The Horace A. Kimball Foundation

General Information:

Name of Organization:
Contact Name:

Address:


City:
State:	Zip:

Email Address:
Phone:
Fax:

Website:

Statement of Intent:

(Please make this concise. Form only allows 5000 characters, including spaces.)

5000 characters remaining

For Previous Grant Recipients:

If you have been awarded a gift by the The Horace A. Kimball & S. Ella Kimball Foundation previously, we would like you to share how you have used the funds.
If you have never been awarded a grant by the foundation, you may leave this field blank.

Verification of 501(c)(3) or 509(a) Status:
501(c)(3) Id #: Date of Issuance: or

509(a) Id #: Date of Issuance:

You must upload proof of your 501(c)(3) or 509(a) status to the Foundation to be considered for a grant. Click the "Upload File" button to upload a scanned copy of your document. Your file must be a pdf, jpg, or png format.

No file chosen

Financial Information:
All figures should be rounded to the nearest dollar. The Kimball Foundation realizes that your financial information could have different headings and sub headings - please do your best to fit them into the following areas to make them as standard as possible.

Balance Sheet as of: (date)

Current Assets
Cash
Property, Equipment and Land
Total Assets (should equal total Liabilities & Equity) and agree with line 16 or part X on IRS form 990

Current Liabilities
Short Term Debt
Long Term Debt
Equity
Total Liabilities and Equity (should equal Total Assets)

Additional Comments on the Balance Sheet:

Income Statement for period ended: (date)
Revenues & Support
Contributions & Grants (in accordance with Part I, line 8 of IRS form 990)
Donations
Earned Revenue
Interest Income
Miscellaneous Income
Total Income
Expenses
Salary of Highest Paid Full Time Employee
Number of full time employees:
Number of part time employees:
Number of volunteers:

Please use the following space to list specific contributors (i.e., other foundations, etc.) and provide any additional comments regarding Revenues & Support:

When you submit this form, you will be redirected to a confirmation page, which indicates that the form has been properly sent. It may take a few moments for your submission to be processed; please be patient.
You will not receive an e-mail confirmation of your submittal.