R2. Preneed License Financial Statements (Forms R2A & R2B)
General Information
(1) Pursuant to rule 69K-5.0026, preneed licensees desiring to renew their preneed license must submit with
their application for renewal the following two financial statements: A) Balance Sheet, and B) Income
Statement.
(2) The Balance Sheet and Income Statement must be prepared in accordance with Generally Accepted
Accounting Principles (GAAP). See rule 69K-5.0016(2).
(3) GAAP requires accrual basis financial statements; cash basis financial statements are not acceptable.
(4) The financial statements must be for the preneed licensee’s most recently completed fiscal year.
(5) Financial statements must be specifically for, and in the name of, the preneed licensee. Financial
statements showing the preneed licensee’s parent firm, or consolidated financial statements for a group of firms
including the preneed licensee, are not acceptable.
(6) Enclosed are a blank Balance Sheet (form R2A), and a blank Income Statement (form R2B). A preneed
licensee may use and submit financial statements on the attached forms, in satisfaction of the financial
statements requirements, subject to the requirement that GAAP must be complied with in using the attached
forms. Alternatively, pursuant to rule 69K-5.0026, a preneed licensee may have its Balance Sheet and Income
Statement prepared by a Certified Public Accountant, in a form determined by the CPA to comply with GAAP.
(7) Please assure that the phrase “Net worth” and the related dollar figure appears on the Balance Sheet.
R2 - Financial Statements – General Information
Form DFS-PNL-R2, Renewal Statement (Rev. 10-06; 69K-1.001)
Form R2A – Balance Sheet of Preneed Licensee
Preneed licensee:
____________
Preneed license number: ____________
For renewal effective on: ____________
Balance Sheet As of ______________ ______, ________ (Month Day Year)
ASSETS
CURRENT ASSETS
Cash on Hand
Cash in Bank (do not include Chapter 497 Trusts)
Short-term investments with
maturity of 12 months or less
Receivables:
Accounts Receivable
Other____________________
Less: Allowance for Doubtful
Accounts
Total net current accounts receivable
Inventory
Prepaid Expenses
Accrued Income Due from Trust Fund*
Other Accrued Income
Other current assets
_____________________________________
_____________________________________
_____________________________________
Total Current Assets
_____________
_____________
______________
______________
_____________
_____________
(_____________)
_____________
_____________
_____________
_____________
_____________
_____________
_____________
_____________
FIXED ASSETS (PROPERTY & EQUIPMENT):
Office Furniture and Equipment
____________
Less: Accumulated Depreciation (____________)
_____________
Automobiles and Other Vehicles
____________
Less: Accumulated Depreciation (____________)
_____________
Leasehold Improvements
____________
Less: Accumulated Depreciation (____________)
_____________
Real Estate Owned
____________
Less: Accumulated Depreciation (____________)
_____________
Other fixed assets
______________________________________
_____________
______________________________________
_____________
Total Fixed Assets
_____________
NON-CURRENT/OTHER ASSETS:
Other Receivables
Long-Term Investments
Organization Cost
Preneed Trust **
Other noncurrent/other assets
_____________________________________
_____________
_____________
_____________
_____________
_____________
R2A - Balance Sheet Page 1
Form DFS-PNL-R2, Renewal Statement (Rev. 10-06; 69K-1.001)
_____________________________________
_____________
Total Non-Current/Other Assets
_____________
TOTAL ASSETS***
_____________
LIABILITIES AND NET WORTH
LIABILITIES:
CURRENT LIABILITIES:
Accounts Payable:
Trade
_________________
_________________
Total accounts payable
Commission Payable
Taxes Payable:
Payroll
Real Property
Federal and State
_________________
Total taxes payable
Notes Payable: (Current Portion of
Long Term Debt)
To Financial Institutions
Real Estate Mortgages
To Officers and Stockholders
_________________________
_________________________
Total Notes Payable
Accrued Interest Payable
Due Trust Fund for Withdrawal of
Appreciation
Other current liabilities
