original mortgage: $__________________ 3. Fair market value at time of investment: $____________ j. Has trustee co-mingled your principal and income account? Yes___ No___ k. Give amounts for deposits into principal account: 1. Donations: $_______________ 2. Sale of any land: $_______________ 3. Other (explain: _______________________________) $_______________ l. Give amounts for withdrawals from income account: 1. Transfer to principal (capital gains and excess income): $_______________ 2. Other (explain: _______________________________) $_______________ m. Is this trust an endowment fund? Yes___ No___ If "yes," is the endowment trust being held pursuant to K.S.A. 12-1675 and city ordinance? Yes___ No___
6/15/07 nr K.S.A. 17-1312a; K.S.A. 16-329 2/5

3. Please answer the following Merchandise Trust Fund questions: a. Do you sell cemetery merchandise as defined in K.S.A. 15-320a? Yes___ No___
If "No," skip to Section 4.
b. Give the original date the merchandise trust fund account was established: _____________ c. If this cemetery elected that contracts of sale made prior to January 1, 1983 are to be covered by the act, give: 1. Principal balance on January 1, 1983: $_______________ 2. Income balance on January 1, 1983: $_______________ d. Number of prepaid merchandise contracts on file with trustee (Do not include the contracts in which the merchandise has been delivered): ______________ *Attach schedule detailing such contracts, including the interest earned (lost) on each contract. e. Amount due to fund that was collected last year and not deposited until this year: $_______________ f. Fill out chart based on THIS reporting year's contracts for which merchandise has NOT been delivered:
Type of Contract Paid in Full With Installment Payments Year Total Number of Contracts Gross Cash Received Minimum Funding Requirement (110% of wholesale costs) Amount Deposited into Fund Amount Due to Fund, Not Deposited until Next Year

g. Fill out chart based on THIS reporting year's contracts for which merchandise has been delivered or contract cancelled:
Type of Contract Partial Delivery Total Delivery Cancelled Contracts Year Total Number of Contracts Minimum Funding Requirement (110% of wholesale costs) Amount Withdrawn Fund

h. Give amount withdrawn from trust for exceeding minimum funding requirements: $_______________ i. Are all cemetery merchandise contracts in writing and signed by the contracting parties? Yes___ No___ j. Do your accounts (either in general ledger or accounts) show separate accounts of deposits, accrued income or losses, and withdrawals for each prepaid cemetery merchandise sales contract? Yes___ No___ k. Were the wholesale costs of the prepaid cemetery merchandise sold on each contract of sale determined on December 31 based on quotations and price lists on file with the cemetery? Yes___ No___

6/15/07 nr

K.S.A. 17-1312a; K.S.A. 16-329 3/5

4. Please fill out Authorization to Release Bank Statements Form:

________________________________________________________________________
Custodian of Trust Funds

_____________________________________________
Address

_____________________________
City

_____
State

_________
Zip

The Secretary of State, or his representative, is proposing to conduct either an office or a field audit of our cemetery, pursuant to K.S.A. 17-1312a and/or K.S.A. 16-325. We hereby authorize the above-named bank/trust company to make available to the Secretary of State's office all information and records relating to the following accounts (cemeteries please include both permanent maintenance and merchandise trust fund account information): Account Number _____________________ _____________________ _____________________ _____________________ _____________________ _____________________ _____________________ _____________________ Account Name ____________________________________________________ ____________________________________________________ ____________________________________________________ ____________________________________________________ ____________________________________________________ ____________________________________________________ ____________________________________________________ ____________________________________________________

___________________________________________________________________________
Common Name of Cemetery

_____________________________________________
Address

_____________________________
City

_____
State

_________
Zip

________________________________________________
Printed Name of Owner or Officer

_____________________________
Title

________________________________________________
Signature

_____________________________
Date

6/15/07 nr

K.S.A. 17-1312a; K.S.A. 16-329 4/5

5. Please complete the Oath and Compliance Report:

I, ____________________________________________________________,
Name of Cemetery Owner or Officer

________________________________,
Title

state that

_____________________________________________________________________________________________________
Name of Cemetery

is authorized to do business in the state of Kansas pursuant to K.S.A. 17-1312a, and is in compliance with Kansas statutes concerning trust funds. At least 15 percent of the purchase price for a grave space or at minimum $25.00 is placed, within 45 days of receipt, into an approved Kansas financial institution. No part of the principal has been paid out without written permission from the Kansas Secretary of State and no part has been used to make loans to stockholders, the corporation, the individual proprietor or the partner. At least 110 percent of the wholesale cost for a prepaid merchandise contract is placed, within 10 days of receipt, into an authorized Kansas financial institution. No part of the principal has been paid out until the corresponding merchandise has been delivered and the trustee has been presented with a verified statement stating such. I do hereby certify under penalty of perjury and pursuant to the laws of the state of Kansas that the information contained in this Annual Report and supplied in any attachments thereto is true and correct, and am willing to submit the books, records, papers and instruments of such cemetery to the examination and inspection of the Secretary of State, pursuant to K.S.A. 17-1312c.

________________________________________________
Signature of Owner or Officer

________________________________________________
Printed Name

________________________________________________
Title

________________________________________________
Date

6/15/07 nr

K.S.A. 17-1312a; K.S.A. 16-329 5/5