| Assets: |
| Cash, bank accounts, and short-term investments | 4100 | $ 287,128 |
| Amounts receivable from non-arm's length parties | 4110 | $ 180,000 |
| Amounts receivable from all others | 4120 | |
| Investments in non-arm's length parties | 4130 | |
| Long-term investments | 4140 | |
| Inventories | 4150 | |
| Land and buildings in Canada | 4155 | $ 4,213,222 |
| Other capital assets in Canada | 4160 | $ 230,443 |
| Capital assets outside Canada | 4165 | |
| Accumulated amortization of capital assets | 4166 | $ -3,863,074 |
| Other assets | 4170 | |
| Total assets (add lines 4100 to 4170) | 4200 | $ 1,047,719 |
| |
| Amount included in lines 4150, 4155, 4160, 4165 and 4170 not used in charitable programs | 4250 | |
| |
| Liabilities: |
| Accounts payable and accrued liabilities | 4300 | |
| Deferred revenue | 4310 | |
| Amounts owing to non-arm's length parties | 4320 | $ 71,322 |
| Other liabilities | 4330 | $ 14,052 |
| Total liabilities (add lines 4300 to 4330) | 4350 | $ 85,374 |
| |
| Statement of operations |
| Revenue: |
| Total eligible amount of all gifts for which the charity issued tax receipts | 4500 | $ 1,420 |
| For all tax-receipted gifts received during the fiscal period please provide: |
| Total eligible amount of tax-receipted tuition fees | 5610 | |
| Total eligible amount of tax-receipted enduring property | 5640 | |
| Total amount received from other registered charities (excluding specified gifts and enduring property) | 4510 | $ 384,002 |
| Total specified gifts from other registered charities | 4520 | |
| Total enduring property from other registered charities | 4525 | |
| Total other gifts received for which a tax receipt was not issued by the charity | 4530 | $ 1,243 |
| Total revenue received from federal government | 4540 | |
| Total revenue received from provincial/territorial governments | 4550 | |
| Total revenue received from municipal/regional governments | 4560 | |
| Total revenue received from all sources outside Canada | 4575 | |
| Total interest and investment income received or earned | 4580 | |
| Gross proceeds from disposition of assets | 4590 | $ 3,000 |
| Net proceeds from disposition of assets (show a negative amount with brackets) | 4600 | $ 3,000 |
| Gross income received from rental of land and/or buildings | 4610 | |
| Non tax-receipted revenues received for memberships, dues, and association fees | 4620 | |
| Total non tax-receipted revenue from fundraising | 4630 | |
| Total revenue from sale of goods and services (except to government) | 4640 | |
| Other revenue not already included in the amounts above | 4650 | $ 8,255 |
| Specify type(s) of revenue included in the amount reported at 4650 (e.g., dividends) | 4655 | GST & PST REBATES |
| Total revenue (add line 4500, 4510 to 4580, and 4600 to 4650) | 4700 | $ 397,920 |
| |
| Expenditures: |
| Advertising and promotion | 4800 | |
| Travel and vehicle expenses | 4810 | $ 4,180 |
| Interest and bank charges | 4820 | $ 215 |
| Licenses, memberships, and dues | 4830 | |
| Office supplies and expenses | 4840 | $ 3,228 |
| Occupancy costs | 4850 | $ 172,454 |
| Professional and consulting fees | 4860 | |
| Education and training for staff and volunteers | 4870 | |
| Total expenditure on all compensation (enter the amount reported at line 390 in Schedule 3 if applicable) | 4880 | |
| Fair market value of all donated good used in charitable programs | 4890 | |
| Total cost of all purchased supplies and assets | 4891 | $ 10,118 |
| Amortization of capitalized assets | 4900 | $ 62,121 |
| Total expenditure for research grants and scholarships as part of charitable programs | 4910 | |
| Other expenditures not included in the amounts above | 4920 | |
| Specify type(s) of expenditures included in the amount reported at 4920 | 4930 | |
| Total expenditures before gifts to qualified donees (add lines 4800 to 4920) | 4950 | $ 252,316 |
| |
| Lines 5000 to 5030 represent a breakdown of the expenditures on lines 4800 to 4920. The total of lines 5000 to 5030 should equal line 4950. |
|
| Total expenditures on charitable programs | 5000 | $ 244,693 |
| Total expenditures on management and administration | 5010 | $ 7,623 |
| Total expenditures on fundraising | 5020 | |
| Total expenditures on political activities, inside or outside Canada | 5030 | |
| Total other expenditures included in line 4950 | 5040 | |
| Total amount of gifts (excluding enduring property and specified gifts) made to all qualified donees | 5050 | |
| Total amount of enduring property transferred to qualified donees (excluding specified gifts of enduring property) | 5060 | |
| Total amount of specified gifts made to qualified donees (including specified gifts of enduring property) | 5070 | |
| Total expenditures (add amount from line 4950 and the amounts from lines 5050, 5060 and 5070) | 5100 | $ 252,316 |
| |
| Other financial information |
| Permission to accumulate property: Only registered charities that have written permission to accumulate should complete this question. |
| | • | Enter the amount accumulated for the fiscal period, including income earned on accumulated funds |
| 5500 | |
| | • | Enter the amount disbursed for the fiscal period for the specified purpose we have permitted |
| 5510 | |
| | • | Enter the amount deemed to be a tax-receipted gift for the fiscal period |
| 5520 | |
| |
| Enduring property and the capital gains pool |
| From the amount reported at line 4950, what is the fair market value of all enduring property spent during the fiscal period? | 5710 | |
| Enter the capital gains from the disposition of enduring property in the fiscal period. Do not enter an amount reflecting a capital loss or a negative amount in this field. | 5720 | |
| Is the charity claiming an amount that is less than the maximum capital gains reduction? | 5730 | |
| If yes, enter the amount from line 11 of Form T1259, Capital Gains and Disbursement Quota Worksheet | 5740 | |
| If the charity has received approval from the Charities Directorate to make a special reduction to its disbursement quota, enter the amount for the fiscal period. | 5750 | |
| Property not used in charitable activities |
| Enter the value of property not used for charitable activities or administration during: |
| | • | The 24 months before the beginning of the fiscal period |
| 5900 | $ 299,500 |
| | • | The 24 months before the end of the fiscal period |
| 5910 | $ 385,770 |
