taxable year form california exempt organization business ... forms/109_2011-12.pdf · unrelated...

11

10

Amount claimed . . .New jobs credit, amount generated.a

2011

Address

Is the organization a non-exempt charitable trust as described

City State ZIP Code

in IRC Section 4947(a)(1)? . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Yes NoIs this organization claiming any Enterprise Zone (EZ), Los AngelesRevitalization Zone (LARZ), Local Agency Military Base Recovery Area(LAMBRA), Targeted Tax Area (TTA), or Manufacturing Enhancement

Is this an education IRA within the meaning of Yes No

Area (MEA) tax benefits? . . . . . . . . . . . . . . . . . . . . . . . . . . . . Yes No

Is the organization under audit by the IRS or has the IRS audited

Yes No

Unrelated Business Activity (UBA) Code

Check if estimate penalty computed using Exception B or C and attach form FTB 5806.

109California Exempt Organization

1

2

2

3

4

5

6

7

8

9

10

11c

12 12

13 13

14 14

15 15

16 16

17 17

18 18

19 19

20 20

21

22 22

23 23

24 24

25

24a

26

24c

27

a

b c

25

27

For Privacy Notice, get form FTB 1131.

Calendar Year 2011 or fiscal year beginning , and ending .

Unrelated business taxable income from Side 2, Part II, line 30 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Multiply line 1 by the average apportionment percentage % from the Schedule R,

Apportionment Formula Worksheet, Part A, line 6 or Part B, line 2. See instructions . . . . . . . . . . . . . . . . . . . . . . . . . .

Unrelated business taxable income from Side 2, Part II, line 30 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Enterprise zone, LAMBRA, LARZ, TTA, or Pierce's disease losses . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Net Operating Loss deduction. See General Information N . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Add line 6 and line 7 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Net unrelated business taxable income. Subtract line 8 from line 5 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Balance. Subtract line 11d from line 10. If line 11d is greater than line 10, enter -0- . . . . . . . . . . . . . .

Alternative minimum tax. See General Information O . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Total tax. Add line 12 and line 13 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Overpayment from a prior year allowed as a credit . . . . . . . . . .

2011 estimated tax payments. See instructions . . . . . . . . . . . . . . . . . . . .

Amount paid with extension (form FTB 3539) . . . . . . . . . . . . . . .

Total payments and credits. Add line 15 through line 18 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Enter amount of line 21 to be applied to 2012 estimated tax . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Use tax. See instructions . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Fill in the account information to have the refund directly deposited.

Type: Checking Savings Account Number . . . . . . . . . . . . . . . . . . . . . . . .

Penalties and interest. See General Information M . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Form 109 C1 2011 Side 1

TAXABLE YEAR FORM

Surrendered (Withdrawn)

CORP #

FEIN

Final Return?Dissolved

Merged/Reorganized (attach explanation)

Corporation/Organization Name

Nature of trade or business

Accounting Method Used:

3641114

C

D

E

F

G

A B

H

TaxCompu-tation

TotalTax

Payments

Refund(DirectDeposit ofRefund) orAmountDue

00

1Taxable

Routing number . . . . . . . . . .

If a box is checked, enter date

Tax due. Subtract line 19 from line 14. Pay entire amount with return. See instructions . . . . . . . . . .

Overpayment. Subtract line 14 from line 19. See instructions . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Refund. If the sum of line 22 and line 23 is less than line 21, then subtract the total from line 21 . . . . . . . . . . . . . . . .

Total amount due. Add line 20, line 22, line 23, and line 25, then subtract line 21 from the result . . . . . . . . . . . . . . . . .

Business Income Tax Return

00

00

00

00

00

00

00

00

00

00

00

00

00

00

00

00

00

00

00

00

00

in a prior year? . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Cash(1) (2) Accrual Other(3)

I

K

Corpora-tion

Enter the lesser amount from line 1 or line 2. If line 2 is zero, enter the amount from line 1 . . . . . . . 003

4 00

005Unrelated business taxable income from line 3 or line 4 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

7

8

9

6 00

Tax % x line 9. See General Information J . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

TrustTaxable

2011 withholding (Form 592-B and/or 593.) See instructions . . . . . . . . .