________________________________
________________________________
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_____________
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____________
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_____________
Total Current Liabilities
______________
LONG-TERM LIABILITIES:
Notes and Loans Payable:
To Financial Institutions
Real Estate Mortgages
To Officers and Stockholders
Other Notes & Loans payable
_________________________
_________________________
Less: Current portion of
long-term debt
____________
_____________
_____________
____________
_____________
(_____________)
Total net long term Notes & Loans Payable
_____________
Preneed Contracts, Liability**
_____________
R2A - Balance Sheet Page 2
Form DFS-PNL-R2, Renewal Statement (Rev. 10-06; 69K-1.001)
Other Liabilities:
______________________________
______________________________
______________________________
______________________________
_____________
_____________
_____________
_____________
TOTAL LIABILITIES
______________
NET WORTH:
Capital Stock
Paid in Capital
Retained Earnings ****
Other
______________________________________
______________________________________
______________________________________
______________________________________
_____________
_____________
_____________
_____________
_____________
_____________
_____________
TOTAL NET WORTH
________________
TOTAL LIABILITIES AND NET WORTH***
(Must Equal Total Assets on Balance Sheet)
________________
Notes:
* Interest Income due from fulfilled contracts that have not been withdrawn as of fiscal year end.
** Preneed trust assets and liabilities are to be recorded reflecting required trusting percentages.
Trusting requirements lower than 100% will generally reflect a trust liability larger than the trust
asset. If the balance sheet records a trust asset larger than the liability, please provide an
explanation. If an explanation is not provided or the explanation does not allow for this difference
to be considered an asset, the difference will be subtracted from your Total Net Worth for
purposes of determining whether the net worth requirement has been met.
*** Total Assets must equal Total Liabilities and Net Worth.
**** Retained Earnings amount must match Retained Earnings, Current Year End on the
Income Statement.
R2A - Balance Sheet Page 3
Form DFS-PNL-R2, Renewal Statement (Rev. 10-06; 69K-1.001)
Form R2B – INCOME STATEMENT
Preneed licensee:
______________
Preneed license number: ______________
For renewal effective on: ______________
For the Year Ended _______________ _____, ________
INCOME:
Preneed Merchandise and Services Fulfilled
At-Need Merchandise and Services
Interest Income
Other income
___________________________________
___________________________________
___________________________________
(Month Day Year)
_____________
_____________
_____________
_____________
_____________
_____________
TOTAL INCOME
_____________
EXPENSES:
Cost of Sales
_____________
Selling, General, and Administrative Expenses:
Admin Fees – Trust
Advertising
Commissions
Dues & Subscriptions
Depreciation & Amortization
Insurance
Interest
Office Supplies
Outside Services
Printing and Supplies
Professional Fees
Rent
Sales
Salaries
Taxes & Licenses
Telephone
Travel
Repairs and Maintenance
Utilities
Other expenses
______________________________
______________________________
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R2B – Income Statement Page 4
Form DFS-PNL-R2, Renewal Statement (Rev. 10/06; 69K-1.001)
Total Selling, General, and Administrative Expenses
______________
TOTAL EXPENSES
______________
Income (Loss) from operations before
federal and state income taxes and
extraordinary items
_____________
Extraordinary Items (Attach schedule
and explanation)
_____________
Federal and State Income Taxes
_____________
Income (Loss) from Current Year
_____________
Retained Earnings, Previous Year
_____________
Less Dividends to Stockholders
_____________
Other (Charges) Credits to Retained Earnings
Retained Earnings, Current Year End*
_____________
_____________
* Retained Earnings, Current Year End amount must match Retained Earnings on the
Balance Sheet.
R2B – Income Statement Page 5
Form DFS-PNL-R2, Renewal Statement (Rev. 10/06; 69K-1.001)