5100-127 Operating and Financial Summary

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

AC 150/5100-19 (Appendix 1)

Operating and Financial Summary
Please use Helvetica, 7 point font

Fiscal year end date

Airport Name

Location ID

Sponsor Name

State

Sponsor Employer Identification Number

Date when AIP was last audited as a major program

Consolidated Report? Enter Yes or No

Is this report based on audited information? Please enter Yes or No

Summary of Revenues and Expenses

E. Non-Operating Expenses

A. Aeronautical Operating Revenue

1. Interest expense

1. Landing fees

2. Other
Total

2. Terminal/international arrival area rental or other charges

$

3. Apron charges/tiedowns
4. FBO revenue: contract or sponsor-operated

F. Depreciation

5. Cargo and hangar rentals
6. Aviation fuel tax retained for airport use

Net

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

7. Fuel sales net profit/loss or fuel flowage fees
8. Miscellaneous (not to exceed 5% of Aeronautical)

Other Financial Information

9. Other (enter total here and add attachment)

G. Reporting Year Proceeds

Total

$

1. Bond proceeds
2. Proceeds from sale of property

B. Nonaeronautical Operating Revenue

3. Contributed capital

1. Land and non-terminal facilities

4. Other

2. Terminal - food and beverage

Total

$

3. Terminal - retail stores
4. Terminal - other

H. Reporting Year Expenditures for Projects

5. Rental cars

1. Airfield

6. Parking

2. Terminal

7. Misc. (Should not exceed 5% of total non-aeronautical)

3. Parking

8. Other (Enter total here and add attachment)
Total

4. Roadways, rail and transit

$

5. Other
Total

$

C. Nonoperating Revenues
I. Reporting Year Debt Payments

1, Interest income - restricted and non-restricted
2. Grant receipts
3. Passenger Facility Charges

J. Indebtedness at End of Year

4. Other

1. Bonds
Total

$

2. Loans
3. Other

D. Operating Expenses

Total

$

1. Personnel compensation and benefits
2. Communications and utilities

K. Net Assets

3. Supplies and materials.
4. Repairs and maintenance

L. Restricted Financial Assets

5. Contractual services

1. Restricted debt service reserve

6. Insurance, claims and settlements

2. Restrictions for renewals and replacements

7. Misc (should not exceed 5% of total op expenses)

3. Other restricted financial assets

8. Other

Total

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

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

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:

Signature

Printed name

Date
Telephone No.

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