21

NoYesFirst Return Filed?

R&TC Section 23712?

J

bonus plan as described in IRC Section 401(a)? . . . . . . . . . . .

Is this organization a qualified pension, profit-sharing, or stockNoYesAmended Return . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Yes No

yeardaymonthyeardaymonth

0011b

c Tax credits from Schedule B. See instructions . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Total Credits. Add line 11b and 11c . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .d

a)

11d 00

b)11

034

07/01/11 06/30/12X X

0505207

CAL POLY POMONA FOUNDATION, INC 95-2417645

3801 WEST TEMPLE AVE. BLDG # 55

POMONA CA 91768-4038

X

XX

RETAIL/DINING

X

X

X721000

8.84

0

09413690002 04/17/2013 10:26 AM

09413690002 04/17t20'13 1O:25 AM

CAI POLY POMONA FOT'NDATION, INCUnrelated Business Taxable lncome

95-24L7 645

Part I

1 a Gross receipts orgross sales

or Business lncomeL , 666 ,235 b Less returns: andallcwa^€s

2 Cost of goods sold and/or operations (Schedule A, line 7)

3 Gross profit. Subtract line 2 from line 1c ....4 a Capital gain net income. See Specific Line Instructions - Trusts attach Schedule D (541)

b Net gain (loss) from Part ll, Schedule D-1

c Capital loss deduction for trusts

5 Income (or loss) from partnerships, limited liability companies, or S corporations. See specific line instructions.

Attach Schedule K-1 (565, 568, or 100S) or similar schedute

6 Rental income (Schedule C)

7 Unrelated deblfinanced income (Schedute D)

8 Investment income of an R&TC Section 237019,23701i, or 23701n organization (Schedule E)

9 Interesl, Annuities, Royalties and Rents from controlled organizations (Schedule F)

10 Exploited exempt activity income (Schedule G)

11 Advertising income (Schedule H, Part lll, Column A)12 Otherincome.Attachschedute See Statement 1

trade orPart ll Deductions Not Taken Elsewhere

aoaoaa

aO

aaaaaoa

L .666 .23762,34t903.894

1,133,8912,O37 .78

deductions musl be connected with the unrelated businesstor

14 Compensation of officers, directors, and trustees from Schedule I

15 Salaries and wages

16 Repairs

17 Bad debts

18 Interest. Altach schedule

19 Taxes. Attach schedul

20 Contributions. See instructions and attach schedule

aoao

ao

14 00

15 862,2t0 00

16 tt2.262 00

't7 00

18 00

19

20 002'l a Depreciation lCorporations and Associations - Schedute J) (Trusts - form FTB 388SF)

b Less: depreciation claimed on Schedule A. See instructions

O 21a 107 , 883loo0021b 21 107,88 00

22 Depletion. Attach schedule .

23 a Contributions to deferred compensation plans

b Employee benefit programs. See instructions24 Other deductions. Attach schedule See Statement 2 .

a 22 00

23a 00

23b 1s8.484 00

24 8L7.214 0025

26

27

28

29

Totaf deductions. Add line 14 through line24Unrelated business laxable income before allowable excess adverlising costs, Subtract line 25 from line '13

Excess advertising costs (Schedule H, Part lll, Column B)

Unrelated business taxable income before specific deduction. Subtract line 27 from line 26Specific deduction. See instructions

ao

a

a28,

25 2.0s8 11 00

26 -20,329 UU

27 00

28 -20,328 00

29 1 .000 00

30 -20.324SignHere

Under penalties of perjury, I declare that I have examined lhis return, including accompanying schedules and statements, and to the best of my knowledge andbelief il is true, correct,rfld co?{ete. qeclartti$ of preparer (other than taxpayer) is based on all information of rvhich preparer has any knowledge.

-

"J':;:J: , f, HnLU.br. |!I",,", ",*",.* l'tf 1,, I ,, |'rlffi$.n -2s4sPaidPrepare/sUse Only

Date

04/L7 /L3Cn.'"r, tr .Jr-employed

. PTIN

P00434118o FEIN

O Telephone

909-859-2 948

1Xv". No

Firm's name (or yours, /if serf-emptoyed) > DAVID F. PRENOVOST, CPAandaddress 3801 W. TEMPLE AVE.

