RD 442-3 Balance Sheet

RD 442-3.pdf

American Rescue Plan Act Emergency Rural Health Care (ERHC) Grant Program

RD 442-3 Balance Sheet

OMB: 0575-0200

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FORM APPROVED
OMB No. 0575-0015
OMB No. 0572-0137
Exp. Date: MM/DD/YY

Position 3

Form RD 442-3
(Rev. 3-97)

Name

BALANCE SHEET

Address

Month Day

ASSETS

CURRENT ASSETS

Current Year

1. Cash on hand in Banks
2. Time deposits and short-term investments
3. Accounts receivable
4. Less: Allowance for doubtful accounts
5. Inventories
6. Prepayments
7.
8.
9.
Total Current Assets (Add 1 through 8)

Year

Month Day

Prior Year

Year

(

)(

)

(

)(

)

FIXED ASSETS

10. Land
11. Buildings
12. Furniture and equipment
13.
14.
Less: Accumulated depreciation
15. Net Total Fixed Assets (Add 10 through 14)
OTHER ASSETS

16.
17.
18.

Total Assets (Add 9, 15, 16 and 17)
LIABILITIES AND EQUITIES
CURRENT LIABILITIES

19. Accounts payable
20. Notes payable
21. Current portion of USDA note
22. Customer deposits
23. Taxes payable
24. Interest payable
25.
26.
27.
Total Current Liabilities (Add 19 through 26)
LONG-TERM LIABILITIES

28. Notes payable USDA
29.
30.
31.
Total Long-Term Liabilities (Add 28 through 30)
32.
Total Liabilities (Add 27 and 31)
EQUITY

33. Retained earnings
34. Memberships
35.
Total Equity (Add lines 33 and 34)
36.
Total Liabilities and Equity (Add lines 32 and 35)
CERTIFIED CORRECT

Date

Appropriate Official (Signature)
RD 442-3 (Rev. 3-97)

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File Typeapplication/pdf
File TitleBalance Sheet
File Modified2021-06-06
File Created2021-06-06

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