5100-127 Operating and Financial Summary

Paperwork Reduction Act Statement: A federal agency may not conduct or sponsor, and a person is not required to respond to, nor shall a person be subject to a penalty for failure to comply with a collection of information subject to the requirements of the
Paperwork Reduction Act unless that collection of information displays a currently valid OMB Control Number. The OMB Control Number for this information collection is 2120-0569. Public reporting for this collection of information is estimated to be
approximately 5 hours per response, including the time for reviewing instructions, searching existing data sources, gathering and maintaining the data needed, completing and reviewing the collection of information. All responses are required to retain a benefit
under 49 CFR 18. Send comments regarding this burden estimate or any other aspect of this collection of information, including suggestions for reducing this burden to the FAA at: 800 Independence Ave SW, Washington, DC 20591, Attn: Information
Collection Clearance Officer, AES-200.

FORM APPROVED
OMB NO. 2120-0569 1/31/2013

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

FAA Form 5100-127

4/01
Previous editions are obsolete