POMONA, CA 91768-4038May the FTB discuss this return with the preparer shown above? See instructions

Side 2 Form 109 cr 201 1 r'fl 3642rr4

Schedule C Rental Income from Real Property and Personal Property Leased with Real Property

%

%

For rental income from debt-financed property, use Schedule D, R&TC Section 23701g, Section 23701i, and Section 23701n organizations. See instructions for exceptions.

%

Add columns 4(b) and column 5(c). Enter here and on Side 2, Part I, line 6 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Form 109 C1 2011 Side 3

Description of property Rent received Percentage of rent attr.or accrued to personal property

Complete if any item in column 3 is more than 50%, or for any item Complete if any item in column 3 is more than 10%, but not more than 50%if the rent is determined on the basis of profit or income

(a) Deductions directly connected (b) Income includible, column 2 (a) Gross income reportable, (b) Deductions dir. connected with personal (c) Net income includible, column 5(a)property(attach

schedule)less column 4(a) column 2 x column 3 less column 5(b)

(att. sch.)

3643114

1 2 3

4 5

Schedule A Cost of Goods Sold and/or Operations. Method of inventory valuation (specify)

1 1

2 2

3 3

4 a 4a

b 4b

5 5

6 6

7 7

Schedule B Tax Credits. Do not claim the New Jobs Credit on Schedule B.

1 1

2 2

3 3

4

4

Inventory at beginning of year . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Purchases . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Cost of labor . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Additional IRC Section 263A costs. Attach schedule . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Other costs. Attach schedule . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Total. Add line 1 through line 4b . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Inventory at end of year . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Cost of goods sold and/or operations. Subtract line 6 from line 5. Enter here and on Side 2, Part I, line 2 . . . . . . . . . . . . . . . . . . . . . . .

Yes No

Enter credit name code no.



Total. Add line 1 through line 3. If claiming more than 3 credits, enter the total of all claimed credits,

Do the rules of IRC Section 263A (with respect to property produced or acquired for resale) apply to this organization? . . . . . . . . . .

00

00

00

00

00

00

00

00

00

00

00

00

00

00

00

00

00

00

California (b) ÷ (a)outside California

Percent within(c)Total within California(b)Total within and(a)Use only for unrelated trade or business amounts

. . .

result here and on Form 109, Side 1, line 2. See instructions for exceptions . . . . . . . . . . . . . . . .

Multiply the factor on line 3, column (c) by 2 . . . . . . . . . . . . . . . . . . . . . . . . . . .

Total. Combine the amounts on line 1 through line 4. See instructions . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Credit recapture. Credit name

IRC Section 197(f)(9)(B)(ii) election to recognize gain on the disposition of intangibles . . . . . . . . . . . . . . . . . . . . . . . .

Method for non-dealer installment obligations . . . . . . . . . . . . . . .

Sales of certain timeshares or residential lots . . . . . . . . . . . . . . . .Interest on tax attributable to installment:

Interest computation under the look-back method for completed long-term contracts. Attach form FTB 3834 . . . . . . . . . . . . . . . . . .

Average apportionment percentage: Divide the factor on line 5 by 4 and enter the6

Total percentage: Add the percentages in column (c), line 1, line 2, and line 4 . . . . . . . . . . . . .5

4

Sales factor: Gross sales and/or receipts less returns and allowances . . . . . . . . .3

Payroll factor: Wages and other compensation of employees . . . . . . .2

Property factor: See instructions . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .1

Apportionment Formula Worksheet

55

44

33

2bb

2aa2

11

Add-On Taxes or Recapture of Tax. See instructions.

Schedule R

Schedule Kexcept New Jobs Credit, on line 4. Enter here and on Side 1, line 11c . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Is this organization electing the Alternate Method – Single-Sales Factor Formula? . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

If “Yes,” skip Part A and complete Part B. If “No,” complete Part A and skip Part B.

Yes No

Part A. Standard Method – Three Factor Formula. Complete this part only if the corporation uses the three-factor formula. (The three-factor

formula includes the double-weighted sales factor.)

This is an irrevocable annual election.

