Question	Answer
Form Name	Form 1028
Form Length	4 pages
Fillable?	Yes
Fillable fields	221
Avg. time to fill out	22 min 38 sec
Other names	nonmember, form 1028 instructions, depletable, what is form 1028

	and the rate of dividend paid:		Shares	Amount		Rate of Dividend
a	Preferred stock (voting)	1a
b	Preferred stock (nonvoting)	1b
c	Common stock (voting)	1c
d	Common stock (nonvoting)	1d
2	Number of shares of capital stock (other than nonvoting preferred) owned by:
a	Producers				2a
b	Nonproducers				2b
c	Current and active producers				2c
d	Total number of shares—Add lines 2a and 2b				2d
e	Percentage owned by current and active producers—Divide line 2c by line 2d				2e	%

Form 1028 (Rev. 10-99)		Page 2

Part III	Activities and Operational Information ( Continued)

9	Does the association deal or plan to deal with both members and nonmembers?	Yes	No
10a	Does the association pay or plan to pay patronage dividends?	Yes	No
b	If “Yes,” are they paid or will they be paid to all patrons, both member and nonmember, on the same basis?	Yes	No
11a	Is the allocation of patronage dividends based on an obligation in existence before the cooperative
	received the amounts allocated?	Yes	No

Form 1028 (Rev. 10-99)		Page 3

Part III	Activities and Operational Information ( Continued)

17	Value of agricultural products marketed or handled	Current tax		3 prior tax years
17	Value of agricultural products marketed or handled
	for: (See instructions.)	year
	for: (See instructions.)	year
		(a) From	(b)	(c)	(d)
*a	Members—	to

20	Does the association plan to do business with the United States Government or any of its agencies in the future?	Yes	No
21a	Were all of the net earnings (after payment of dividends, if any, on capital stock) for the years shown on
	lines 17–19 distributed as patronage dividends? (See instructions for lines 17–19.)	Yes	No
b	If “No,” were undistributed net earnings apportioned on the records to all patrons on a patronage basis?	Yes	No
22a	Has the organization operated in a manner consistent with the information given since the date formed?	Yes	No

Form 1028 (Rev. 10-99)		Page 4
Part IV	Financial Data (See instructions.)

Statement of Receipts and Expenditures, for period ending													,		.
	(If you prepare a statement of receipts and expenditures that is more descriptive and detailed than the statement below, you
	may submit that statement instead of this one.)
		1	Gross dues and assessments from members										1
		2	Gross dues and assessments from affiliated organizations										2
		3a	Gross amount derived from activities related to organization’s exempt						3a
			purpose (attach schedule)						3a
<![endif]>Receipts		b Less cost of goods sold							3b	(		)	3c
		4a	Gross amount from other business activities (attach schedule)						4a
		b	Less cost of goods sold						4b	(		)	4c
		5a	Gross amount received from sale of assets, excluding inventory items
			(attach schedule)						5a
		b Less cost or other basis and sales expense of assets sold (attach schedule)							5b	(		)	5c
		6	Interest, dividends, rents and royalties										6
		7	Other receipts (attach schedule)										7
		8	Total receipts—Add lines 1 through 7 in far right column										8
		9	Compensation of officers, directors, and trustees (attach schedule)										9
		10	Other salaries and wages										10
<![endif]>Expenditures		11	Interest										11
		12	Rent										12
		13	Depreciation and depletion										13
		14	Dues and assessments to affiliated organizations										14
		15	Other expenditures (see instructions—attach schedule)										15
		16	Patronage dividends (see instructions—attach schedule)										16
		16	Patronage dividends (see instructions—attach schedule)										16
		17	Total expenditures—Add lines 9 through 16										17
		18	Excess of receipts over expenditures (line 8 less line 17)										18
Balance Sheets								Enter				Beginning date			Ending date
Balance Sheets								dates ▶
								dates ▶
		19	Cash							19
		20	Trade notes and accounts receivable (less allowance for bad debts)							20
		21	Inventories							21
<![endif]>Assets		22	Investments (attach schedule)							22
		23	Other current assets (attach schedule)							23
		24	Depreciable and depletable assets (less accumulated depreciation/depletion)							24
		24								24
		25	Land (net of any amortization)							25
		26	Other assets (attach schedule)							26
		27	Total assets							27
		28	Accounts payable							28
		29	Mortgages, notes, bonds payable in less than one year							29
		30	Other current liabilities (attach schedule)							30
		31	Mortgages, notes, bonds payable in one year or more							31
		32	Other liabilities (attach schedule)							32
<![endif]>Capital		33	Patronage dividends allocated in noncash form, other than capital stock and
			interest-bearing obligations							33
		34	Per-unit retains allocated in noncash form							34
<![endif]>and		35	Capital stock (enter numbers at			Number of shares
		35	Capital stock (enter numbers at		Number of
			end of year):		Number of	Issued for		Issued as
					shareholders
<![endif]>Liabilities					shareholders
						money	patronage benefits

		a Voting preferred stock		35a
		b Nonvoting preferred stock		35b
		c Voting common stock		35c
		c Voting common stock		35c
		d Nonvoting common stock		35d
		36	Paid-in or capital surplus							36
		37	Retained earnings (attach schedule)							37
		38	Less cost of treasury stock							38	(		)	(	)
		39	Total liabilities and capital							39

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