Attachment D
Page 1 of 5
CTV FORM 300
STATEMENT OF REVENUE & EXPENSES
PART A
INCOME STATEMENT
Reporting Entity:CurrentPrior
Franchises Served:YearYear
Year Ending:December 31, 20______
______
OPERATING INCOME
Subscriber Revenues
620Installation Income______
630Equipment Revenue______
640Basic/Other Tier Subscriber Revenue______
650Premium Channel Revenue______
660Pay Per View Revenue______
670Other Subscriber Revenues______
680Total Subscriber Revenues______
Non-Subscriber Revenues
690Advertising Income______
700Other Income______
710Total Non-Subscriber Revenues______
720Total Operating Income______
2/8/01
Attachment D
Page 2 of 5
CTV FORM 300
STATEMENT OF REVENUE & EXPENSES
PART A
INCOME STATEMENT
Reporting Entity:CurrentPrior
Franchises Served:YearYear
Year Ending:December 31, 20______
______
OPERATING EXPENSES
Direct Operating Expenses
730Programming Expenses______
740Net Bad Debt and Collection Expenses______
750Salaries and Benefits______
760Repairs & Maintenance______
770Light, Heat, Power______
780Pole & Duct Rental______
790Administration-Office and Billing______
800Marketing______
810Local Origination______
820Other______
830Total Operating Expenses______
Depreciation and Amortization
840Depreciation ______
850Amortization______
860Total Depreciation and Amortization______
870Total Expenses______
2/8/01
Attachment D
Page 4 of 5
CTV FORM 300
STATEMENT OF REVENUE & EXPENSES
PART A
INCOME STATEMENT
Reporting Entity:CurrentPrior
Franchises Served:YearYear
Year Ending:December 31, 20______
______
Other Income and Expenses
880Other Income______
______
______
890Interest Expenses______
900Other ______
910Total Other Income and Expenses______
Provision for Income Tax
920Currently Payable______
930Deferred______
940Total Provision for Income Tax______
Extraordinary Items
950Gain/(Loss) on Sale of Fixed Assets______
960Other Extraordinary Items______
970Total Extraordinary Items______
980Net Income______
CTV FORM 300
STATEMENT OF REVENUE & EXPENSES
PART B
STATEMENT OF GROSS ANNUAL RECEIPTS
Description of Gross Annual Receipts
The amount to be reported as gross annual receipts is the total of all revenues earned (reduced by anticipated bad debts) from cable television activity in the Commonwealth. These revenues should include all income from the basic service tier, cable programming service tiers, premium and pay-per-view channels, the rental of converters and remote controls, installations, advertising, local origination, leased access, rentals and management fees.
The amount reported should reflect the total operating income amount reported in the company’s general ledger account. These accounts are included in the operating income accounts set forth in the Cable Division’s Uniform Reporting System - Rules for Completing Financial Reporting Forms. (Total Gross Annual Receipts should equal the total provided on Line 720 of Form 300 for all forms filed by the cable operator.)
Operator:
Address:
I hereby certify that the amount shown below is the gross annual receipts for this company for the calendar year as defined below.
Year: ______Gross annual receipts: $______
______
(Name - Print) (Date)
______
(Name - Signature)(Telephone)
______
(Title)
2/8/01
Attachment D
Page 5 of 5
CTV FORM 300 - STATEMENT OF REVENUE & EXPENSES
PART B - STATEMENT OF GROSS ANNUAL RECEIPTS
Systems Included In Report
Please provide a breakdown of each reporting unit (franchise, system or legal entity) and the corresponding gross receipt amount for each. The total of all the units should comprise the total gross annual receipts amount reported on the previous page.
Reporting UnitGross Receipts for Reporting Unit
Total Gross Receipts* $ ______
* This figure must equal the gross annual receipts figure shown on page 4 above.
2/8/01