Alternate Method – Single-Sales Factor Formula. Complete this part only if the corporation elects the single-sales factor formula.Part B.

(a) Total within and (b) Total within California (c) Percent within

outside California California (b) ÷ (a)

Use only for unrelated trade or business amounts

1 Total Sales . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

2 Apportionment percentage. Divide total sales column (b) by total sales

column (a) and enter the result here and on Form 109, Side 1, line 2 . . . . . . . . . . .

034

CAL POLY POMONA FOUNDATION, INC 95-2417645Cost Method

32,185765,429

797,61435,273

762,341X

X

0 00 00 0

N/A

0

09413690002 04/17/2013 10:26 AM

connected withincome in column (5)

Side 4 Form 109 C1 2011 3644114

Schedule E

column 4 ÷

sch.)

8765432

1

321 5 64

987654

21 3

but not less thanbut not more thanincomeless column 3business4 less column 76 less column 5column 5unrelated businessbusiness, column 2from trade orincludible, columnexpense, columnattributable toactivity that is notunrelated trade orbusiness incomeNet incomeExcess exemptExpensesGross income fromNet income fromGross unrelated

Description of exploited activity (attach schedule if more than one unrelated activity is exploiting the same exempt activity)

Taxable Income Net unrelated

Nonexempt Controlled Organizations

IdentificationEmployerName of controlled organizations

column 4 less column 5(attach schedule)column 2 less column 3(attach schedule)Set-asidesDeductions directly connectedAmountDescription Balance of investment income,Net investment income,

(attach schedule) column 5

3(b) x column 6property (attach schedule)to debt-financed propertycolumn 7 less column 8total of columns 3(a) andcolumn 2 x column 6allocable to debt-financedindebtedness on or allocable percentage,

Net income (or loss) includible,Allocable deductions,Gross income reportable,Debt basisAverage adjusted basis of orAmount of average acquisition

sch.)propertyOther deductions (attach(b)Straight-line depreciation (attach(a)allocable to debt-financed

Gross income from orDescription of debt-financed property Deductions directly connected with or allocable to debt-financed property

Total. Enter here and on Side 2, Part I, line 10 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Subtract line 5 from line 4. Enter here and on Side 2, Part 1, line 9 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Enter gross income from members (dues, fees, charges, or similar amounts) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Total. Enter here and on Side 2, Part I, line 8 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Total. Enter here and on Side 2, Part I, line 7 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Exploited Exempt Activity Income, other than Advertising Income

Interest, Annuities, Royalties and Rents from Controlled Organizations

Investment Income of an R&TC Section 23701g, Section 23701i, or Section 23701n Organization

%

%

%

Unrelated Debt-Financed Income

production

Schedule F

Expenses directly

Schedule D

connected with

of unrelated

Schedule G

Deductions directly

controlling org.is included in thePart of column (4) that Net unrelated

income (loss) payments madeTotal of specified

Exempt Controlled Organizations

income (loss) payments made

Total of specified Part of column (9) that isincluded in the controlling

organization's gross in column (10)

connected with income

Deductions directly

1

2

3

4

5

6

Add columns 5 and 10 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Add columns 6 and 11 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

4 651 2 3

7 8 9 10 11

gross incomeNumber

income

3

2

1

business income column 4 zero

034


N/A

N/A

N/A

N/A

09413690002 04/17/2013 10:26 AM

Form 109 C1 2011 Side 53645114

7654321this year

ratedepreciationyearsbasisof property orcomputingor allowable in prior

Depreciation forLifeMethod ofDepreciation allowedCost or otherDate acquiredGroup and guideline class or description

Balance. Subtract line 5 from line 4. Enter here and on Side 2, Part II, line 21a . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Amount of depreciation claimed elsewhere on return . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Total . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Other depreciation . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Other (specify)

Machinery and other equipment . . . . . . . . . . .

Transportation equipment . . . . . . . . . . . . . . . . .

Furniture and fixtures . . . . . . . . . . . . . . . . . . . . . .

Buildings . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Other depreciation:

Total additional first-year depreciation (do not include in items below) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

6

5

4

3

2

1

Depreciation (Corporations and Associations only. Trusts use form FTB 3885F.)Schedule J

account654321

Part III

allowancesunrelated businessto businessattributable totime devoted

ExpenseCompensationPercent ofTitleSSN or ITINName of Officer

Enter total here and on Side 2, Part II, line 27Enter total here and on Side 2, Part I, line 11

cols. 4 and 7 listed in Part II, column 4names of non-consolidated periodicalsnames of non-consolidated periodicals amounts listed in Part II, Part I, column 4, and amountsPart I, column 4 or 7, and

Enter total amount from(b)Enter "consolidated periodical" and/or(a)Enter "consolidated periodical" and/or(a) (b) Enter total amount from

Total. Enter here and on Side 2, Part II, line 14 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

%

%

%

%

%

Compensation of Officers, Directors, and Trustees

Column B – Excess Advertising CostsColumn A – Net Advertising Income

Schedule I

Part III

Part ISchedule H

Part II

Advertising Income and Excess Advertising Costs

Income from Periodicals Reported on a Consolidated Basis

Income from Periodicals Reported on a Separate Basis

Totals . . . . . . . . . . . . . . . . . . . . . . .

Name of periodical Gross Direct Advertising income Circulation Readership If column 5 is greater thancolumn 6, enter theadvertising advertising or excess advertising income costs

income shown in columnincome costs costs. If column 2 is4, in Part III, column A(b).greater than column 3,If column 6 is greater thancomplete columns 5,column 5, subtract the6, and 7. If column 3

is greater than sum of column 6 and

column 2, enter the column 3 from the sum ofcolumn 5 and column 2.excess in Part III,

column B(b). Do not Enter amount in Part III,

complete columns 5, column A(b). If the

6, and 7. amount is less than zero,

1 2 3 4 5 6 7

enter -0-.

034


N/A

N/A

N/A N/A

N/A

0

See Statement 3 107,883

107,8830

107,883

09413690002 04/17/2013 10:26 AM

09413690002 CAL POLY POMONA FOUNDATION, INC 4/17/2013 10:25 AM

95-2417645 California StatementsFYE: 6/30/2012

Statement 1 - Form 109, Part I, Line 12 - Other Income

Description AmountUBIT - KELLOGG HOUSE $ 10,760UBIT - CONFER CENTER & LODGE 1,123,131

Total $ 1,133,891

Statement 2 - Form 109, Part II, Line 24 - Other Deductions

Description AmountADVERTISING $ 19,002AGRICULTURE 4,408BANK CARD FEE 36,369GENERAL AND ADMINSTRATIVE 159,700INSURANCE 28,088MEALS AND REFRESHMENTS 1,339OTHERS 72,124POSTAGE 3,803RENT 34,514SERVICES 152,981SUPPLIES 181,409TELEPHONE 36,991TRAVEL 1,981UTILITIES 84,565

Total $ 817,274

1-2



Statement 3 - Form 109, Schedule J - Depreciation Detail Information

Description

Date Cost / Accum Life / Current Add'lAcquired Basis Depr Method Rate Depr 1st Year

DEPRECIATION$ $ $ 107,883 $

Total $ 0 $ 0 $ 107,883 $ 0

3



Statement 1 - Form 199, Part II, Line 6 - Gross Amount Received from Sale of Assets

Description

How Whom Date Date Gross Cost & NetReceived Sold Acquired Sold Proceeds Expense Depr Basis

DONATED SECURITIESDonation 7/01/11 6/30/12 $ 254,758 $ 259,183 $ $ 259,183

INVESTMENT SECURITIESPurchase 7/01/11 6/30/12 8,654,859 8,626,271 8,626,271

RESIDENTIAL REAL ESTATEPurchase 6/30/11 8/25/11 230,000 221,000 221,000




EQUIPMENTPurchase 7/01/11 6/30/12 1,019

Total $9,975,636 $ 10011444 $ 0 $ 10011444

1



Statement 2 - Form 199, Part II, Line 7 - Other Income

Description AmountTASTING AND AUCTION $ 59,448HOSPITALITY UNCORKED 262,059ATHLETICS DEPT RAFFLE 20,796ADMIN FEES AND OTHER INCOME 967,829UNREALIZED INVEST GAIN/LOSS -307,647

Total $ 1,002,485

2



Statement 3 - Form 199, Part II, Line 9 - Contributions, Gifts, Grants, and Similar

Amounts

ActivityNo. Class Name Address CityStateZipRelationshipStatusPurpose

Noncash FMV Book Value Book ValueAmount Description Explanation Amount Explanation Date

EQUIPMENT CAL POLY POMONA UNIVERSITY 3801 W. TEMPLE AVE. POMONACA917683,930,872

1,387,842

1,267,991

467,462

Subtotal$ 7,054,167 $ $

Total$ 7,054,167 $ $

Statement 4 - Form 199, Part II, Line 11 - Officer Compensation

Name Address

Avg CompensationCity State Zip Title Hrs Amount

BECKY PEPPINGEX-OFFICIO 0.50

EVIN COUKOSSTUDENT DIR 0.50

CASSANDRA REYESSTAFF COUNCI 0.50

EDWARD MERITTFACULTY MEMBER 0.50

DAVID PRENOVOSTCHIEF FIN OF 40.00

3-4



Statement 4 - Form 199, Part II, Line 11 - Officer Compensation (continued)

Name Address


DOUGLAS FREEREX-OFFICIO 0.50

RICHARD LAPIDUSDEAN MEMEBR 0.50

EDWIN BARNES IIIEX-OFFICIO 0.50

G. PAUL STOREYEXEC DIR 40.00 222,258

J. MICHAEL ORTIZCHAIRMAN 0.50

LOWELL OVERTONCOMUNITY DIR 0.50

WINNY DONGFACULTY MEMBER 0.50

MARTIN DENBOEREX-OFFICIO 0.50

LISA ALEXEX-OFFICIO 0.50

MEI LEIN CHANGMEMBER@LARGE 0.50

OLIVER SANTOSCOMUNITY DIR 0.50

SCOTT WARRINGTONEX-OFFICIO 0.50

SUSIE DIAZSTAFF COUNCIL 0.50

JOHNATHAN JIANUEX-OFFICIO 0.50

JOHN MCGUTHRYEX-OFFICIO 0.50

HAE YEON KANGSTUDENT DIR 0.50

WILLIAM PRIESTCOMMUNITY DIR 0.50

4



Statement 4 - Form 199, Part II, Line 11 - Officer Compensation (continued)

Name Address


THOMAS GOFFMEMBER@LARGE 0.50

MICKEY SEGALMEMBER@LARGE 0.50

KATHY TULLYMEMBER@LARGE 0.50

MICHAEL FERGUSONMEMBER@LARGE 0.50

Total 222,258

4



Statement 5 - Form 199, Part II, Line 17 - Other Expenses

Description Amount$

TASTING AND AUCTION VARIOUS 122,408 CATERING 3,061 ENTERTAINMENT 1,700

HOSPITALITY UNCORKED VARIOUS 96,670 CATERING 131,278

ATHLETICS DEPT RAFFLE VARIOUS EXPENSES 815

BUILDINGS Insurance 28,700 Advertising 2,579 Supplies 26,598 Travel 38 Repairs 73,783 Utilities 223,958 POSTAGE 20 SALARY & WAGES 117,898 EMPLOYEE BENEFITS 47,585 RENT 1,797 TELEPHONE 41,131 SERVICES 263,169 MEALS REFRESHMENT 194 OTHER 74,522 DEPRECIATION 682,945OTHER EMPLOYEE BENEFITS 1,480,012OTHER EMPLOYEE BENEFITS 418,926OTHER EMPLOYEE BENEFITS 146,436OTHER EMPLOYEE BENEFITS 406,895PAYROLL TAXES 356,556PAYROLL TAXES 342,299PAYROLL TAXES 64,421PAYROLL TAXES 193,222 Consulting and Other Service 1,483,972CONSULTING AND OTHER SERVICES 708,086CONSULTING AND OTHER SERVICES 595,661CONSULTING AND OTHER SERVICES 292,029ACCOUNTING 135,903ACCOUNTING 9,384ACCOUNTINGLEGAL 60,118LEGAL 50,580LEGAL 9,568INVESTMENT MANAGEMENT 8,084INVESTMENT MANAGEMENT 23,074TRAVEL 160,906TRAVEL 272,902TRAVEL 378,875TRAVEL 4,579Conferences/Meetings 36,462

5



Statement 5 - Form 199, Part II, Line 17 - Other Expenses (continued)

Description AmountConferences/Meetings $ 79,721Conferences/Meetings 1,455Repairs and Maintenance 612,231Repairs and Maintenance 86,975Repairs and Maintenance 132,570Utilities 842,054Utilities 12,785Utilities 306,241Feed 103,772Feed 209,870Agriculture 371,532Agriculture 18,301Miscellaneous 462,598Miscellaneous 749,517Miscellaneous 414,920Miscellaneous 407,795General Administrative 622,104Meals & Entertainment 6,473Meals & Entertainment 235,710Meals & Entertainment 770,647Meals & Entertainment 126,323Laundry 11,133Equipment Purchase 39,569Equipment Purchase 38,788Equipment Purchase 166,602Equipment Purchase 25,588Bad Debts 53,820Bad Debts 939Bad Debts 4,340Taxes 39,019Taxes 2,712Taxes 5,088Indirect Costs Returned 441,952RE Closing Costs 34,717Transfer in/out 77,031RE Write-down 56,893PENSION PLAN CONTRIBUTIONS 456,744PENSION PLAN CONTRIBUTIONS 439,316PENSION PLAN CONTRIBUTIONS 82,680PENSION PLAN CONTRIBUTIONS 247,987ADVERTISING AND PROMOTION 181,633ADVERTISING AND PROMOTION 73,005ADVERTISING AND PROMOTION 25,352OFFICE 1,609,986OFFICE 1,144,789OFFICE 1,083,609OFFICE 639,917INFORMATION TECHNOLOGY 412,589INFORMATION TECHNOLOGY 133,498INFORMATION TECHNOLOGY 40,305ROYALTIES 320,738Insurance 344,755Insurance 991Insurance 11,005

5



Statement 5 - Form 199, Part II, Line 17 - Other Expenses (continued)

Description AmountInsurance $ 37,786Laundry 53,785Laundry 108,224ROYALTIES 25,800ROYALTIES 50,772

Total $24,676,850

Statement 6 - Form 199, Schedule L, Line 5 - Federal and State Government

Beginning End ofDescription of Year Year

TREASURY NOTES $15,137,315 $11,778,971AGENCY SECURITIES 5,048,318 8,590,600DEBT SERVICE RESERVES 237,396

Total $20,423,029 $20,369,571

Statement 7 - Form 199, Schedule L, Line 7 - Investments in Stock


EQUITY SECURITIES $ 4,337,267 $60,250,593

Total $ 4,337,267 $60,250,593

Statement 8 - Form 199, Schedule L, Line 9 - Other Investments


EQUITY INVESTMENT $ 421,953 $

Total $ 421,953 $ 0

Statement 9 - Form 199, Schedule L, Line 12 - Other Assets


ASSETS HELD FOR SALE $ 1,791,980 $ 691,217Prepaid Expenses 335,257 154,744INTEREST CAPITALIZED 978,075 931,302COST OF ISSUANCE 286,150 267,265

Total $ 3,391,462 $ 2,044,528

5-9



Statement 10 - Form 199, Schedule L, Line 18 - Other Liabilities


DEPOSITS HELD IN CUSTODY FOR OTHERS $ 574,254 $ 527,660LEASE OBLIGATIONS 15,274 24,449UNITRUST LIABILITY 695,994 874,354CAL POLY POMONA FOUNDATION 185,000CAL POLY POMONA FOUNDATION 3,505,553 3,321,636CAL POLY POMONA FOUNDATION 26,996,294 26,408,897Deferred Revenue 1,196,199 1,101,951

Total $33,168,568 $32,258,947

Statement 11 - Form 199, Schedule M-1, Line 4 - Income Not Recorded on Books

Description AmountInvestment expenses $ 23,074

Total $ 23,074

Statement 12 - Form 199, Schedule M-1, Line 8 - Deductions Not Charged Against Book Income

Description AmountInvestment expenses $ 23,074

Total $ 23,074

10-12

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